Dr.Shivani Salil

‘I think sometimes it makes you sicker than what you really are to take so much medication’- Dorothy Moore

Medication is often tougher than the illness; both for the patient and the treating doctor. And when it is a psychiatric illness, it’s twice as tough.All of us want to be healthy but not many want to do something about it. A trip to the doctor is something we all dread and the prospect of medicines puts us off. Especially if the medicines are to be taken for a longer time span, then it’s a lost cause. Why is it so difficult for us to understand a simple correlation as ‘Take medicine= Get better’? A lot of clinical studies have been done and the reasons for non-adherence are varied. It could be the patient’s or his family’s attitude about the pills and a whole lot of complex issues that need to be addressed to.

Taking pills is an affirmation, a proof that something is wrong with me. We feel that people around us will get to know and question us. And with a mental illness, there is a huge desire to hide it considering the stigma attached.

🙂 Knowledge is always the best antidote to fear. Awareness of mental conditions goes a long way in helping the patients get better. Pharmacotherapy (medicines) and Psychotherapy are more effective if the people surrounding the patient are understanding and empathetic of the situation.

🙁 Side effects

Side effects are often the biggest dampener of all. Everyone seems to shake their heads when it comes to adverse effects. Especially now when the fad of going organic and natural seems to be catching up. And the medicines that work on our brain worry us even more. What needs to be driven in, is the risk vs. benefit of taking medicines. Somehow when the patient/ care giver reads the indications and the adverse effects, it is the side effects that

What needs to be driven in, is the risk vs. benefit of taking medicines. Somehow when the patient/ care giver reads the indications and the adverse effects, it is the side effects that they seem to remember more than the uses. While it should be the other way around. The side effects are mentioned to create awareness of the possibilities – most of them occur rarely and the most common ones are usually mentioned by the treating physician. Unfortunately, it alarms more than it alerts. Patients and care givers worry that psychiatric medicines slow down the brain and affect their liver and kidney. It needs to be understood that most psychiatric medicines are very safe. There are very few drugs that require careful monitoring which is essentially done as required.

🙁 Too many pills

Complex regimens add to the confusion. Swallowing one too many pills is a huge encumbrance. So eventually it is none at all.

🙂 Having multiple pills is nobody’s idea of fun but it needs to be kept in mind that the psychiatrist chooses therapy based on the symptoms. It is a deliberate process intended to heal.

🙁 I am not getting any better

The patient develops an aversion for medicine because he feels he isn’t getting better.

In psychiatry, medications take a while to take effect. Remember that it takes months or even years for the disease to develop so naturally it will take a few days/weeks for the symptoms to subside. And their physically measurable advantages are fewer. Unlike a symptom like fever that can be measured, feeling good is an abstract concept that cannot be compared on a scale.

Inherent resistance to taking treatment

Aversion is a mindset that refuses to go away. We all like to play the doctor and assume it will work.

This inherent resistance gets compounded if the psychiatric illnesses impair judgment. The patient may be forgetful in taking the pills or may have no interest in getting better owing to the nature of his illness. In such cases expecting cooperation is futile so the onus lies totally with the care givers in severe cases.

Alternative medicine seems attractive

Alternative medicine/ therapy has always had a stronghold in our country. Those methods are luring because we all want to believe in what gives us hope. Who doesn’t like short cuts and quick fixes. Without undermining their importance, let me just quote Munna bhai and Circuit who liken it to ‘brain main chemical locha’. An imbalance in chemicals can be corrected by balancing those chemicals. Simple as that!

High costs weigh heavily on the mind

Health care is expensive unfortunately and requires a serious thought to make it accessible to people for whom the cost outweighs health.

Despite the general perception, psychotropic medications are relatively cheaper.

Fear of addiction and lifelong dependence on pills

This is a major area of concern for most which makes them too scared to start treatment at all.

🙂 It may sound surprising but none of it is true. Psychotropic medicines are NOT addictive. And like DOTS for TB is a 9 month regimen, even psychiatric illnesses have a well thought of time bound course. It is not a random call. A lifelong course is NOT required in most cases.

To sum it up, on the psychiatrist’s part prescribing medication is just the beginning. That it is adhered to is important or rather more important in the healing process. And the patient and his care givers need to put trust in the doctor. Questions are good and a blind trust is not encouraged. And though fearing medication is normal, being paranoid is not.

Fear and paranoia are two different things but we shall leave it for another time!!!


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