If the person wants to stop or reduce a helpful medication

Below are some suggestions about ways to respond if the person you care for intends to stop or reduce a medication that has been helpful.

Listen to the person’s reasons for making changes to their medication regime.

Try to understand their point of view. You don’t have to agree with them. Keep in mind that the person may have a good reason for making changes to their medication regime ( e.g. intolerable side effects or medication is not helpful) and have discussed these with their doctor.

Consider how to respond

  • Let the person know you understand their reasons.
  • If the person has not talked openly about their medication with their clinician, encourage them to do so. If the person has anxieties about the long-term safety of their medications, their doctor may help to exclude those fears that are baseless. Doctors can discuss possible ways to reduce side effects. To make an informed choice the person may need to know that certain medications do not work as well when they are stopped and then started again. Certain medications should be stopped gradually and the doctor can inform the person about how to stop their medication.
  • If necessary, offer the person a different perspective. For example, if the person is concerned about stigma, reassure them that taking charge and using medication to treat an illness is nothing to be ashamed of. Taking medication is an active coping strategy not a sign of weakness. If the person is worried about dependence on their medication, they may need to know that the only type of medication prescribed for bipolar that is addictive is anti-anxiety medication (Benzodiazepines). If the person wants to stop their medication to experience elevated moods, consider mentioning that depression or the negative consequences of mania are also part of bipolar disorder.
  • Discuss your concerns with the person using ‘I statements’ (e.g. “I am concerned that stopping your medication may increase your chances of becoming ill again” and not “You are a fool to stop your medication as you will become ill”).

Adapt your response to how well or ill the person is

If the person is relatively well:

  • Ask them to consider the pros and cons of taking medication, and what is at stake if they relapse.
  • If the person has stopped their medication, negotiate an agreement with them to resume medication if signs of relapse appear.

If the person has symptoms of depression, mania or hypomania:

  • Suggest that they wait until they are well to make such important treatment decisions.
  • Mention to the person who is ill that their medication may relieve symptoms that the person finds particularly unpleasant (e.g. agitation or racing thoughts).

If you are concerned because the person wants to stop their medication when they are very ill, call the person’s clinician or mental health team and express your concerns.

What if the person forgets to take their medication?

If the person often forgets to take their medication, suggest strategies that might help (e.g. using a pill organizer or taking medication at the same time as doing another routine activity).