Why do many people with schizophrenia stop taking medication?
Schizophrenia is a complex disorder that generates serious difficulties and a high level of dysfunction and suffering for those who suffer from it and / or their environment. This alteration is considered chronic and requires continuous and permanent treatment, being the essential medication to keep the patient's symptoms controlled and keep the subject stable and without psychotic outbreaks.
But nevertheless, there are many people with schizophrenia who fail pharmacological treatment prescribed over time. Why do many people with schizophrenia stop taking medication? Throughout this article we will see some of the most frequent reasons for this.
- Related article: "Types of antipsychotics (or neuroleptics)"
Schizophrenia: a disorder considered chronic
Schizophrenia is a mental disorder of psychotic type whose diagnosis requires the presence for at least six months of symptoms such as hallucinations, delusions, speech disturbances (at least one of these three being present) together with other disorders such as motor restlessness, catatonia, alogia or impoverishment of thought, affective flattening or apathy.
The suffering of this disorder is a great alteration in the day to day of the person, affecting all or almost all vital areas such as personal interaction, partner, work, studies or leisure. It is possible that some of these subjects are not aware of the presence of alterations or that they do not consider them as such, but as part of their reality, but it usually supposes suffering for many of those who suffer and their families .
It is a disorder that can present very different courses depending on the person and the type of symptoms that present. However, this is a chronic disorder for which there is currently no cure, focusing the treatment on the control of symptoms. Said treatment, in order to maintain the stability of the patient, requires to be continued throughout the life of the subject. To a large degree, part of the well-being that can be enjoyed depends on the use of these drugs .
Reasons that lead people with schizophrenia to stop medication
Although, as a general rule, great attention is paid to making clear the need for continued treatment, a large percentage of people with schizophrenia decide to stop taking the medication or do not follow the guidelines indicated by the doctors. In fact, different studies indicate that less than half follow such medical guidelines as indicated (some by default, others by excess). It is estimated that among people who leave 25% do so during the first ten days, half a year and 75% at two years. Why? Below we indicate a series of reasons why the abandonment of pharmacological therapy is frequent.
1. No disease awareness
One of the reasons that can lead a person with schizophrenia not to take medication, especially in the initial stages after diagnosis, is the absence of awareness regarding their disorder. Not knowing what they have or do not have capacities to recognize the existence of alterations (for example, patients with cognitive impairment) does not consider the possibility or need to consume drugs.
These patients can take the medication at a given moment by inertia or by initial medical prescription, but end up abandoning it when considering that its use does not make sense.
2. Panic or flight reaction to diagnosis
Being diagnosed with a mental disorder, especially one considered chronic, such as schizophrenia, is very hard and difficult to assume. It is not uncommon for the initial moments to show a denial of the diagnosis and a profound rejection of the idea of medication or treatment, as if doing so meant accepting that one has that disease. This can cause people diagnosed with this disorder to refuse to start taking medication or, even if they have started to do so, they suddenly decide to leave it. As in the previous case, this it is especially frequent in the first moments after diagnosis .
3. Alterations caused by the disorder itself
In some patients, the disorder itself can lead to withdrawal of medication. For example, a paranoid subject may begin to see medicating as proof that he is trying to be poisoned or externally controlled and to react aversively to it. Although the effects of the medication would in principle alleviate the psychotic symptoms, the acquisition of tolerance or the lack of effectiveness of a medication in a specific case can cause hallucinatory symptoms to appear that generated such rejection.
- Related article: "The 15 types of hallucinations (and their possible causes)"
4. Reactance
Another possible reason why someone may stop taking medication is their reactivity to the idea of being forced to take it. This can occur in patients who are initially forced to take the medication or in people who feel rejected to the idea of having to take something for life, reacting with aversion to this idea and causing them to end up abandoning the medication. As well can be reactance or even fear of the idea of depending on the taking of pills the rest of his life.
- Related article: "Psychological reactance: what is it and what are its effects?"
5. Side effects
The main and most frequent reason that leads a person with schizophrenia to stop taking medication is the existence of side effects caused by the medication. And is that many of the antipsychotics and drugs used can cause serious discomfort in those who use them, especially when we talk about the classic neuroleptics. Some of the most common are drowsiness and sedation, along with weight gain .
Among them we can find the emergence of motor problems such as the appearance of akathisia or motor restlessness, dyskinesias, uncontrollable movement or even parkinsonian tremors. Sometimes antiparkinsonians are added to the medication to be taken precisely for this reason. They can also generate symptoms of a sexual nature, such as gynecomastia, galactorrhea (milk expelled by the breasts regardless of gender), amenorrhea or erectile dysfunction. Dizziness, gastrointestinal disturbances, tachycardia and other alterations such as an elevation of the blood glucose level (facilitating the onset of diabetes) may also occur. In some cases even more dangerous problems may arise, such as neuroleptic malignant syndrome or agranulocytosis (which can be fatal).
6. Drowsiness and diminished capabilities
Although it is part of the aforementioned side effects, this element has been separated due to its high prevalence among patients who decide to stop taking medication. And is that one of the reasons why more people stop medicating is the sedation that many of these drugs produce, which in turn generates repercussions in a large number of vital domains.
Although the drug may have the symptoms of schizophrenia under control, many patients report having problems concentrating or giving in mentally, as well as Get fatigued and sleepy for much of the day . It has also been mentioned a decrease in creativity, energy and the desire to do things. This can generate alterations in family life, leisure or work.
6. Lack of effectiveness
Not all drugs work the same in all cases, there is even the possibility that some drugs are not effective in the treatment of some cases or that the subject is resistant to them. Although the procedure to be followed would be to modify the dose or the drug, some patients may feel hopeless and abandon the treatment.
7. Stable improvement
One reason that some people stop medication, both in schizophrenia and in other disorders (for example, it is common in depression or bipolar disorder), is the more or less stable absence of overt symptoms over a relatively long period of time. The subject may think that he has already overcome the problem and that it has ceased to be necessary to take said medication, having already been cured with the previous medication. Unfortunately, the symptoms usually end up reappearing over time or with the presence of stressors.
The importance of adherence to treatment
The reasons described above are multiple and, in many cases, understandable. However, schizophrenia is a disorder that generates a great dysfunction in the life of those who suffer it if it is not treated, both in the life of the person and in their environment. It is necessary to use a continuous treatment over time. It is essential for professionals who treat patients with this disorder perform psychoeducation for the patient and their environment , explaining its operation, the need to take medication and have a high adherence to treatment, the risks of not doing so and giving space to the expression of fears, doubts, thoughts, feelings and questions.
If a drug was not effective or had very serious side effects it is possible to look for different alternatives and substances that can replace it . Depot intramuscular presentations are also available, which means that many subjects do not have to take medication on a frequent basis (which would solve an aversion to frequent drug consumption or to the actual forgetting of the doses and need to take the medication), and even some preparations such as paliperidone palmitate that can be injected monthly (or in some cases even quarterly).
This is not an obstacle so that new drugs and alternatives that allow us to deal with this disorder in a less aversive way are not investigated. In fact, it was this concern that generated the exploration and research that led to the emergence of atypical or second generation antipsychotics, as well as numerous advances that are now applied.
