Compliance or Non-Compliance
Mary had been in hospital for three weeks. Prior to being admitted she had
seemingly changed overnight from a 25 year old wife and mother of 2 little boys,
to an out of control raging inferno. If there was anything that could be done,
Mary could do it better. She talked more and louder, socialized constantly
bragging that she could “drink any man under the table” and for the first time
ever in her 6 years of marriage became sexually promiscuous. Her husband,
James, was frantic as her engines revved higher and higher. She spent
money like water and when he refused to give her more she sold her car.
One day he came home to find her smashing china that had been handed down
through the generations from both of their families…her china was her most
prized possession and when he tried to restrain her she began hitting him and
screaming. James called 911. Mary was manic. After two weeks her mood reversed
and she became silent and severely depressed. Mary’s diagnosis? - Bipolar
Affective Disorder.
Medication is the primary treatment for Bipolar Disorder. Mary was given
Depakote, a mood stabilizer and Haldol (an anti-psychotic medication). She was
having trouble sleeping and a sleeping medication was added. The haldol caused
shaking and tremor and an anti-parkinson medication was added to the regime. As
her depression deepened a small dose of an antidepressant medicine was added as
well. Before long Mary was taking a plethora of medications…some aimed at
treating the illness…others aimed at helping with the side effects of those medications. Taking numerous
medications at the same time is known as polypharmacy and it is seen often in
Bipolar Disorder.
Mary recovered and went home. She felt flat and had no interest in leaving her
home or doing her chores. She was able to look after her house and children but
there was no joy in her life. She questioned the diagnosis, and even more the
drugs, which she blamed for making her feel so bad. Soon other things began to
bother her including a weight gain of 30 pounds in 3 short months. Mary
researched these drugs and found weight gain to be a side effect of many of the
ones she was taking. Mary quit taking her medicine. Mary was non-compliant and
it was most probable that she would soon have another episode.
In a recent article written for Medscape Psychopharmacology Today titled
Polypharmacy Dr Thomas Kramer brings out some excellent points. Thomas AM
Kramer, MD, is Director of Psychopharmacology Consultation Service for the
Arkansas State Hospital in Little Rock. He is an Associate Professor of
Psychiatry at the University of Arkansas for Medical Sciences and Assistant
Director for Training at the Mental Health Research & Training Institute, Little
Rock, Arkansas. For the full text of this article go to
http://www.medscape.com/Medscape/psychiatry/journal/2000/v05.n03
/mh0509.kram/mh0509.kram.html
From my understanding of his article Dr Kramer is saying that while treatment
with as few medications as possible is ideal, many patients require the use of
polypharmacy to be well. Individuals with depression may be seen and managed
well by their family physician by the prescription of an antidepressant
medication. Severe or treatment-refractory cases are the ones that are referred
to a psychiatrist and in these cases polypharmacy is most likely required.
Dr Kramer states further that “No medication regimen has any hope of being
effective if the medications themselves are not actually ingested.” There is
more than one reason for “non-compliance”.
A confusing combination of medications that a patient is unable to keep track of
may make him/her throw his hands in the air in defeat.
-helpful changes may include taking medicine all at one time or
twice a day
instead of 3 or 4 times daily
-use of a weekly or daily drug reminder box
Cost of medication may not permit some patients to obtain them
Side Effects (short and long term)
Drug Interactions
My personal thoughts on compliance and polypharmacy are these. Work with your
psychiatrist to find the right medication combination for you. It may take a
while, but don’t despair or give up. You have a life time illness when you have
Bipolar Disorder…proper treatment is only way to be well as often as you
possibly can. Do your best to form a good relationship with you psychiatrist,
keep your appointments and take your medications. Contact your doctor first
before even thinking of stopping them.
