Bipolar Affective Disorder · Medication

Medication (non) compliance

Yesterday I was discharged from hospital after almost a month with a shopping bag full of meds and a stark warning from one of the nurses to ‘take your tablets even though you don’t need them- because you DO need them!!’ She was referring to the fact that every meds time without fail since being admitted, I had to be prised off the sofa and sometimes literally frogmarched by a nurse down the hall to the treatment room, insisting I didn’t need my medication.

Last night was my first night as a free woman and I broke the first cardinal rule I set myself each time I leave the hospital: to take my meds at the time I take them in hospital. It honestly just slipped my mind- it was nearly midnight before I noticed the time, and by then it was nearly two hours since I should’ve taken them. And so began the thoughts that I should just not bother. Sure why would ye?

Day one out of hospital and I am struggling to take my meds as prescribed. Or rather, struggling with the idea of taking my meds as prescribed.

But see, that’s the thing, I struggle with med compliance at the best of times, but now I’ve been told that I’ll have to take these for the next few years, and now I know that I have a condition (which, I should add, often makes me feel like there’s nothing the matter with me anyway) that can give me euphoric highs and these meds are (‘hopefully’) going to stop that from happening- I’m more than a little reluctant to keep taking my lithium.

It wasn’t always like this though. At 16 I would dutifully line up in front of my mother who would pour my 60mg fluoxetine oral suspension onto a 5ml spoon and open my mouth. If I’d forgotten to take it on the days when mum wasn’t there to supervise me, I’d be standing in front of my head of year at break time panicking that the foul mood I happened to be in that day was a direct result of having not taken my prozac that morning before school, until CAMHS gently reassured me that taking my dose a few hours later than normal would not, in fact, have any impact on my mood for that day. Phew!

After 8, 9 months on Prozac I was swapped over to mirtazapine, which involved a five day period of no meds after a few weeks of weening me off the fluoxetine. A five day period during which my mood, as observed by my mum and psychiatrist, declined rapidly. That was Christmas 2010, and the recollection of that five day slump was enough to keep me on the straight and narrow and convinced that I did, in fact, need medication until late 2012.

So I’m not sure why exactly it was that I decided I no longer needed it. Usually, it’s a host of different reasons that all melt into one giant uber reason that then renders it impossible to start taking them again. Below is a list of some of the reasons I’ve stopped taking my meds in the past.

  • Believing I don’t need to be on medication at all
  • Believing I no longer need to be on medication, in that, I’m stable, so I must be cured!
  • Believing I don’t deserve to take medication/be well/stable
  • Believing the tablets weren’t doing anything anyway
  • Because I was too sedated to study for my finals
  • Curiosity/experimenting to ‘see what happens’
  • To self sabotage
  • Because I hoped if they made me feel worse/agitated I would get the final push I needed to attempt sucidie ‘wholeheartedly’
  • Rules in my head that told me I ‘wasn’t allowed them’
  • To induce hypomania
  • Frustration at having to take meds
  • Unintentionally missing a dose, then one of the above reasons kicking in

Sometimes there’s no reason at all, I skip a dose just because, and before I know it I haven’t taken them in months and am high as a kite or in something resembling a mixed state- rotten suicidal and violently dark thoughts coupled with the incessant energy and agitation of mania. Whatever the reason, stopping my meds has never ended well- twice ending with psychiatric hospital admission, but usually a general hospital admission, or a trip to A&E or threat of section at the very least.

But this time I have a very good reason to try and remain med compliant. Never mind the whole bipolar/lithium thing- I’m due to start a nursing course in September, and the nurses in hospital all reassured me that ending up in hospital shouldn’t put a big red cross next to my name, but rocking up manic will.

For the past four weeks in hospital, every contestation around Taking My Meds or Needing To Settle has involved the nurses whipping out the nursing card, and god it’s been sickening. ‘I want to see you back in here in a nurses uniform, not as a patient, and sure that’ll not happen if you don’t take these tablets *shake of dixie cup full of lithium, haloperidol and lorazepam*’,  ‘you’ll make a great nurse- once you’re settled and to do that you need your lithium’, ‘you can speak to the doctor in the morning but for now you’ll not get to be a nurse if you don’t take these tablets’ et cetera et cetera. Last week during ward round, in fact, I declared I didn’t need the blessed tablets, wasn’t bipolar, or coming down from a manic episode, or ‘still easily excitable’- to hell with the lot of it! And was promptly told in response that I wouldn’t last a ‘wet weekend’ on my nursing course if I began it as I am now, or as I have been recently, that as healthcare professionals, my mood would be picked up on immediately and I wouldn’t be let loose anywhere near a ward. Touché.

Reluctantly, I’ll admit I’m still probably not quite as ‘settled’ as I like to insist, and so I’m not entirely convinced by the whole bipolar/needing to take my lithium situ as of yet, and I’d still much rather forget the pills and get back to being head and shoulders above the clouds, transcending reality and being of genius level intellect. But while right now I’d rather be manic than a nurse, I’m ‘settled’ enough to be able to tune into that tiny part of my rational brain that’s telling me in 6 months time I’d probably rather be starting my nursing course than in hospital being eaten alive by the worms in my brain that accompany a mania when it tips too far, which is what I’m told will happen if I stop taking my lithium. So for now I’m taking it, begrudgingly, and despite the fact I’m adamant I don’t really need it. Sure, my favourite nurse has promised she’ll ‘kill me’ if she sees me back in hospital or hears of me fucking up my nursing course because I haven’t taken the damn stuff. So there’s that to consider, too.



One thought on “Medication (non) compliance

  1. I loved this post. I know exactly what you mean about struggling to or not to take drugs. I currently take 5 different medications at varying strengths and when I look down into my hand and see about 7-8 pills, I begrudgingly pop them in my mouth and swallow. I tell myself and others tell me that it’s my responsibility to the people that love me in order to the prevent the risk taking behavior, the suicidal ideation, and, like you, the hospital admissions. You are not alone in your struggle with this, I literally just covered it in my blog (please don’t take that as a shameless promotion). Thank you for your insight, good luck.


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