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Mental Illness Guide: Care, Support, and Education
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Medications are an important part of treating bipolar disorder and other serious psychiatric disorders. Long-term stability and feeling better can be achieved with on-going treatment, but the chances of feeling and getting better are a lot lower when people go on and off medication. In fact, the cycle of stopping and restarting medications, can lead to worsening symptoms.

As a client, I recognize the need for proper medication management as a vital part of the recovery process to start

Often, as the frequency of bipolar cycles increases, so does the intensity of symptoms. For this reason, it is extremely important to stay on medication to prevent new episodes to improve the long-term course of illness. Other serious forms of mental illness, like schizophrenia, also improve steadily when you use medication regularly over a long period of time.

While taking medications consistently and regularly promises the best results, dealing with the dosage changes and adapting to side effects can certainly be frustrating. One of the main reasons people go on and off medications is to avoid the side effects, but this also decreases the chances for long-term benefits and recovery.

This pamphlet was written to address some of the main concerns people have with taking medication; to explain what is really happening, and to offer tips and solutions for addressing those concerns and feeling as good as possible.

Common Reasons People Stop Taking Medications

1.I just can't handle these side effects any more

Side effects can be unpleasant. Pharmaceuticals have not been perfected yet, and the industry is always working to formulate medications with more positive effects and fewer negative ones. In the meantime, the mental health field does have several good medications that have been proven to treat mood and thought disorders, and often it is a matter of tweaking and adjusting doses and combinations of medications to determine the correct combination for YOU. Keep in mind that the side effects listed on pharmacy inserts include ALL the possibilities, including those that are minimal in severity and extremely rare. You should not expect them all to occur. In fact, you may experience none of them. Your prescriber can work with you to minimize and hopefully eliminate them by adjusting dosages. Depending upon which medications you are taking, some of the side effects people do often experience are:

Change in appetite (increase or decrease)
Change in weight (increase or decrease)
Change in energy level (often a decrease)
Tremors (involuntary shaking, most often of the hands)
Movement disorders (muscle tightness, inability to stay still, etc)

It is very important to call the doctor right away if those movement symptoms occur

Maybe you need a dosage change, a different medication altogether, or a different combination of medications. Possibly, just a few weeks is needed to adjust to what is known as transient side effects (those are the temporary side effects that go away spontaneously once your body gets used to the medication).

It is important to keep your appointments or call for an earlier one if needed, and to let your prescriber know what you are experiencing. Be clear and make sure you feel heard by your prescriber. Thoroughly describe what you are experiencing, including your feelings and thoughts about the medications. Together, you can collaborate to find the perfect combination of medications and dosages for you. Please be
patient; sometimes this process of tweaking takes a little while.

2. I am not going to stop what I am doing and take these pills every single day

Another reason people stop taking their medications is they may feel it is a hassle to do so every single day, or they have trouble believing they actually need it. Some people may also be reacting to the social stigma that is associated with being treated for a mental illness.

If there was another way to treat these disorders, that would be wonderful, but just as glasses are necessary to poor vision, and as Insulin is necessary to diabetics, medications (whether by pill or injection) are necessary for people with bipolar disorder and other mood/thought disorders. This is nothing to be ashamed of, and in fact is quite common.

Think back to when the problem began. What happened to your mood, thought patterns, behavior, and life at that time? If you ponder this for a while and still feel treatment is not warranted, please consider talking to your prescriber, or to a trusted friend or family member. Ask them to be honest with you about what was happening before you started on your medication, how you appeared to them, and how life has changed for you since then. Maybe it does, in fact, need to be explored further, but never quit your medications cold turkey. If it is in fact time to make a change, be sure to work closely with your prescriber to do so safely.

3. I liked the way I felt better when I was manic

Some people stop their medications because they remember enjoying the feelings they experienced when manic. This is understandable. The exhilaration and/or high energy level was surely enjoyable in many ways! However, that exhilaration and energy most certainly came at a cost, whether it was relational, legal, educational, financial, vocational, etc. It may be worth taking the time to reflect on this idea.

4. These meds are ridiculously expensive, I simply can't afford them

Though we agree that costs can be daunting, and sometimes prohibitive, there are creative ways to deal with this issue. Discuss cost with your prescriber, treatment team and insurance company. Generic forms of prescribed medications may be good options. There are also Patient Assistance Programs (PAPs) which you may be eligible for through the drug company itself. Your good health IS worth the costs, so let your prescriber work with you to determine the best approach for YOU.

5. Sometimes I remember to take them, but not all of the time. I do my best

It is easy to forget. No one remembers every dose of every medication all of the time, and that includes antibiotics, vitamins, antidepressants, or any type of medication. It is unrealistic to expect perfection. However, it is important to try our collective best (that means you and your treatment providers working together) to keep on track as much as possible in order to get the benefits.

In addition, some people are very sensitive and missing even one or two doses can have a negative impact on mental health. You should NOT double up if you forget a dose. If you are regularly missing doses or you experience any symptoms as a result of a missed dose, then you need to get some help remembering. Here are some tips:

Brush and Med. If you are taking a twice-daily dose, and if you are a person who always brushes your teeth to start and end each day,
putting your dose right by your toothbrush (if there are no children in the house a safety concern) might be a great idea for you.

Lights Out. If you have only a bedtime prescription, leave it on your nightstand and take it when you settle down for the night.
Multiple Reminders. Do you take several doses a day? Maybe a watch or cell phone alarm would work for you? Think outside the box and let your treatment providers help you find a reminder system that helps you stay on track.

Weekly Minders. Maybe a weekly pill minder would work best for you. You can purchase one of these from your pharmacy and fill it yourself. Your treatment providers would be happy to fill it for you weekly, or more or less frequently, depending upon your individual needs.

We Are All In This Together

You may think it is easy or even unfair for a mental health professional to encourage you to stay on medications that they don't have to take themselves. Please try to be open-minded that most professionals working in the mental health field are quite empathetic about your concerns, as well as your illness and issues arising from that illness, AND any problems associated with medications that are prescribed for you. Also, you may or may not know that there are many people in your community who are working, going to school, parenting, functioning on many levels, who are taking these very medications and you are not aware of it because their side effects are being managed, or at a point in which they are non-existent. And yours can be too!

Maybe the next portion of this brochure would help you to form your thoughts/concerns about your own side effects. You may use it as a worksheet to help yourself think things through if you desire, or even bring it with you to your next psychiatry appointment to try to make your concerns as clear as possible. It is your choice; just another tool.

Side Effects Worksheet

1) My chief complaint about my medications is:

2) The #1 side effect I can and will absolutely NOT tolerate anymore is:

3) The side effect(s) I would really like to see go away as soon as possible is/are:

4) On a scale of 1-5, I am a #_____ on being invested in treatment for my illness.
(Key: 1=not invested, 2=slightly invested, 3=moderately invested, 4=very invested, 5=would not stop treatment under any circumstances)

5) Two things my doctor could do to help me on stay on track with my treatment, including medications:

6) Two things I can do to help me stay on track with my treatment, including medications:

This pamphlet was written to assure you, the individual, that health professionals do understand and acknowledge the challenges of taking certain medications that treat many disorders, such as bipolar disorder, and want to educate and support you in how to have your needs met while adhering to the treatment regimen that's been designed for you. Well work together to ensure an excellent prognosis and steady recovery.