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Sat, Dec. 14

The role side-effects play in medication adherence

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There are consequences for not taking medications as prescribed - no matter what the med, no matter what the illness. When a doctor sits down with a patient to review medication options for heart disease, high blood pressure or mental illness, there is a discussion of pros and cons. There are benefits and risks to taking any medicine, and for not taking the medicine. However, according to a 2003 World Health Organization report, "Adherence to Long-Term Therapies," there is a worldwide problem with poor adherence to medication therapies over time for chronic conditions. A number of rigorous reviews found that, in developed countries, adherence among patients suffering chronic diseases averages only 50 percent.

And when it comes to discontinuing one's medicine as prescribed for a mental health condition, the stakes can be high. Medications for mental health diagnoses do work - the research has proven them to be effective, particularly in combination with other interventions such as therapy. When people choose not to take them, the negative outcomes can range from hospital visits both for physical and psychiatric symptoms, actions that can lead to a jail visit, self-medication with legal and illegal substances, and even death. These consequences are devastating life events that may be avoided with adherence to medication therapies as prescribed. So, what would cause someone with a mental health disorder to walk away from a tool that can help avoid these outcomes? The Counselor's Column will look at this issue in two parts, this week and next, beginning now with a focus on side-effects.

Mental health medications are taken over a long period of time to address chronic conditions. Side-effects vary, depending upon whether someone is taking a medication for depression or for delusional thinking. But it is important to note that side-effects are real and can be severe. "Side-effects are the number one reason people don't take their meds. Things like shaking hands, a mouth so dry you can't talk, gaining lots of weight, sedation, and decreased sexual drive," said Katy Welty, Team Leader for the Peer Support Program at West Yavapai Guidance Clinic.

"When patients come to doctors or nurses to review side-effects with them, there is a chance they are signaling that they are considering not taking their meds. So this is the time for the professionals to really reinforce the benefits vs. the risks.

A med that a client is not taking is not going to help."

Acceptance that the disorder is real, and treatable with medications, is at the heart of one's decision to take mental health medications. Medications produce the best results when a client is addressing a disorder with other complementary strategies such as healthy lifestyle, a supportive network of friends and family, education about their disorder, etc. But the medications work at a biological level, to address the brain's chemical imbalance at the root of the disorders.

"The best strategy I can recommend to a person taking medicine for a mental health diagnosis is to develop an ongoing, frank and collaborative relationship with the prescriber," said Raymond Frey, MSSW of West Yavapai Guidance Clinic, who added that in addition to side-effects there are myriad other reasons why someone may choose not to take medicine as prescribed. "It can be because of lack of insight related to their illness, cognitive or memory difficulties, cost, stigma, the complexity of the medication regimen, lack of intended effect, difficulties with packaging, size of pills, and cultural barriers, just to name of a few."

Next week, the Counselor's Column will review specific tools and methods to encourage someone with a mental health disorder to take their medications as prescribed.

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