The Importance of Treatment Adherence and Coordinated Care

I’ve been medicated for bipolar disorder for 17 years. Recently I had to undergo a colonoscopy, a test that required me to eat no solids for a few days and stick to a liquid diet.

I also received instructions that I was only allowed to take medication for high blood pressure if needed during the preparation process, and I could have nothing by mouth for three hours before the process. Since the test was at 7:30 a.m., that kept me from taking my morning bipolar medication until after the test was over.

My test was on a Friday morning. I took my night meds Wednesday before 8 p.m., which was when I was supposed to start the colonoscopy preparations. When I got up Thursday morning, I followed directions — I didn’t take my morning medications for bipolar disorder.

By mid-day, my husband said he could tell a difference in my demeanor and attitude. He said I was “flying a little high.” I was concerned, but not overly so. By nighttime, I knew I was going to have a rough night between getting up to go to the bathroom and my wakefulness as a result of not taking my nighttime medications.

The day of the colonoscopy went well, and as soon as I got home (around noon), I took my daily medications for the morning and for midday. But the damage was done, and I almost died as a result.

This experience represents the importance of both adhering to your treatment plan and working with providers to ensure your mental and physical health care are coordinated.

The Consequences of Not Taking My Medication for 24 Hours

The next week, I spent several days racing around the house, trying to accomplish tasks that weren’t urgent but seemed so at the time. I kept thinking of the next thing that needed doing and worried that it wouldn’t get done. So I did a slapdash job of whatever I was working on at the moment, requiring me to later retrace my steps over the same task to do it correctly.

Finally on Monday, I knew I was experiencing mania. Mania for me involves high spirits that quickly morphs into extreme anxiety and paranoia. I was at the extremely anxious stage and heading for paranoia. I called my psychiatrist, who advised me to go to the Emergency Room to see if I would be admitted to stabilize my manic symptoms.

I was not. Apparently heading symptoms off at the pass wasn’t enough to keep me hospitalized to ride it out. I spent a long afternoon sitting in the emergency room with my husband accompanying me — so long that he was able to go out and get us lunch and dinner while waiting. Soon after I finished eating my second takeout meal, I was called back into a holding room and evaluated. But the verdict was that since I was not yet suicidal, my current symptoms were not severe enough to keep my hospitalized.

On Tuesday, I went to my psychiatrist, who changed my medication combination to bring me down from my mania. The paranoia continued to grow even with the medication change. I went to lunch with a friend a few days later and couldn’t stop talking about how I was scared my husband was going to divorce me — for no apparent reason. My moods kept fluctuating wildly, with my psychiatrist dropping one of my new medications and cutting down on one of my old ones to bring me out of the spin.

A week later, I wanted to be done with the paranoia, the fluctuations, and the hopelessness. I attempted to go to sleep and never wake up. Luckily my daughter found me, before I did too much damage to myself, which saved my life.

My Takeaways From this Experience

This is a lesson from this experience I will never forget: Avoid going off your medications for any reason unless supervised by your psychiatrist. I was only off meds for 24 hours. It took three weeks to overcome the effects.

Additionally, always emphasize to other providers the importance of your psychiatric medication if you have a severe mental illness. Other arrangements should be made to keep you safe if you must take a break in your medication regimen.

A few weeks after my suicide attempt, I had to undergo a sleep study, with yet another set of instructions to not take any medication before it. I called the office and worked my way up the personnel ladder until I got a call back from my sleep doctor. I detailed the colonoscopy experience and reiterated that I was going to have to take all my night medications before going to sleep, whether that was standard procedure or not. The doctor listened and made a note on my chart as to why I needed each medication, and I was allowed to take them before I went to sleep at the lab.

Always understand the medications you are taking and why you are taking them. Be ready to explain how essential each medication in your treatment plan is to your mental stability and do not allow a doctor who does not have a thorough understanding of psychiatric medications dictate whether you adhere to your treatment plan.

 

Julie Whitehead lives and writes in Mississippi. A reporter for Mississippi Center of Investigative Reporting, Julie covers topics on mental health, mental health advocacy and mental health education. She also blogs at Not Quite Right: Living with Bipolar Disorder.