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When going to a doctor, you mostly aim for two things to happen: one, you want the doctor to tell you what kind of disorder you are currently suffering from and two, you hope for him or her to give you adequate treatment. While most people are able to follow their physician’s instructions well enough when they have to take medication like antibiotics for a few days, the longer the therapy needs to be, the less likely they are to “adhere”.

Adherence is a term to describe to what extent a person’s behavior in taking medication corresponds with agreed recommendations from a healthcare provider1. This means that after a physician has informed you about possible treatment options, you decide together what kind of treatment you are going to receive². Afterwards, if you stop taking the medication or choose not to take some of it, your behavior might be classified as non-adherent. Said non-adherence has significant impact on treatment effectiveness, individual suffering and health care costs³. If prescribed medication is secretly not taken, doctors might increase doses or switch to different substances as they suspect the current drug is not working properly.

A recent study explored adolescents’ health beliefs and subjective opinions relating to psychotropic medication, and statistically linked them to reported medication adherence. Adolescents age 12-17 answered a series of interview questions regarding their personal perceptions of their own course of disease, experienced symptoms and physician–patient relationship. Additionally they reported on their individual appraisal of positive effects from psychotherapy and/or medication, thoughts on adverse events, and thoughts on disease-related interactions with their friends and families.

Authors found that patients classified as non-adherent could be characterized as more likely to report feeling worse after taking medication, to describe a lower sense of self-efficacy concerning the improvement of their symptoms, and/or to perceive a less trustful physician–patient relationship. Furthermore, non-adherent patients were more likely to state that their attitude toward medication worsened after experiencing “side effects”, that they subjectively felt less support from their relatives, and/or they had fewer individuals in their family who were fully informed about their condition4.

In summary, if the medication you are taking is making you feel worse than you did before, if you feel like you have little or no control over your own symptoms, if you distrust your physician or if you feel your family isn’t supporting you (enough), this might lead you to stop your medication – possibly without telling your physician about it.

What can we learn from these results?

Health care providers can learn how important it is to repeatedly talk to their patients about their feelings towards the medication and encourage them to speak openly about medication-related doubts or worries. They can also learn how important their interaction with patients is, as even the best drug can’t work properly if it isn’t taken.

As a patient, one might realize that not wanting to take prescribed medication is a common occurrence, and one shouldn’t feel embarrassed or guilty about it. What is important, though, is to openly talk to the treating physician about it and find a solution together.

REFERENCES:

1  World Health Organization: Adherence to Long-Term Therapies. WHO Library Cataloguing-in-Publication Data, 1–211. 2003. www.who.int/chp/knowledge/publications/adherence_full_report.pdf

2  Ahmed, R., & Aslani, P. (2014). What is patient adherence? A terminology overview. Int J Clin Pharm, 36(1), 4-7, 2014.

3  Julius RJ, Novitsky MA, Jr., Dubin WR: Medication adherence: A review of the literature and implications for clinical practice. J Psychiatr Pract 15:34–44, 2009.

4  Niemeyer, L., et al., “When I Stop My Medication, Everything Goes Wrong”: Content Analysis of Interviews with Adolescent Patients Treated with Psychotropic Medication. J Child Adolesc Psychopharmacol, 2018. 28(9): p. 655-662.

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About the author

Larissa Niemeyer is a junior doctor in the Department of Child and Adolescent Psychiatry at the Central Institute of Mental Health in Mannheim, Germany. Her doctoral thesis focuses on reasons for non-adherent behavior in adolescents with psychiatric disorders. She studied medicine at the University of Heidelberg, Germany and did medical internships in Switzerland and Luxembourg.


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