By Becky Elbert, CNS, The Village Family Service Center
Editor’s note: This article is taken from the First Step Recovery August newsletter. First Step Recovery is a licensed addiction treatment facility in Fargo, N.D., that provides comprehensive, confidential treatment of alcoholism and other drug dependency. For more info, visit http://firststep-recovery.com.
Every day, prescriptions are written for various health problems. Providers spend time with clients talking about the risks, benefits, and side effects of the medications they prescribe. But do providers spend time talking about the importance of medication compliance? Perhaps you are wondering what we mean when we talk about medication compliance. You would be considered med compliant if you took the prescribed medication exactly as it was intended. Medication noncompliance is when you don’t follow the instructions given with the prescription.
I have to admit I don’t spend a great deal of time talking about the importance of medication compliance. I guess I assume most people have all had at least one prescription before and they understand the importance of taking the medication as prescribed. The No. 1 reason for taking the prescription as prescribed is to get the desired effect from the medication. If it is an antidepressant, you should expect that it would treat your depression and thus improve your mood.
Sounds pretty simple, right? Unfortunately, it’s not that simple and medication compliance is a problem providers encounter every day. Why? Because we are human—we make mistakes and we forget things. Research has shown the medication compliance rate for a person taking one medication a day is only 80%. A person doesn’t plan on missing a dose—it just happens. What if a medication has to be taken two, three, or four times a day? Medication compliance rates drop to 50% when a person has to take a medication four times a day. It has been reported that medication compliance rates for antidepressants is approximately 67%. At that rate, you can’t expect the medication to be effective at treating depression. So the first pitfall to avoid is forgetting to take your medication or not taking it as it was prescribed.
Noncompliance with many psychiatric medications has other ramifications. First and foremost is something called “discontinuation syndrome,” which occurs with many psychiatric medications (i.e. like some SSRI antidepressants) if a dose is missed for even one day, or if a medication is abruptly discontinued. A person who experiences discontinuation syndrome can have side effects such as tingling or prickling of the skin, numbness, or electric-shock-like sensations. To avoid discontinuation syndrome you must remember to take your medications at approximately the same time every day and do not abruptly stop taking your medication without first discussing it with your provider.
Lastly, I cannot stress enough the importance of telling your provider everything. That includes such things as missing doses, changing the time you take the medication, or taking lower or higher doses than the originally prescribed dose. It is also important to inform your provider if you just decided not to fill the prescription and you didn’t start the medication. Whatever the case may be, BE HONEST. Honesty will not get you in trouble, rather it will help the provider determine the next step to take in treating your illness.
FACTORS THAT IMPACT MEDICATION EFFICACY:
- Diet. Dietary intake can affect how medications are absorbed, metabolized, and eliminated from the body. For instance, the antipsychotic Ziprasadone should be taken with meals because food doubles the bioavailability of the drug. Your provider should discuss any dietary interactions with you at the time of your appointment. It is important to mention that eating disorders, such as anorexia, have a significant impact on medication efficacy.
- Smoking. Cigarette smoke can alter the metabolism of many medications, requiring the individual to need higher doses of a medication to get the same effect.
- OTC Medications, Herbs and Supplements. It is imperative that you tell your provider about any other preparations you are using. Just because you don’t need a prescription to take them doesn’t mean that they won’t interfere with your other medications. For example, St. John’s Wort has been said to help some types of depression, but the evidence is not definitive. It is well known that taking St. John’s Wort in conjunction with some antidepressants can cause serious risks, and can also limit the effectiveness of many prescription medications. If you have questions or concerns, your pharmacist can also advise you on these issues.
- Alcohol. Alcohol may decrease the effectiveness of medications or render them useless. In other cases, mixing alcohol with some medications can be harmful and even toxic to the body.
- Caffeine. Caffeine can cause a variety of interactions with different medications. It is important to tell your provider if you are drinking caffeinated beverages. For example Disulfiram (Antabuse) can decrease how quickly the body gets rid of caffeine, which might result in increased effects of caffeine and side effects that can include jitteriness, hyperactivity, irritability, and others.
I encourage you to use the above information and guidelines to get the best response to the medication(s) you are prescribed. And remember…medications don’t work in patients who don’t take them.
First Step Recovery is a licensed addiction treatment facility in Fargo, N.D., that provides comprehensive, confidential treatment of alcoholism and other drug dependency. At First Step Recovery, we believe these are treatable illnesses, and we base our recovery program on this guiding principle:
Alcoholism and other drug dependencies are physical, emotional, social, and spiritual disorders. They are characterized by excessive, compulsive, and uncontrolled use of alcohol and other drugs that affect not only the person who is dependent but also family members and significant others.