Can Medication Noncompliance in Bipolar Ever Be a Good Thing?

Medication noncompliance in bipolar disorder is generally considered a bad thing -- and it generally is -- but can medication noncompliance ever be a good thing? I would say so, in very limited situations. Read on to see why medication noncompliance in bipolar disorder can occasionally be a good thing.

What Is Medication Noncompliance in Bipolar Disorder?

Medication noncompliance, also more politically correctly called medication nonadherence, is simply when a patient doesn't follow his or her medication treatment plan. This might mean not taking the medication as prescribed or not taking the medication at all.

Isn't Medication Noncompliance in Bipolar Disorder Bad?

And most of the time, when people with bipolar disorder don't take their medication as prescribed, it leads to very bad things. It's most common for people to miss the positive effects (and forget the negative effects) of bipolar mania and so they stop taking their medication to try to retrieve those effects. In other words, some people want the "high." People also commonly become medication noncompliant due to medication side effects.

And as a person with bipolar disorder, I can say that I understand both of these reasons but that still doesn't make them good ideas. Nope, if you're just being medication noncompliant as a knee-jerk reaction to something or because you want parts of the illness back, then I see a hospital stay in your near future.

When Medication Noncompliance Is a Good Thing in Bipolar Disorder

That said, there are times when not taking your medication as prescribed -- for very short periods of time -- can make sense. This medication noncompliance should always lead to an immediate doctor's visit to discuss the reasons for noncompliance.

Here are some reasons why medication noncompliance can be a good thing:

• When you experience severe, possibly dangerous side effects or signs of being allergic to the medication -- Examples of this are getting a rash when you're taking an anticonvulsant (there is one rash that can become life-threatening so it's better to be safe than sorry) or if you experience changes in your heart rate.
• When you're tapering off a medication and the latest medication decrease causes too many withdrawal effects -- In this case, it may be reasonable to stay on the previous dose even if that wasn't the plan. (Although what to do in this case should be part of a good plan.)
• When you're getting on a medication and the latest increase in medication is causing too many side effects -- In this case, it may be reasonable to stay on the previous dose.

I will mention here that withdrawal effects and side effects do tend to lessen over time so the above is the exception and not the rule. In general, I try to give the doctor's plan a chance, even if it causes some pain along the way. That said, I've probably been medication noncompliant in all three of the above cases at one time or another in my bipolar career.

However, I can't stress enough, in all the above cases, you should see your doctor as soon as possible to make a new plan. 

Medication Noncompliance in Bipolar Just Because You Disagree with Your Doctor

I would say that simply disagreeing with your treatment plan isn't a good reason to be medication noncompliant. Sometimes we all have to do things we don't want to do. Sometimes that leads to wellness. Sometimes your doctor really does know better. 

That said, I believe in working with your doctor as much as possible to create a plan that you do agree with. You may be the patient and he or she may be the knowledgable and learned doctor, but that doesn't mean your voice doesn't mean anything. After all, you're the one who has to actually take the pills. Your doctor should listen to you.

And if you can't reach a place where you agree with your doctor's treatment plan, the best idea isn't to be medication noncompliant; the best idea is to find a new doctor. I know that's easier said than done, but it's worth it to work with someone who will work with you. Because while medication noncompliance does make sense occasionally, it certainly doesn't make sense generally so you need to facilitate a situation where that won't be an issue for you.