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.



 



 

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