Nonadherence to psychotropic medications is high, almost 50%. Close to half of patients with major psychiatric disorders, major depression, schizophrenia, and bipolar disorder do not adhere to taking medications as recommended by medical professionals. Psychiatric disorders are a growing world health concern. So much so the World Health Organization (WHO) has developed strategic planning (2012-2030) to combat the negative impact psychiatric disorders have on a person and the world. There are many factors affecting adherence to medication for mental health disorders. Here are a few perspectives from the patients and the medical professionals, along with ways medical professionals can help patients increase medication compliance.
Side effects: A significant reason for noncompliance with medication is the side effects. Patient reports of side effects include but are not limited to daytime sleepiness, weight gain, extrapyramidal symptoms, difficulties concentrating, restlessness, dry mouth, decreased sexual drive, and dysfunction. Despite the effectiveness of the medication, observational reports of medical professionals show patients will still discontinue the drug due to side effects resulting in a relapse of symptoms.
Understanding of mental health disorders and medications: Another common factor among psychotropic nonadherence is a lack of knowledge about the mental health disorder they are experiencing. This includes an overall sense of the disorder and the consequences when medication is not adhered to. Medical professionals observe that when families and patients hold little knowledge of the disorder, it is sometimes believed that medication can be discontinued with symptom relief.
Stigma: Studies showed that when a patient perceives stigma from their healthcare professionals, family, and community, this has an impact on medication adherence. Stigmas range from the belief of getting better without medication, fear of dependency, embarrassment about taking psychotropic drugs, and feelings that taking pills is not natural.
Patient attitude toward medication: The patient’s attitude is one of the crucial factors in medication adherence. A patient’s negative attitude toward medication makes them more likely to seek alternative treatments or refuse medication. Patients who feel suspicious of medication believe medications will harm them, and voices telling them not to take medication also affect their attitude toward psychotropic drugs. A study also suggests an association between medication compliance and the patient’s motivation for treatment.
Family support: Family support is crucial for the patient's ongoing care. Family involvement can help the patient with medication reminders, transport to appointments or the hospital, and unity and cohesion within the family. Families can find themselves taking on the load of care for individuals with mental health disorders. Lack of family support is linked to higher nonadherence to medication.
Strategies to improve adherence to meds:
· Include the patient in the decision-making and treatment-planning process. Involve the patient in planning their medication regimen. Including the patient and family can help with their attitude and stigma towards treatment.
· Know what side effects may be temporary and which can be treated with other medications. Also, be aware of what other medication options are available for the patient.
· Help increase and explore the patient’s motivation for treatment.
· Explore the patient’s insight into their illness and what misconceptions they may have. Provide education and resources.
· Investigate the stigmas the patient and family may have about medication use and provide support and education to eliminate those stigmas.
· Encourage family support and educate the family on the best ways to be helpful.
· NAMI provides patients with psychotropic drugs education on medication adherence.
References:
1. Deng, M., Zhai, S., Ouyang, X. et al. Factors influencing medication adherence among patients with severe mental disorders from the perspective of mental health professionals. BMC Psychiatry 22, 22 (2022). https://doi.org/10.1186/s12888-021-03681-6
2. Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. Systematic Reviews, 9, 17. https://doi.org/10.1186/s13643-020-1274-3
3. Caroline Barnard, PharmD, February 2019. NAMI. https://www.nami.org/about-mental-illness/treatments/mental-health-medications/medication-plan-adherence/. Assessed and Endorsed by the MedReport Medical Review Board