Individuals with serious mental illness (SMI) like bipolar disorder or schizophrenia often stop taking their medications at some point. There are several common reasons behind this. If someone you know has stopped taking their mental health medications, it’s important to take the time to understand why. This can help you to figure out how you can help.
Why Do People Stop Taking Their Meds When They Are Doing So Much Better?
Individuals with schizophrenia or bipolar disorder (BD) often fail to take their medications (usually antipsychotics and/or mood stabilizers) at least some of the time. This is called nonadherence and is one of the biggest problems in psychiatric care because it can lead to “relapse of symptoms, rehospitalizations, homelessness, incarceration in jail or prison, victimization, or episodes of violence.”
Why is there such a high level of nonadherence among people with schizophrenia or bipolar disorder? Here are a few common reasons.
They Feel Like the Medication Doesn’t Work or They Don’t Need It
Some people quit taking their medication because they feel that:
- It isn’t working anyway – but some medications take time to work. SSRIs, a common type of drug prescribed for mental health conditions, can take at least 2 to 4 weeks to be fully effective. Stopping treatment before the drug takes full effect means that the individual doesn’t experience the full benefits of the treatment. It can also be dangerous to suddenly quit certain drugs without talking to a doctor first.
- Having a mental illness is shameful. There’s still so much stigma around mental illness, especially around SMI, so it’s no surprise that some people don’t want to take medication for SMI.
- They no longer need the medication. If their symptoms have improved, they may think that they are doing better now and no longer need to take their medication. But the truth is that medication needs to be taken regularly to continue to be effective
- They don’t have a problem. It’s very common for individuals with schizophrenia or bipolar disorder to experience what is called “anosognosia” – a lack of insight into their condition. They don’t understand that they are sick. This doesn’t mean that your loved one is in denial or just being stubborn – anosognosia is actually caused by processing problems in the brain
About anosognosia, Xavier Amador, Ph.D. says:
“People will come up with illogical and even bizarre explanations for symptoms and life circumstances stemming from their illness, along with a compulsion to prove to others that they are not ill, despite negative consequences associated with doing so.”
The Cost of Medicine Is Too High
In countries that don’t have universal healthcare, like the U.S., prescription cost can be a major hindrance to medication adherence.
A review of studies done by the National Library of Medicine found that all-cause health care costs (ie, inpatient, outpatient, prescription medications) for individuals with bipolar disorder are about four times higher than those for matched individuals with no mental health conditions.
Another study reviewed by the NLM reported that individuals with BD who were on an employee health plan had higher all-cause health care costs “than those with diabetes, depression, asthma, or coronary artery disease.” This is largely due to the higher costs of medications and psychiatric care among those with bipolar disorder. Only those “diagnosed with both diabetes and coronary artery disease” had higher all-cause health-care costs than those with bipolar disorder.
Schizophrenia is also one of the most expensive mental illnesses to treat, with an estimated annual per person direct treatment cost that’s about “2-fold higher than the cost of major depression and more than 4-fold higher than any anxiety disorder.”
With costs so high, it’s understandable that people with SMI might skip out on taking their medications sometimes.
Undesirable Side Effects From Medications
Many psychiatric medications come with undesirable side effects like:
- Weight gain
- Low libido or sexual ability
- Dizziness or drowsiness
- Acne or dry skin
- Problems with concentration
- Sleep problems
- Nausea or upset stomach
Depression is a symptom of both BD and schizophrenia. When someone is depressed, they will often stop taking medications, either because they’ve forgotten to take them or simply don’t care anymore.
Alcohol or Drug Abuse
Substance abuse is common among people with mental health conditions. If someone is told by their doctor not to take their medication with alcohol, they might decide to not take the medication at all, so they can still drink. Some medications can also interfere with the effects of drugs or alcohol, so someone who’s dependent on substances might quit taking the medication, so they can continue to experience the desired effects of the substances they use.
They Feel Like They Don’t Have Support
A lot of people struggling with SMI don’t feel like they have the support they need. They might have a poor relationship with their medical provider and as a result, don’t take their advice.
A 2021 study from Brigham and Women’s Hospital found that a lack of support is a common reason that people with SMI stop pursuing treatment.
Dr. Asta Ratna Prajapati, Ph.D., lead researcher on the project says:
“We recommend that the prescribers talk to patients about their thoughts and experiences of the medications they take, paying particular attention to these issues which may stop patients taking their meds.”
Individuals might also feel like they don’t have support because of a poor relationship with family or friends. Social support is extremely important when managing a SMI. Those who don’t have close relationships with others should consider joining a support group.
What To Do if Someone Stops Taking Their Bipolar Disorder or Schizophrenia Medication
If someone you know has stopped taking their medication against their doctor’s orders, the best thing you can do is to let them know that you want to understand and that they have your support. Ask about their reasons and then listen actively, making sure to not interrupt or make them feel judged. Ask them what they need from you and if they’re willing, talk to them about their options.
A Community of Hope
If someone you care about has stopped taking their medication, there is hope. After offering them your full support, the next best thing you can do is to let them know how they can get help when they’re ready.
In Franklin, Suffolk and the counties of Isle of Wight and Southampton, Western Tidewater Community Services Board is the single-point-of-entry for mental health services. We’re your local authority on all things mental health and we’re dedicated to connecting our community members who are living with SMI with the resources and supports they need to not only manage their condition, but to thrive. We provide mental health counseling, case management, residential care and more. And don’t let worries about money keep you from asking for help. We can work with individuals to minimize costs.