Refusing to Take Medication

Treatment noncompliance, or refusing to take medication for a mental health disorder, can pose serious risks to the individual and even those around them. Depending on the specific mental health condition, refusal to comply with treatment may result in psychosis, suicidal ideation, or panic attacks, as just some examples. In most cases, the individual who is refusing to take medication for their mental health disorder will likely become sicker as a result.

Perhaps you have a loved one who struggles with depression, bipolar disorder, or even a psychotic disorder and are frustrated that this person is neglecting their treatment regimen. This may lead to further emotional instability and even dangerous outcomes. While it may be difficult to understand why someone might refuse to take their medication knowing it will improve their quality of life, there are several common reasons why this takes place among individuals with a psychiatric condition.

About Psychotropic Drugs

Drugs, which are formulated to treat individuals with a mental health condition, can have a significant impact on the management of symptoms. These drugs work by altering brain chemistry, which can change mood, perceptions, and behaviors. These medications work by adjusting neurotransmitters, such as dopamine, norepinephrine, GABA, and serotonin. The main groups of psychotropic drugs include:

  • Antidepressants.  Antidepressants manipulate serotonin levels. There are approximately 30 different antidepressants on the market.
  • Anti-anxiety drugs. Anxiolytics are the drugs in the benzodiazepine category, which cause a relaxing or calming response.
  • Antipsychotics. These block dopamine in the brain and are prescribed for such mental health disorders as schizophrenia.
  • Stimulants. Stimulants increase norepinephrine and dopamine levels in the brain, and are used to treat ADHD and narcolepsy.
  • Mood stabilizers. These drugs are used to treat bipolar disorder and depression. They may calm certain areas in the brain, and that helps reduce mood swings.

When prescribing psychotropic drugs to treat a mental health disorder, the doctor is looking for the best clinical response with the fewest side effects. Some drugs may have such intolerable side effects that the patient may abandon treatment.

5 Reasons Why a Patient Would Discontinue their Medication

There are various reasons why someone may abandon their medication. It is helpful to sit down with a loved one and discuss the issue that is preventing them from treatment compliance. They may need a little coaxing to get back on their medications, or possibly offering to accompany them to the psychiatrist to be their advocate will encourage them to pursue the issue. The bottom line is that the individual needs to follow the treatment plan if they are to experience a better quality of life.

Some of the most common reasons for discontinuing medication include:

  1. Medication side effects are intolerable. Many of the medications used to treat mental health disorders carry potential side effects. These can range in severity and may include such adverse effects as weight gain, nausea, dizziness, constipation, sexual dysfunction, loss of appetite, sleep disturbance, and stomach issues.
  2. Poor therapeutic alliance. The relationship between a patient and the psychiatrist or therapist can be influential in patient treatment compliance. When that relationship is poor, it can result in a breakdown in the patient-provider dynamic. This can be caused by a doctor’s lack of listening to the patient, or explaining treatment clearly to them.
  3. Anosognosia. The term anosognosia indicates the patient seems unaware that they are sick or that they are in need of medication. They simply do not perceive the illness. According to Xavier Amador, Ph.D., who spoke at a convention for the National Alliance for the Mentally Ill, “People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness.”
  4. No improvement in symptoms. When a patient has unrealistic expectations about the treatment timeline they may expect to immediately see results. In many cases, the medications may take weeks to become effective in reducing symptoms. The patient may become impatient, assuming the drug isn’t working for them, and just stop taking the medication.
  5. Co-occurring substance use disorder. Individuals with concurrent drug or alcohol addiction may select not to take their medication due to potential adverse side effects. Most medications carry a warning not to drink alcohol while on the medication. A patient may then chose to continue drinking and not take their prescribed medications.

Other reasons a patient might stop taking their medications include the expense of the drugs, mental confusion, distrust of doctor or medical system, or being homeless or imprisoned.

Dangers of Refusing to Take Medications

Living with an untreated mental health disorder can make the demands of daily life difficult to manage. When someone refuses to comply with a treatment plan and take the medication things can unravel quickly. Mood swings, disruptive behavior, angry or violent outbursts, and even suicide attempts can result when a serious mental illness goes untreated.

Some of the negative outcomes of refusing to take medication for a mental health disorder include:

  • Loss of employment
  • Homelessness
  • Dropping out of school
  • Legal problems
  • Declining physical health
  • Neglect of personal hygiene
  • Loss of custody of children
  • Interpersonal problems

Social support services may be necessary for individuals who become mentally unstable due to noncompliance. In some cases, the individual who is refusing to take their medication may become a danger to themselves or others. If this transpires, there is a need for acute stabilization at an inpatient or residential setting.

Strategies to Improve Treatment Adherence

When considering ways to help improve adherence to pharmacological treatment it starts with gaining a clear understanding of the reason or reasons why the individual is not willing to take the medication. That becomes the starting point for initiating positive change. For some patients fear is the driving motivator behind treatment noncompliance.

For example, the individual may be afraid of the side effects or fear the drug changing their personality. When these perceptions are behind the resistance to taking the medication, it helps to clearly build a case for how the medication can help alleviate the symptoms of the illness as well as avoid hospitalization. By presenting a positive attitude about the benefits of taking the medication, and educating the individual about how medications can be tweaked and changed to avoid side effects, their willingness to adhere to the treatment plan is improved.

If the individual is struggling with a co-occurring substance use disorder an effort should be made to get them into a dual diagnosis treatment program. There an integrated treatment approach will address both the mental health disorder alongside the substance use disorder. This can significantly improve the individual’s overall clinical outcome, especially when aftercare and case management are included in the planning.

When the reason for refusing to take medication stems from a poor relationship with a mental health provider, suggest that they interview a couple of other providers in hopes of finding a better fit. When finding a provider that the person feels they can trust, and who they believe genuinely cares about the treatment outcome, it creates a positive therapeutic relationship that can significantly improve treatment adherence.

Mental Health Disorders that May Lead to Treatment Noncompliance

Some mental health disorders have a higher rate of resistance to treatment adherence. These include:

Major depressive disorder. The side effects associated with antidepressants are a common reason why a patient might abandon medication. In reality, doctors are accustomed to making medication adjustments when treating depression to arrive at the best fit with the least adverse effects. A patient may trial one drug and simply give up without allowing the doctor to replace it with another one.

Bipolar disorder. Individuals with bipolar disorder often fear taking the medications. They may complain that the drugs make them feel “flat” and they may not be ready to give up the manic episodes, as some patients enjoy them.

Schizophrenia. Individuals with schizophrenia often fall into the category of anosognosia, or a lack of awareness that they have a need for treatment at all. They may not recognize that they have a problem, as they often are divorced from reality.

When there is a Need for More Intensive Treatment Intervention

If the individual continues to resist treatment adherence and their symptoms worsen, it is appropriate to consider a higher level of care. This becomes evident when the individual is struggling to perform even basic functions, has become isolated, has developed a co-occurring substance use disorder, or is vulnerable to exploitation, abuse, or suicide. Residential treatment provides the more intensive and targeted treatment protocols within a safe, structured setting.

Residential treatment encompasses the following interventions:

  • Medication management. Medication will be prescribed depending on the specific diagnosis. Medication may include antipsychotics, benzodiazepines, antidepressants, or mood stabilizers. For some individuals these medications will be necessary to help manage the disorder on a long-term basis, and will likely be prescribed for a lifetime.
  • Psychotherapy. While in a residential treatment the individual will be involved in various types of psychotherapy. The focus for therapy involves helping the individual recognize irrational thoughts and behaviors and to replace those with healthy thought-behavior patterns. Types of psychotherapy include:
    • Cognitive behavioral therapy
    • Psychodynamic therapy
    • Dialectical behavior therapy
    • Cognitive enhancement therapy
    • Social recovery therapy
    • Mindfulness-based cognitive therapy
  • Family psychoeducation. Family-focused therapy can assist family members by guiding them toward forming healthy boundaries, learning more effective communication techniques, and generally teach the family how to be supportive of their loved one in their recovery journey.
  • Holistic therapy. Holistic therapies are often utilized as complementary treatments for mental health disorders. Activities such as yoga, mindfulness meditation, acupuncture, and massage therapy in a mental health retreat are helpful in controlling stress and promoting relaxation.

Mental Health Hope Offers Treatment Solutions for Individuals Struggling with Treatment Compliance

Mental Health Hope is an online resource for individuals needing some direction in pursuing treatment for a mental health condition. Our expert mental health specialists can offer workable solutions for those whose loved one is refusing to take medication for their condition. Let our team assist you in finding the resources that can lead to a successful treatment outcome. Call Mental Health Hope for your free confidential assessment today at (877) 967-9274.

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