There is one question I have heard repeatedly over the years: “Why do psych patients always stop taking their meds?”

The answer to this is multilayered and complex, but allow me to shed some light on the subject.  Of course I cannot speak for anyone other than myself but I’d imagine that there are many who can identify with this.

1. “It wasn’t that bad.”  Once I have been stable on my meds for a period of time and more distance is created between me and whatever episode I most recently experienced, be it mania or depression, the less I can get in touch with what it must have been like to be in that emotional space.  The idea I could have ever been that bad off becomes something I can’t fathom – and then doubt begins to creep into the picture.

“Maybe I wasn’t really that bad.”

“Other people overreacted.”

“It was caused by a stressful event and that has passed.  Things will be different now.”

Whatever the reason or rationale, the thought that I could somehow do it again and make it through, knowing what I know now, is possible.  Once that possibility takes root in my mind, I’m likely to stop taking my medications again soon, or at the very least, cut back on the dose.

2. “Why me?”  One of the most powerful motivators for stopping meds is a resentment over the fact that other people seem to manage their lives just fine without being on a medication, so why not me?  Why do I need a pharmaceutical to be “normal” and behave like everyone else?  There is, perhaps, a hint of self-judgement in this one.  An internal criticism develops and suddenly the act of taking pills every night, becomes an act of self-loathing rather than a measure to keep myself mentally well.  I feel chained to a drug in order to exist, and that is a hard pill to swallow.

3. “It’s not me, it’s you.” In the middle of mania, there is the complete inability to recognize that I am my own source of turmoil.  Everything is caused, in my mind, by extrinsic factors well beyond my control.  Any ordinary person would react as I am reacting to whatever stressful situation is occurring.  This is a time when it’s nearly impossible to get me to a doctor or to recognize that I am the one causing the problems.  But the same mindset begins to creep in during times of stability.  As the aftermath of mania or depression fades, so does the ability to see that the behavior was generated by my own means.  My mind normalizes the behavior and blames it on others.  Losing accountability means losing motivation to stay medicated.

4. “Big pharma.”  This is a tough one for me.  Mainly because I prefer to live my life as healthy as possible.  This means eating a clean diet, using homemade cleaning products, only taking medication when absolutely necessary, exercise, time outdoors, etc.  Along with this comes various blogs and magazines I subscribe to about how to live a cleaner and more natural life.  Rarely do these outlets provide praises about psychotropic medications.  Rather, I get blasted with how I am slowly killing myself by taking Tylenol for a headache and the conspiracy of big pharma over things like cancer treatments or the psychiatric population.  And where does one draw the line between what is truth (there are always studies or research to back up their claims) and what is a fiction and biased, hysterical, conspiracy theory mindset?  Either way, once the seed is planted, taking my medication becomes an act of shame and guilt.  Damage done.

5. “Friends and Family.”  There are always those patients who want to take their medication and would fully plan on cooperating with their treatment regime if it weren’t for pressure and judgment from friends and family.  They hear things like, “You can do it alone.  You don’t need those drugs.”  Back before I was diagnosed, when I was in the trenches of this illness, I turned to a friend.  I told them how deeply depressed I was, not recognizing that I had come down from a damaging manic episode.  I mentioned that maybe I should go see a doctor.  She looked at me and said, “Whatever you do, stay away from doctors!  You don’t need them and they’ll just put you on a bunch of poisonous medications.  You can snap out of it with a little willpower.”  I can’t tell you how crushing that was to me.  I had the sense of what I needed to do to help myself and that moment dangerously delayed my treatment.  Needless to say, I didn’t keep that person in my life for long but for others, it’s their very family saying these words.  And the sad thing is that their words have nothing to do with the patient, and everything to do with their own insecurity.

6. “Side Effects.”  This is a real and true issue.  Many medications come with several unwanted side effects.  I’ve been lucky in this department to not suffer terribly from any physical side effect that would render my medication as off limits.  However, It’s a careful balancing act.  In order for me to express myself creatively through writing, photography, music, etc. I need to be on a lower dose of medication.  On a fully therapeutic dose, I find myself not interested in those things as much.  I’m mentally stable, but also feel a bit dull and I miss my more vibrant, playful, creative self.  However, the tradeoff is more mood lability.  Allowing that to continue, effects my relationship with my children and husband.  The obvious answer is to go back up to the full dosage, but it’s not so easy for me.  To do so would also mean saying goodbye to what I consider to be an important part of myself.  For some, it’s dealing with a bad tremor, weight gain, hair loss, etc.  Rarely, severe side effects can be life-threatening.  Someone may find a medication that works well for them but the side effect trade-off isn’t worth it and there is no easy solution.

This is only a partial list.  But as you can see, it is never just one thing that causes someone to go off their meds.  Be sensitive and understanding.  Unless you’ve been there and walked in these shoes, you don’t know what it’s like.  Remember that.