When patients fill a prescription, it doesn’t always mean that they’ll follow through on the important part: taking it. Taking medication as prescribed is called medication adherence – and it’s a practice too often neglected.
Turns out, about half of all patients with chronic conditions such as diabetes or high blood pressure don’t take their medications exactly how they’re supposed to,1 and 1 in 5 patients never get their prescriptions filled in the first place.2
That’s true for mental health medications too. In a recent study, more than 50% of participants didn’t take their antidepressants as prescribed, and 44% had stopped taking them completely within three months.3
These behaviors are known as medication nonadherence, and they have negative outcomes for everyone involved.
Why is medication adherence important?
Medication adherence is an important factor in ensuring the success of a treatment plan.
Medication adherence ensures that you give every treatment option a fair shot.
Medication adherence is important because it allows you and your healthcare provider to conduct an accurate assessment of how well a drug and dosage work for your treatment. If you don’t take your medication consistently and as directed, you won’t truly know if it can help relieve your symptoms or not.
Many drugs need to be taken consistently to show their intended effects. For example, antidepressants like selective serotonin-reuptake inhibitors (SSRIs) usually require daily administration for two or more weeks to feel the beneficial effects.4
Adherence can also involve taking a drug at the same time everyday. Some drugs, like birth control, should be taken around the same time each day so that an appropriate amount of medication is always in your body. Too much or too little of a drug in your system can cause side effects or inefficacy.
Furthermore, some drugs have specific directions for consumption before, with or after food. Adhering to food-related instructions can help lower your risk of side effects in some instances. In other cases, adherence can ensure the effects of a drug are not being enhanced or inhibited by food.5
Medication adherence can prevent new or worsening health problems.
Failure to adhere to your prescriptions, or medication nonadherence, can negatively impact your quality of your life.
Each year, medication nonadherence leads to about 100,000 preventable deaths — and it keeps people from living a healthy, happy life.1
If you don’t follow your prescribed medication routine, your treatment may not work as it is intended. 30-50% of chronic disease treatment failure can be attributed to medication nonadherence, according to the CDC.6 This treatment failure can cause new health problems to arise and/or exacerbate existing condition(s).
For example, if you don’t take your blood pressure medication, you become at-risk for long-term heart disease, heart attack, kidney failure or stroke.7 Unforeseen health problems like these often lead to complications and hospitalization. In the worst case scenario, medication nonadherence can be fatal.
“Medication adherence has a direct impact on your health,” says Kevin Lazaruk, RPh. He’s a board-certified geriatric pharmacist in Los Angeles. “Taking your medication the right way is as important as the medicine itself. And it’s a significant issue when it comes to mental health — nonadherence can make you more likely to suffer relapse or even end up in the hospital.”
For instance, stopping antidepressants abruptly, without your doctor’s supervision, can lead to severe discontinuation symptoms.8 One recent study showed that stopping antidepressants abruptly can even put you at higher risk of a relapse of depression a year later.9
Medication adherence should save you time and money.
Just as medication nonadherence can trigger physical burdens, they are financially costly as well.
Each year, medication nonadherence leads to $100-$300 billion in extra healthcare costs. By reducing the risk of disease progression, medication adherence could reduce the number of costly medical visits and hospitalizations.2
At the individual-level, medication adherence can help you avoid the costs of unnecessary medical visits and prescription refills.
Let’s say you don’t follow your treatment plan as directed, and you report back to your clinician that your prescription isn’t helping your condition. Your clinician is then likely to increase your dose. If the higher dose does not work for you or causes an adverse drug event, your clinician may choose a new drug for you. This costs time and money via extra visits to your clinician and filling additional prescriptions – when you may not need to do either. Since you didn’t adhere to your original prescription, it is possible that the original dose and/or medication could have helped you.
These costs illustrate why it’s important to get to the bottom of why people may not take their medications as prescribed.
5 reasons why you may not take your medication as prescribed – and what to do about it.
Why do so many people skip their medications — or never start taking them in the first place? Here are common reasons people may not be adherent to medications, along with tips that can set you on the path to better health.
1. You feel embarrassed and ashamed.
Even in the 21st century, there’s still a big stigma around mental illness. In one large study, patients who experienced shame over a diagnosis of bipolar disorder had the highest rates of nonadherence to their medications.10 “People may think that taking meds for depression or other issues is a sign of weakness,” says Lazaruk. “It’s a huge barrier keeping people from getting better.”
As Lazaruk advises, remember that there’s no shame in seeking help and taking the medications your doctor prescribes. After all, in 2019, 15.8% of all American adults — that’s more than 50 million people — were taking medications to treat a mental health condition.11 And that was before the COVID-19 pandemic, which has exacerbated mental health challenges for Americans.12
2. Your medication instructions are too confusing.
More than half of adults 65 and older take four or more prescription medications.13 It’s no wonder that so many people are confused by their medication regimen, forget, or just decide that taking medications isn’t worth the trouble.
If you’re feeling overwhelmed, it’s time to get organized. Try a multi-compartment pill box, suggests Lazaruk. Or talk to your doctor about getting your medications in blister packs. Some pharmacies will even send your prescriptions packaged and labeled with the date and time you need to take them. And don’t forget: Your pharmacist is a great resource who’s there to help you keep your prescriptions in order.
3. You’ve heard that medications are dangerous.
Maybe your best friends have shared their personal medication nightmares, or a random post on social media offers “proof” that your prescription medication is dangerous.
But you know yourself best. Instead of making medication choices for yourself based on this type of information, seek out reliable sources that will help you get the information you need about your medications. These might include:
- Talking to your clinician or pharmacist. Find out exactly why your medication is necessary, how to take it, and other medications you may want to avoid while taking it. Both clinicians and pharmacists have a wealth of knowledge about potential side effects, possible reactions, and even the best time of day to take your medication. You may also be able to set up an annual medication review with your pharmacist to make sure you’re on the right track.
- Reading your medication’s package insert. It provides all the basic information, and it’s much more reliable than social media.
- Asking your doctor about precision health tools like pharmacogenetic (PGx) testing. By analyzing your genes as they relate to how you tolerate medications, PGx testing is designed to help your provider identify safer drugs and dosages for you. This type of testing, along with gene-drug software and one-on-one consultations, is provided by precision health companies such as Genomind. Find out more here.
4. You want instant results.
“People often stop taking their medications because they don’t feel better right away,” says Lazaruk. “But sometimes it can take four to six weeks until you start noticing a difference.” That’s especially true of some behavioral health medications.14
Talk to your clinician or pharmacist about when you can expect the medication to start taking effect. They may have a better idea on the typical timeline.
5. Your side effects are worse than your condition.
Although adverse drug events (ADEs) can be mild or serious, you shouldn’t take any of them lightly. Make an appointment with your clinician or pharmacist to go over potential risk factors or what it might look like to stop taking or swap out one medication for another.
Some medications have mild side effects like headaches. But if you’re prescribed certain antidepressants, for example, taking them could make you gain weight or experience sexual problems, both potential reasons why you might think that stopping them would seem like the right move.15 But it’s not a good idea to stop taking a medication without first consulting your clinician.
“Sometimes a medicine just won’t agree with you,” explains Lazaruk. “But that’s no reason to just stop taking it. Those side effects may disappear over time.” If the side effects don’t go away, Lazaruk suggests talking to your clinician. Alternatives could range from tapering down the dose of the medication to considering a new drug altogether.
As was noted in the previous section, you could also ask your clinician if they’re familiar with precision health companies like Genomind and PGx testing, which is designed to address the issues Lazaruk noted, regarding side effects and switching to alternative therapies. Many side effects, for example, can be caused by an excess of medication in your body. With a better understanding of how your body metabolizes different drugs, your clinician can tailor your prescriptions to a dose that may be less likely to produce harmful side effects.
Genomind also has proprietary precision medicine software, which can be used by clinicians to assess potential gene-drug and drug-drug interactions that may be causing unwanted side effects. With both the PGx testing and software at their fingertips, clinicians can better optimize your treatment plan.
- Stats on chronic condition drugs/adherence: The Unmet Challenge of Medication Nonadherence (2018)
- Percentage of people who never fill prescriptions, annual costs of nonadherence: CDC Grand Rounds: Improving Medication Adherence for Chronic Disease Management — Innovations and Opportunities (2017)
- Antidepressant adherence study: How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist (2020)
- SSRI timeframe: Number One Reason SSRIs Take Four to Six Weeks to Work (2017)
- Medication directions with food: Why must some medicines be taken with or after food? (2021)
- Nonadherence and treatment failure: Why You Need to Take Your Medications as Prescribed or Instructed (2016)
- Consequences of nonadherence to blood pressure medication: Medication Adherence – Taking Your Meds as Directed (2022)
- Antidepressants/discontinuation: Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum (2020)
- Stopping antidepressants/relapse: Maintenance or Discontinuation of Antidepressants in Primary Care (2021)
- Stigma/nonadherence: Connection between self-stigma, adherence to treatment, and discontinuation of medication (2016)
- Stats on mental health drugs: Mental Health Treatment Among Adults: United States, 2019 (2020); https://www.cdc.gov/nchs/products/databriefs/db380.htm
- Stats on mental illness during the pandemic: The Implications of COVID-19 for Mental Health and Substance Use (2021)
- Information on 65+ taking multiple medications: Data Note: Prescription Drugs and Older Adults (2019)
- Background on behavioral health drugs: What to Expect From Your Medications (2016)
- Side effects of antidepressants: Mental Health Medications (2016)