Studies show that patients do not follow one out of every three prescriptions written. This is a major limitation to medical therapy as it hinders the effectiveness of psychiatric treatment. One of the strongest predictors of outcome in psychiatry is adherence to pharmacological (medication) treatment, but for many years, adherence rates have been around 50%. There are a variety of new drugs with fewer side effects, and in some cases, greater effectiveness, but these medications are ineffective if patients do not take them.
When patients do not adhere to their medication regimes, studies have shown that higher relapse rates occur, increased number and duration of hospitalizations. Early discontinuation of antidepressant medication is associated with relapse and recurrence of depression, and violence in psychotic patients is strongly associated with the co-occurrence of medication non-compliance and substance abuse.
There are a number of reasons why many people do not stick with their medications for the recommended time. Medication-related issues, such as side effects and inappropriate doses, are strongly related, as are such environmental issues as inadequate interpersonal support, transportation or money. When asked why they discontinued their medication, patients most frequently reported disliking side effects (62%), believing medication was unnecessary (56%), feeling better (50%) and believing the medication was not working (32%). All these reasons are addressable in treatment and discussing the diagnosis; simplifying the medication regime; patient education about how long the medication takes to have effect, side effects to be expected, duration of side effects and the recommended duration of treatment; involving family members where appropriate; arranging follow-up appointments and inviting the patient to call if problems occur would improve adherence.
Elderly patients have distinct issues that influence medication adherence. These issues include difficulties reading medication labels, opening safety caps, understanding instructions and paying for expensive drugs. Additionally, many elderly patients are prescribed multiple medications and many suffer from dementia and/or depression.
Cultural factors are socially transmitted beliefs and behaviour patterns that affect medication adherence. Curiosity about patient's cultural beliefs and practices, as well as empathic understanding of their predicaments in culturally alien settings, can often help clinicians reduce or eliminate these barriers.
Over the years, in attempts to combat this problem, physicians have tried to diagnose patients and select the best therapies for them. Recent thinking emphasizes integrating pharmacological treatment with the patient's goals, functional status and lifestyle. New cognitive techniques such as motivational interviewing help physicians examine medication priorities from the patient's perspective and elicit the patient's participation in selecting and adhering to treatment. Some evidence exists that patients who feel actively involved in choosing among treatment alternatives are more likely to adhere to treatment.
Groups have also long been used to promote treatment adherence. Techniques vary from lectures to group psychotherapy and behavioural skills training. Self help groups have for many years provided education, support and advocacy for individuals with psychiatric illnesses and their families. For more information, telephone counselling, and referrals to appropriate mental health professionals, contact the Depression and Anxiety Support Group, 8am to 7pm, Monday to Friday, and 8am to 5pm on Saturday, on (011) 783-1474/6.
Before discontinuing your medication, it is best to get professional advice. In most cases, any problems you are experiencing can be rectified or managed. Even if you are feeling better, sometimes it is not a good idea to stop taking your medication as it can lead to relapse and in some cases, to even more serious problems.