Television commercials repeatedly show a depressed person unsmiling, parked in the bed or sofa, with dim lighting in the background. Then that person tries whatever medication being promoted and the lighting in the commercial is suddenly brighter, the person is smiling and suddenly participating in daily living activities again. This portrayal of medication effectiveness on a devastating mental illness is misleading and inaccurate and misleading.
The truth is that medication alone often does not help patients recover to full previous mental illness states, creates difficult side effects, and fails to fully eradicate the suffering mental illness creates. Many patients become non-compliant with their psychiatrists orders and refuse to take medication at all or experiment on their own with dosage amounts and dosage timing.
According to Jamison, “For patients taking antidepressants, the compliance rate is between 65 and 80 percent; for anti-psychotic medications, about 55 percent; and for lithium, about 60 percent (p. 257).” There are at least a few main reasons patients become non-compliant with psychiatric medication orders; (1) Side effects of medication (2) Disappointment with medication effectiveness (3) Patients feel like they are an experiment when psychiatrists say “Let’s try this” at every visit (4) Inability to afford medications or (5) Difficulty keeping up with multiple complicated daily dosage requirements.
Karp describes an even better explanation of why patients may become non-compliant with medication requirements: “Perhaps the relationship between extremely distressed, vulnerable patients and powerful psychiatrist intrinsically generates friction, discomfort, and anger. The gap between the expectations that patients bring to a psychiatric professional and what their doctors can actually deliver may be so great that disillusionment is inevitable (p. 117).”
Unfortunately, patients who refuse to take their medication put themselves at risk for becoming suicidal. According to Jamison, “The most common element in suicide is psychopathology, or mental illness (p. 100).” Family members and friends can try to help advocate for someone they know who has a mental illness, but it doesn’t always help.
Psychotherapy can also be helpful according to Jamison because it can help a mentally ill person “deal with the critical and gnarly problem of treatment compliance (p. 256.).” Until researchers can find medications that eradicate the suffering mental illness creates noncompliance with psychiatric medication will continue to be an issue.
Jamison, Kay Redfield. Understanding Suicide. New York: Random House, 1999.
Karp, David A. Speaking of Sadness: Depression, Disconnection, and the Meaning of Illness. New York: Oxford University Press, 1996.