What's the secret to medication compliance?

[Banned]

I'm off my meds again. I'm having such a hard time with so much stuff, and it always starts the same...I forget for a day or two, and then just don't go back to them because I felt fine for that day or two so I figure I must be ok. I know that's so wrong...logically.

I think right now I'm having a really hard time trusting them. I know that sounds weird, but when I look at them, I look at them as an extension of the person who prescribed them, among others, and don't see the value in them. I know people who have bipolar tend to go off meds...it's a big problem, and while my one doctor is questioning that diagnosis, I'm not for a second. I know I have bipolar. I know I need them. Why can't I shove them down my throat and just be done with it?

I have to find a way to get back on them stat. I'm away at the end of July and CANNOT crash while I'm at the other end of the country with no support or resources. I'm in Vegas in August and want to enjoy that trip. I cannot be hospitalized before, during, or after either of these trips.

I don't want to become another statistic. I don't want to be in a place where I feel like suicide is an option again. I've fought so hard, for so long, that I want to succeed at this.

I hate that I struggle so much with them. I was doing well - six and a half months of taking them...and now this. It really sucks. But I'm going to find a way to start back on them...I'll force myself...I have to. I don't want to be a statistc that could have been prevented just by taking them. I suppose I don't have to like it...I just have to learn to trust them, right? Maybe that's the secret for me...trust that they will help me.

 

[Always Changing]

Re: Ok, what's the secret?

Hi Turtle,
I can really relate to your struggle with taking the meds, for me I find if I question taking them for a second that is enough for me to say "forget it! I don't need these, I will be fine without them". These thoughts usually appear because (similar to you) I have forgotten to take them the previous day, it is hard not to start thinking as you\I do, For me I have found that in order for me to be able to continue to take my meds, I have a sort of routine, Med time, open the press, take the meds, close the press and walk away and do something, anything in order not to have that huge debate start and continue in my head. I think right now what is helping when I do go down that road, is looking back at where I have been and trying to believe that its the meds that have me where I am now. Not actively suicidal. I still struggle with taking them though.

Maybe for you, something similar might work to get you back on them (for all the reasons you listed above). Don't think about them at all, don't let the debate go on and on,, this is what has you still off them. IMHO.

There is no magic trick I am afraid, except to say, don't think about it, just do it.

:hug:

 

[Cat Dancer]

Re: Ok, what's the secret?

I agree with Always. I think you just have to do it. Go back on them and try to shut down the dialogue inside over them. I am not bipolar and I constantly questioning my meds. I don't think the consequences of being off them are as bad as what you go through though.

 

[Banned]

Re: Ok, what's the secret?

You're totally right, AC. And I'm sooooo ridiculously analytical that I start evaluating everything. Then I get caught in this mental loop of end up exactly like you described.

You're right - just do it. Just chug 'em down and don't even think about it. I definitely don't want to go back to being even a little bit suicidal. Not now. Not when I'm just starting to enjoy stuff, and look forward to things. I think that also has to propel me....looking forward instead of back.

The more I write this out, the easier it seems...and the more it makes sense, even in my own mind. This is why laying awake all night and letting things fester is not good either.

Thank you!!

Added: I'm at work and thinking about this, and I think I liken it to running a marathon, sort of. Sometimes I'm totally "into it" and on board and other times I get a "cramp" and am not sure of what I'm doing. I guess with runners they try and run through the cramps to their second wind, and maybe that's a good analogy for me - keep "running"...even through the cramps...I think it's a perpetual marathon with no end in sight, but maybe if I focus on the here and now instead of the whole life ahead of me, it'll be better and less overwhelming.

 

[Daniel E.]

I would add that for most people (without a PhD in psychopharmacology or whatever), one can always increase one's level of "psychoeducation," which, as you know, helps in other areas of treatment besides medication compliance:

The action of psychoeducation seems to go beyond compliance enhancement and may support a tripod model composed by lifestyle regularity and healthy habits, early detection of prodromal signs followed by prompt drug intervention, and finally treatment compliance.

Psychoeducation efficacy in bipolar disorders: bey... [J Clin Psychiatry. 2003] - PubMed result

And, by the way, one example of internalized stigma:

"I must be really inadequate if I can't fix this myself."

http://www.dbtselfhelp.com/html/ie_handout_4.html

 

[Always Changing]

maybe if I focus on the here and now instead of the whole life ahead of me, it'll be better and less overwhelming.

I agree, thinking too far ahead at times is not so good, however, a little forward planning on the other hand is okay. You have so much to look forward to in the coming months
I truly hope that you go back on your meds and continue to remain well and stable.

Enjoy your trips :2thumbs:

 

[Banned]

Daniel,

Is it possible that too much knowledge can be just as dangerous as not enough? When I last saw my doctor, she told me that my problem is that I'm way smarter than the average person and therefore my psychiatrist doesn't have to do any work because I've done it all for him. I'm going back to see my psychiatrist on the 5th and I'm layin' down the smack. The Seroquel is not working (which is why my family doctor doesn't think I'm bipolar - she forgets that there ARE other medications for it) and I want him to come up with a solution for me. So far I've been going in and saying "this is what's going on and this is what I think I should try" and he's been giving it to me - no questions asked. This time I'm making HIM come up with a solution. Don't get me wrong - I know what I want to try next, but I want to see where he goes with this. In the past he's been like this helpless little boy who's taking orders from me. It's just weird.

I think part of why it was easy to go off meds this time was because they haven't been working anyway...which makes it justifiable in my mind, but I have to remember that even if I don't feel like they're working, there's still an impact on my body and I can't just stop them suddenly.

AC - yes - I have so many wonderful things coming up! I've bought a second business (originally it was going to replace my current business but it looks like I'm keeping both now, so I'll have two) plus I have school, I'm learning to scuba dive, I have two trips planned...I want to be able to enjoy all of this to the fullest...so I have to stay focused on my mental health as well in order to do that.

 

[Daniel E.]

Is it possible that too much knowledge can be just as dangerous as not enough?

Well, here's the paradox: Such an insight, if true, would still fall under psychoeducation

So I think "paralysis by analysis" and other such problems are not due to psychoeducation but rather one's lack of applying psychoeducation.

 

[Banned]

Hmmm....yes, I suppose.

I think I just need to pick a career and go with it. My doctor tells me I missed my calling and I should have been a doctor. I make good money training dogs, and it incorporates a tonne of psychology. On the other hand, if I get a degree in psychology, then maybe I'll be smart enough to fix myself. But then, I like teaching, and I'm learning to scuba dive, and it would be fun to be a dive instructor one day. Oh and did I mention that I also groom dogs, which is a whole other career, and run my own business. I'd also like to learn a couple more languages (I currently have English, French, Spanish)....

I hope I live to be 730. I'm gonna have to, to fit all this in, I think.

 

[Daniel E.]

I think part of why it was easy to go off meds this time was because they haven't been working anyway...

I would think that Seroquel would at least help with getting enough sleep For example, are you more likely to sleep at least 7 hours at night while taking Seroquel and less likely to sleep less than 5 hours at night?

I know you have kept a mood log before. Doing so again may help, if you aren't currently. (For example, people with depression have a much harder time remembering positive experiences/moods, even if it was just a week ago. And, of course, a mood log can make things easier for communicating with psychiatrists.)

 

[Banned]

The Seroquel does help with sleep, I'll give it that. I haven't been taking Imovane because if I take the Seroquel at night I will fall asleep. If I take nothing, I get no sleep. Not a minute. But I have to find some balance. When I was in school I finally figured out if I took half the Seroquel in the morning and half at night, I could get up for class. If I took it all at night, I was still sleeping at 1pm. I was also on a lower dose than I am now. When I go back to school in September, I have an 8:30am class three days a week, and a 10am the other two, so I HAVE to be able to get up and be at class. Being in school full time, and most likely running two busineses, I have to be alert and on my game. I can't be sleeping all the time or never....I have to figure out that balance.

Yes - I've done mood logs in the past. The trouble I have with the ones on the computer is that it doesn't give me enough room....my mood can change drastically several times a day. This means a manual mood log...and that's ALOT of work. When I'm doing well, I forget about when I wasn't, and vice versa, so it would definitely be beneficial...its just making the time to do it.

 

[Chain Lightning]

I look at it this way Turtle, as bad as I feel now...it would be 10x worse without the "magic salt"

 

[Banned]

Yes....and for me, it's the opposite. I'm finally starting to feel good...and I think part of it is I expect to crash so why not just bring it on...but I want to maintain where I'm at now, so I have to maintain that with meds...hmmm...I could have a mantra..."maintain the meds, maintain the mood"...something like that. Ok, I'm retarded that way :lol:.

 

[Chain Lightning]

You're saying you feel worse on your meds than off?

 

[kelsischanging]

Turtle,
For me, taking my meds is just like brushing my teeth...it's part of my routine. Just like I know that brushing my teeth is healthy, I don't think about that fact everytime I brush my teeth. I know taking/staying on my meds is healthy for me and I don't think about that fact everytime....I just take them. Not that it's not important to be educated about what you are taking and why you are taking it but analysizing those facts everytime you have to take your meds is not helpful.

Good luck!

 

[Daniel E.]

Since a lot of people with bipolar disorder have problems with medication compliance, another metaphor would be flossing, since a lot of people will do that only once a week or so. Personally, I'm more motivated to floss daily before and after going to the dentist. So, anyway, I think seeing or calling a psychiatrist or even a medication-savvy therapist more often may also help, such as calling one's psychiatrist with concerns about the medication not being as helpful as one would expect.

BTW, concerning patient compliance in general:

No single strategy or programmatic focus showed any clear advantage compared with another. Comprehensive interventions combining cognitive, behavioral, and affective components were more effective than single-focus interventions.

http://journals.lww.com/lww-medical...ss_of_Interventions_to_Improve_Patient.4.aspx

 

[David Baxter PhD]

a lot of people with bipolar disorder have problems with medication compliance

Indeed, this is characteristic of bipolar disorder for many patients, not the least because they tend to have very limited insight into their moods and other symptoms and tend to disregard the observations and advice of those around them. Such bipolar patients are noncompliant because they don't believe they need the medication, no matter how many people point out how much better they are when they are taking the medication.

Another reason is that many bipolar patients miss the highs that the medications are designed to prevent or limit.

 

[Daniel E.]

Another reason is that many bipolar patients miss the highs that the medications are designed to prevent or limit.

Yeah, reminds me of the Richard Gere movie Mr. Jones:

YouTube - Mr. Jones (Richard Gere) Movie Trailer

 

[Banned]

For some reason I'm having difficulty replying to multiple posts, but...

CL - not saying at all that I feel better off meds than on. Just saying that sometimes I feel like they aren't working, or aren't the right combo. I think my biggest issues are irritability and depression, and I still feel really irritable...so I think some adjustments are in order.

David - yes...the highs are important...I feel like anyone else I'm sure - I get my inspiration during them, I am more productive, I have more energy, I feel like life is worth living. I've always lived my life at extremes - everything has always been black and white, so in a way it seems appropriate that it would continue into my moods. I know from an academic perspective that the highs usually precipitate a crash, and I can be "dangerous" during them. This is where, as you've pointed out before, having a support system in place is important. I do feel I lack that, and I therefore need to be more aware myself, which comes back to the whole issue of not being able to be objective. I also feel like I have more insight than I probably actually do...I think I'm doing better than I am, or when I'm depressed, I think I'm doing worse than I am.

I need outside objectivity and perspective, and I just don't have it. I also know I'm my own worst enemy. I do have a hard time trusting other people, and to let someone else have that outside perspective means letting them in and trusting, and I'm just not sure I'm able to do that right now.

 

[Daniel E.]

You might be interested in the books/videos by Tom Wootton:

YouTube - A New Perspective On Bipolar Disorder, Depression, Mania, Hallucinations, and Delusion!