One of the most significant challenges I face as a pharmatherapist is getting my bipolar clients to continue taking their medications as prescribed. More often than not, the culprit driving inconsistent usage patterns is the thrilling and invigorating manic “high.”
The manic phase of bipolar disorder carries a peculiar treatment challenge that most other mental disorders do not: Because mania is a desirable and enjoyable state for many, if not most patients, medication noncompliance is a particular hazard during these manic episodes. Repeatedly starting and discontinuing mood stabilizers results in erratic blood levels of these medications and a subsequent decrease in their overall effectiveness. This, in turn, can lead to an increased susceptibility for the occurrence of future episodes, a progressive worsening of symptoms and a heightened mortality risk. Clinicians should continually emphasize the serious risks of noncompliance with these patients and focus on coaching them to take these medications as prescribed.
Enlisting the assistance and cooperation of the bipolar client’s family members can prove to be a significant asset toward gaining medication compliance. Family members are our de facto healthcare specialists and are too infrequently utilized by prescribers and therapists as sources of information regarding the client’s progress (or lack thereof). They are often first to recognize the warning signs of symptom reemergence and can serve as our first-line allies in getting their de-compensating, medication noncompliant bipolar loved one back on the road toward progress.