Over the last two years, the number of people experiencing depression and anxiety has increased by 25 per cent, according to the World Health Organization. And about one in four Americans suffer from a diagnosable mental disorder. About half do not seek professional help. The current mental health crisis is a pressing issue yet to be addressed fully. It’s unfortunate because most mental disorders are highly treatable.
Among those with anxiety, less than 37 per cent receive treatment, which may include, alone or in combination, psychotherapy and prescription medications, like selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants. Since many of the medications prescribed for anxiety and depression can take time to work (from two to six weeks), consistency is key.
Medication consistency nets better results
“It is always best practice to take all medications as prescribed by your doctor,” says Dr. Paul Poulakos, a board-certified psychiatrist, based in Greenwich Village, N.Y. “For medications to be effective, patients need to be mindful of the specific dosage, the frequency at which they take the medication and the duration of treatment. All are crucial to obtaining results. In addition to maximizing the successful outcome of the drug and its intended effects, taking medications as prescribed can avoid potential interactions or undesirable side effects that could even be dangerous.”
“The current mental health crisis is a pressing issue yet to be addressed fully. It’s unfortunate because most mental disorders are highly treatable.”
For certain medications, missing a dose can result in experiencing unpleasant withdrawal symptoms, he points out. These symptoms may include anxiety, headaches, sleep difficulty, mood alteration, flu-like symptoms and fatigue. It underlines how important it is these medications are taken consistently and as prescribed so that symptom remission isn’t further delayed.
Inconsistency with medications that manage mental disorders is not uncommon among patients. One study published in the medical journal Neuropsychiatry found adherence decreases as the duration of therapy lengthens. Among older patients, non-compliance is “a real, complex problem for older patients receiving polypharmacy,” concluded another study, which looked at patients newly released from the hospital. The rate of medication non-adherence reached almost 70 per cent.
“Stopping one’s medications because one feels good, though it may seem reasonably intuitive, can have serious consequences,” says Dr. Poulakos. “Often times illnesses such as depression and anxiety are chronic, meaning that they are lifelong illnesses that are treated indefinitely. When initiating medications, I often caution my patients with anxiety and depressive disorders that feeling good is an indication the medication is working, not instruction to haphazardly stop taking it. One should not stop taking the medication without serious consideration and consultation with a doctor. Your doctor can educate you on risks, benefits, and help you come to a clinically informed decision.”
Why some patients don’t take medication
There are a number of other reasons why patients may discontinue taking their medication. “In my practice, one of the most common reasons for discontinuing one’s medication(s) is the experience of adverse side effects to the medication,” he says. “While side effects do not occur in all patients, they do occur in some, and this is definitely something for patients to bring up with their doctor. A doctor may instruct them to change the dosage, to take it less frequently, or discuss a different treatment entirely.”
Another common reason why patients do not take a medication as prescribed is anxiety-related, he notes. “There is a lot of misinformation out there, not to mention negative stigma, surrounding psychiatric illness. I have found that one of the reasons my patients don’t take their medication as prescribed is the anxiety due to this misinformation. A common fear is that the medication makes one feel ‘unlike themselves.’ I have found this fear to be quite common amongst patients despite it being a rare report I hear as a psychiatrist. I take this opportunity to reassure patients that the medication is not intended to change you, rather help you function as your best self.”
“ONE WAY TO STAY ORGANIZED WHEN TAKING MULTIPLE PRESCRIPTIONS IS USING ADHERENCE PACKAGING…CAN ALLEVIATE THE STRESS OF REMEMBERING”
Managing multiple prescriptions is another factor for non-adherence. According to a post from American Medical Association, “When a patient has several different medicines prescribed with higher dosing frequency, the chances that they are non-adherent increase.”
Solutions for managing multiple prescriptions
For patients who are managing concurrent health conditions simultaneously, this can often mean juggling multiple prescription medications, perhaps prescribed by various different doctors across various medical specialties. “This can feel overwhelming and increase the possibility for error (i.e. forgetting a dose), hence, it is crucial to be organized,” says Dr. Poulakos. “By remaining organized, one removes a lot of the stress and anxiety they may have about their ability to juggle various medications.”
One way to stay organized when taking multiple prescriptions is using adherence packaging. “Predetermined packaging that is organized for both morning and night can alleviate the stress of remembering when to take what medication and adds a sense of ease into your medication management,” he explains. “This can enhance medication adherence, effectiveness and lessen the risk of adverse side effects brought on by missed doses.”
It is important to take medication for managing mood disorders, like anxiety and depression, as prescribed because that is how it was studied, he points out, and it is under those instructions (i.e. dose and frequency) that the medication was found to be effective. “If not taken as prescribed, one cannot be certain of potential side effects that could result from an excess concentration of the medication in your system,” he says.
When providing education and instructing his patients on how to take a particular medication, he likes to frame it as a relatively minor intervention that can have a huge impact. “I accomplish this by helping the patient make the connection between something seemingly as simple as swallowing a pill each day to the immense effects it could have on one’s health and quality of life,” explains Dr. Poulakos.
Produced with support from Jones Healthcare Group.