Pharmacotherapy is often the first line treatment for the major psychiatric disorders. Moreover, even with less severe conditions such as adjustment disorder and bereavement, patients are often given a pill to ease their suffering.
Indeed, in today’s fast-paced, fix it now culture, it is as common for a person to receive a prescription as it is to undergo talk therapy.
This is unfortunate considering the limitations associated with pharmacotherapy and the benefits of evidence-based psychotherapies.
The risks, limitations, and benefits of psychiatric medications and psychotherapies are a discussion for a future article. As a psychologist who prescribes medications, I am well aware of the fact that some of my patients do not benefit from medication.
But for many of my patients, I see significant improvements in symptoms and functioning. In a portion of these patients, I see life-changing improvements.
When considering whether or not a medication works, multiple factors must be taken into account. First and foremost of these factors is compliance. Medication compliance, or what some refer to as medication adherence, is the degree to which a patient takes a prescribed medication as directed by the prescriber. Obviously, if the patient does not take the medication (or does not take it as prescribed) then the medication will not work.
The rate of medication non-compliance varies. Some research indicates that certain disorders, like bipolar disorder and schizophrenia, have higher non-compliance rates compared to depression and anxiety, whereas other research shows relatively stable rates across all disorders.
In some cases, compliance rates have been less than 50 percent. Additionally, recent research has highlighted that medication non-compliance is a global challenge for psychiatry and is associated with poorer outcomes, increased hospital admissions and suicide.
Yet, psychiatry is not the only issues that faces this challenge. Similar rates have been noted in primary care medicine.
Although many factors are associated with medication non-compliance, there are three primary factors which lead to poorer compliance related outcomes for psychiatric disorders–patient characteristics, medication characteristics and prescriber characteristics.
A person’s beliefs and attitudes about medication is a common patient barrier to effective pharmacotherapy. In essence, many people do not believe in taking drugs. The reasons vary and can include cultural, religious, health, financial and familiar factors.
In my practice, I often hear concerns from patients regarding not wanting to take medication because they believe the medication will disrupt their delicate brain chemistry and physiology or fear that they will develop a psychological or physical dependence to the medication.
Concerns over being seen as weak or crazy are also often voiced. These are valid concerns.
The side effects inherent in all psychiatric medications are often problematic for patients. Many of the drugs used to treat psychiatric disorders cause drowsiness, fatigue, stomach upset, sleep disturbances, agitation, dry mouth and sexual problems in both men and women.
As you might expect, the latter can be troubling for young and healthy individuals. Additionally, in my experience, loss of sex drive, impotence, and delayed ejaculation are the most common reasons patients being treated with antidepressants stop taking their medication.
There are several characteristics of psychiatric prescribers, that if present, can lead to poor medication compliance. These include a perceived lack of empathy, an overly directive or authoritative style and a prescriber who neglects to explain the purpose and side effects of the medication.
Impact on Compliance
Even the basic process of explaining to the patient how he or she is supposed to take the medication, when not done adequately, can have tremendous impact on compliance.
If you have patients who have been prescribed medications for their problems, talk with them about any concerns they may have about the medication. This is especially important if you don’t believe their provider has adequately explained the purpose, risks, limitations and side effects of the medication. You should not assume this has been done.
Unfortunately, as psychiatric medication appointments become shorter, less time is spent on education. And if there is any uncertainty on your patient’s part about how to take the medication, remind him to review the instructions on the pill bottle or contact his healthcare provider or a pharmacist where the medication was dispensed.
Medication has an important place in the overall care of your patients. Pharmacotherapy is an effective, safe, and complementary adjunct to psychotherapy. However, a variety of factors are associated with non-compliance and can prevent, stall, or delay recovery.
These factor should be reviewed frequently and addressed as needed with your patients. Remember, unless the prescribed medications are taken as recommended, they are as useless as the packaging in which they come.
*This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”
Refusing medication photo available from Shutterstock