Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More
One of the most serious problems in the treatment of behavioral disorders is compliance with medications. Why is it difficult for therapists to get patients to take their medications on a regular basis? Here are some possible explanations:
Reason for stopping medications:
1. Even today, when people are much more enlightened about mental health issues and their treatment, there is a stigma attached to taking medications. In my experience, there are more than a few people who refuse medications or end their usage after a few months; for fear that they will be judged negatively by family and peers.
2. Each time a medication is taken the patient is reminded that there is a problem that they would rather ignore. The fact that the medication reduces or even eliminates the symptoms of such things as anxiety and depression seems to make no difference. The act of taking the medicine becomes a rude reminder that there is something wrong. The fact that "something is wrong" continues to carry the stigma, mentioned in number one, that the problem is mental rather than physical. More than a few patients have reported to me, over the years that "mental problems" represent not being in control.
3. Side effects are one of the greatest obstacles to compliance with psychiatric medications of all types and varieties. First, all medicines, even those sold over the counter, carry side effects. Second, the nature of the side effects with psychiatric medications is particularly bothersome.
For example, anti depressants, particularly the SSRIs, and those are the most frequently used today; create sexual difficulties in both men and women. SSRIs such Prozac, Effexor, Paxil and others, lower libidinal desire and delay orgasm. While there are other medications that the Doctor can use in combination with the SSRI to counter this sexual side effect, the result is often less than satisfactory.
4. The cost of these medications is often prohibitive in nature so that even insurance companies are reluctant to reimburse for them unless there is a generic version of the particular medicine.
5. A certain number of individuals state that they do not believe in "Western Medicine" and do not want to put anything that is not "natural" into their bodies. Curiously, some of these will take all types of herbal medicines, sold over the counter in health food stores, under the mistaken belief that they are harmless. No medications are harmless if taken incorrectly. In addition, even when certain herbal medicines do relieve symptoms, there are no controlled studies to determine size and frequency of doses.
What is most frustrating about some of these same individuals is that they will smoke cigarettes, drink alcohol and take all types of illicit drugs. Perhaps they consider these substances as "natural."
On the other hand:
6. There are some people who, feeling better after starting medication therapy, drop out of psychotherapy, insisting that there is no need to continue because they do feel better. Of course, the reason for continuing psychotherapy is to learn how to control and even prevent future symptoms without the use of medications. In my experience, some people enter and leave therapy a few times before they are convinced that their problems are not simply a matter of taking medication.
I continue to maintain the idea that a combination of medication, psychotherapy and self help techniques like exercise, sleep, meditation and good nutrition, are best in treating depression and anxiety and in maintaining good mental health.
What are your comments about this issue?