Rather than a “lack of insight,” it is actually a thoughtful weighing of complex risks and benefits that ultimately drives some people diagnosed with bipolar disorder to eschew psychiatric medications, according to a qualitative study in the Journal of Affective Disorders. And these people often develop sophisticated strategies in their efforts to manage without medications.
Three UK-based researchers conducted in-depth interviews of ten people diagnosed with bipolar disorder who were not taking psychiatric medications and were satisfied with their decisions, and then analyzed their responses using grounded theory.
“When asked about their reasons for stopping medication, all participants cited side effects as a major concern, describing distress resulting from problems including weight gain, tremors, loss of libido and lithium toxicity,” reported medwireNews. “Participants also frequently described side effects changing their view of themselves in ways they found undesirable.”
The participants “were generally very aware of their moods,” sought feedback from friends, and continually evaluated their condition and decisions. They also “used a wide range of strategies to manage their moods, including nutrition, self-discipline and channelling their energy into something positive,” reported medwireNews. Other strategies included using essential oils, cognitive techniques, exercise and creative pursuits.
The researchers described their study as the first systematic assessment of reasons for medication non-adherence in people diagnosed with bipolar disorder, and indicated that their findings were a fundamental challenge to a common belief that medication non-adherence is driven by “a lack of insight.”
“The complexity of the processes described by participants suggests that traditional models of explaining non-adherence may over-simplify some individuals’ experiences,” concluded the researchers. “Future research could focus on identifying factors predictive of successful attempts to manage moods without medication. Professionals should place more emphasis on non-medication approaches in order to increase engagement with people who do not use medication. This may involve focussing on individual׳s longer-term goals rather than on modifying moods in shorter-term.”
Non-use of bipolar medication typically follows careful ‘risk–benefit’ evaluation (medwireNews, December 11, 2014)
(Abstract) Managing bipolar moods without medication: A qualitative investigation (Cappleman, Reed et al. Published Online ahead of print December 05, 2014. DOI: http://dx.doi.org/10.1016/j.jad.2014.11.055)