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It Can Be Difficult to Stay on Medication



Have you or your child been prescribed medication as part of ADHD treatment?  Sometimes people have trouble staying on the medication (“medication adherence”) for any number of reasons. You may have difficulty getting the prescription filled. Perhaps you’re concerned about possible side effects. Or maybe you’re concerned because of negative comments you’ve heard about stimulant medication.

Abruptly discontinuing medication for ADHD can create problems, such as:
  • having your symptoms return
  • difficulties at work or school 
  • complications in your treatment plan
  • problems with social relationships
  • irritability
  • tiredness
  • headache
  • reckless or impulsive behavior
  • possible changes in your heart rhythm
Over the long run, people who do not take their prescribed medication have been shown to have lower self-esteem and poorer academic or workplace outcomes. It is important to find ways to stay on your medication. Talking with your doctor before stopping medication is better than going off it on your own.

The more complex and difficult it is to take the medication, the more likely people will stop taking their medication. Research published in Current Psychiatry Reports saw that about 50 percent of people have stopped using medication consistently after two years and by five years, only about 36 percent of those originally prescribed medication continue to take it regularly.

“More studies have focused on medication adherence in children/adolescents than in adult ADHD,” according to researchers from Cornell University. “Medication nonadherence is more prevalent in immediate-release versus extended-release psychostimulants in childhood/adolescent ADHD, but differences in the formulations have not been studied extensively in adults.”  Researchers believe that the long-acting versions simplify the treatment, making it easier for patients to maintain the routine of taking their medicine.

There are extra burdens on getting prescription medication for ADHD. The psychostimulant medications most commonly used to treat ADHD are classified as Schedule II drugs by the US Food and Drug Administration, requiring monthly visits to the doctor’s office and the pharmacy. Some insurance companies have restrictions on which medications can be prescribed for adult ADHD. Medication prescribed at a higher dose needed for some adults might not be covered by their insurance program. 

Adults and teens may experience stigma, sometimes feeling they are viewed as potential drug addicts because they are taking a controlled medication. Others are worried about being seen as “lazy” parents who use medication to control their children’s rambunctious behavior. These extra burdens and barriers can overwhelm some people and make medication adherence harder.  It becomes tempting to just give up on using medication to manage your ADHD symptoms. 

What can you do?

  • Take an active role in your treatment plan: Determining whether to use medication is a decision made jointly with you and your prescriber.  Discussing with your prescriber how medication can improve your ADHD symptoms, as well as the possible side effects, can help increase your likelihood of staying on the medication to maximize the benefit of the treatment.

  • Understand the role of medication in your treatment plan: Medication does not cure ADHD; when effective, it can reduce ADHD symptoms during the time it is active. Studies have shown people affected by ADHD who are treated with medication can improve academic outcomes, reduce the likelihood of substance abuse problems, and lessen the chance that they will have difficulty with the law.  

  • Work with your provider and check in: Continuous communication with your health care provider about what is working and what isn’t working can improve any treatment you undertake. 

Why do teens have difficulties with medication adherence?

Some teens stop taking medication, often making this decision on their own. They may feel that they do not want to take medication forever, may not understand the need for medication, or may not think the medication is helping them. Some teens who stop medication on their own feel the benefits do not outweigh the negative effects or the stigma of taking medication.

“Medication is a key component of evidence-based care for children with ADHD, and patterns of treatment adherence are complex,” write researchers Alice Charach, MD, MSC, and colleagues for Clinical Psychiatry Reports. “Despite the fact that many young people show impaired functioning well into adolescence, many who begin medication treatment either stop and start medications over several years or discontinue use altogether. “

Medication adherence could be improved by shared decision making among practitioners, parents, and young people, Dr. Charach writes, and by monitoring the effectiveness and safety of the prescribed medication and onset of any new difficulties. 

How can I make sure my child or teenager continues to take her medication as prescribed?

Dr. Charach recognizes some parents are hesitant to include psychostimulants in their children’s ADHD treatment and may discontinue medication use. She provides clinicians with strategies to improve medication adherence in the journal Consultant for Pediatricians. These strategies can also help you improve adherence for your teen:

  • Involving young people in the decision and asking their opinion about using medication.
  • Being upfront about possible side effects, including feeling less social and effects on their personality.
  • Getting teens to be more engaged in their own care, possibly suggesting medication breaks so they can see how they are different when not on the medication.
  • Encouraging families to attend parent support groups and offering quality sources for information.
  • Providing parents or young people with a standardized symptom checklist.
  • Having teens fill out their own symptom and adverse effect checklists to see where they are affected by ADHD symptoms.
  • Discussing with teens their needs for their level of concentration and adjust medication as needed.

“An important aspect of initial assessment and ongoing monitoring should be an exploration of the family’s and young person’s perspectives, since patient preferences are an integral part of the best clinical practices,” Dr. Charach says. 

With these tips and suggestions, you can take control of your disorder and play an active role in your and your child’s treatment.

For more information:

Have you struggled with remaining on your medication or having your child continue to take his medication? Share your experience.

This article appeared in ADHD Weekly on February 02, 2017.
     


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