How to Manage Your Medications

Psychiatrists have stated repeatedly that the most difficult part of any treatment plan for patients with mental illness is getting them to take their medication. There are many reasons patients have given for this; such as being unable to get their medication or just forgetting to take it. Because many patients are on several medications at the same time, medication management can range anywhere from simply confusing to downright overwhelming. Here are some suggestions that may help:

Have someone else give you your medications.
Sometimes, especially when first diagnosed, everything seems overwhelming, including medications. Trying to keep straight which medications to take and when to take them can be very confusing, even for someone who does not have a mental illness. If you have a spouse or loved one living with you, or a home health nurse or other health care professional, you can have them give you your medications at the proper times. This does not necessarily have to be a permanent solution-you can just do this in the beginning if you choose and then select another method later on.

Take your medications at a specific time.
Medications never specify times. Instructions are always vague; such as, "Take one (1) at bedtime;" "Take twice daily;" "Take three (3) times a day;" and (the most confusing) "Take every four (4) hours, (or 6)." Regarding the "every four [six] hours", the question then is, "Do I take them during the night, too?" As for the other medication instructions, taking your medications at specific times will help you remember to take them. For instance, "twice daily" could be when you wake up and when you go to bed, or 8 am and 8 pm, etc. "Three times a day" could be breakfast, lunch, and dinner. "Or, specifically, "every four hours" could be 8 am, noon, 4 pm, and 8 pm. Talk with your doctor and/or his nurse and ask if you have to take medication during the night. Have them help you work out times to take your medications and set up a schedule. Then stick to the schedule.

Associate taking your medications with something specific.
Taking your medications with something you do every day at a specific time will help you remember to take them--for instance, with your morning coffee and/or with the evening news. In my case, I associate my morning pills with making my bed and evening pills with readying the covers for sleep (mine are "twice a day" prescribed medications). The stricter the routine and the more specific the action, (like brushing your teeth), the more likely you are to remember to take your medications.

Use a kitchen timer or watch alarm to remind you to take your medications.
For those who are working outside the home, or those who are away from home when medications are due, owning a watch with an alarm feature is a simple and discrete way to remind you to take your medications. If you stay at home and/or work from home, you can use a kitchen timer device to remind you. A timer can be picked up rather inexpensively at a discount store; or, most stoves and microwaves now have a built-in timer that you can use to remind you to take your medications.

Develop a pill-taking system.
One of the biggest problems patients have faced with their medication has been not being sure if they have taken it or not. There are several suggestions I can offer here:

Most stores, and definitely pharmacies, offer inexpensive plastic pill boxes in a variety of types, so you can choose the best one to suit your needs. The simplest one just has seven compartments with labels for each day of the week, so you can put all your day's pills in each slot at the beginning of the week, and just take each day's pills from the slot on that day. This is a great way to know if you've taken your pills for the day or not. There are pillboxes for AM/PM; morning, noon, and night; all the way up to the most complicated of needs. There are even pillboxes in large print and in Braille.
Another problem is confusing medication bottles. One suggestion might be to use a black magic marker to number the bottles or otherwise identify the medication and/or when to take it. Another suggestion might be to keep different medications on different shelves in the medicine cabinet; thus keeping the medication separated. I don't have a medicine cabinet, so I have mine on a shelf-left side are my morning pills, right side are my evening pills. This works for me, because I take different pills at night than I do in the morning; however, it would not work for someone who takes some of the same medication at both times. The important thing is to develop a system that works for you.
An easy way to know if you have taken your medications or not is to make a checklist, listing the day and the times you are to take your medication, and simply put a checkmark in the appropriate place each time that you take it. Then, if you have any doubts, just look at your checklist.

NEVER, EVER, RUN OUT OF YOUR MEDICATIONS!! Use the 3-Day Rule, and watch for "No Refills Available" label on prescription bottles.

One of the biggest excuses patients give for going off their medications is that they ran out of medication. Do not let this happen to you. Keep track of the amount of medication you have. Apply the 3-Day Rule. When you have three days of medication left, call the pharmacy and have them refill your prescription. Then you have three days to pick up the prescription before you run out. This way, you are not pressured or panicked at the last minute, and you will not run out of your medications. In case something happens, such as bad weather, car problems, difficulty getting to the pharmacy, arranging for someone else to pick up your prescription, etc., you will still be able to get your medications in time.
Also watch out for the "No refills available" label on all your medication bottles, and call your doctor that day (30 days in advance of running out) to ask for a new prescription to be called in and/or set up an appointment. Even though you will not need the medication for another 30 days, the pharmacy will keep the new prescription on virtual for you, so that it will be available when you need it. Again, remember the 3-Day Rule. If you see that you will run out of medication before your next doctor's appointment, ask your doctor to call in enough medication to last you until the appointment.

Fill all your prescriptions at the same time and at the same pharmacy. Get to know your pharmacist.
It may not always be possible to fill your prescriptions at the same time, but if it is at all possible, keep them on the same refill schedule; it is the least confusing way to keep track of your medications. Use the same pharmacy for all your medications, and make sure that all health care providers who prescribe medication for you have your pharmacy's name and phone number listed in your medical chart. Make sure your pharmacy has all their names and phone numbers as well. Also check to see that your pharmacy keeps a history of all your medications on a computer. And get to know your pharmacist-make him and his pharmacy staff a part of your support system. Not only will you get that personal touch, but the familiarity with you, your illness, and your medications makes the pharmacist more alert to possible drug interactions with your usual medications, possible side effects from new medication, medication substitutions, be able to answer questions you may have about medications, etc.

Carry a list of current medications with you at all times.
This is extremely important. First of all, for convenience sake-if you are on several medications, trying to remember each medication's name, dosage amount, and when to take it, is confusing even at the best of times. Many of us get flustered when we go to the doctor's office and are asked what medications (names, amounts, times) we're taking, and we can't recall them all. Sometimes our dosages have been adjusted since the last visit, and medical records need to be updated, and we can't remember what our new dosage is. Carrying an updated, detailed medication list, complete with the name and phone number of the doctor who prescribed each medication (if there is more than one), along with your emergency contact person and their phone number, is much easier. The size of this list can be very small, as long as it has all the above information, and can fit right in your wallet between your driver's license and insurance card. The reason this is so important is that, in an emergency, if you cannot speak for yourself, the first two things looked at are your driver's license (for identity) and insurance card (for the hospital). By having this list between the two cards, you can make sure emergency personnel will know what medications you are on and will be able to contact your doctor and/or psychiatrist if necessary.

Be able to get your medication even in an emergency situation.
Besides carrying a wallet card with the information described above, many people
have also chosen to wear medical alert bracelets in case of an emergency situation in which they cannot speak for themselves. Even before searching for a driver's license, medical personnel will notice a medical alert bracelet and be alerted to your identity and other important information you list on your bracelet. You only have a few lines to be engraved on the back side of the bracelet, but they will engrave any information you choose. For instance, you can list items such as your illness or the medications you take for your illness, contact person or just the phone number of your contact person, allergies to medications, etc. If you carry a wallet card as suggested above, you might want to wear a medical alert bracelet that has information on it not included on your card, or engrave the words, "See wallet card" on the bracelet. In any case, you will be able to let someone know what medications you need, even in an emergency situation.

Learning how to manage medications is often a difficult and confusing task even for people who do not suffer from mental illness; however, for the 1 in 5 adults who suffer from a diagnosable mental disorder, managing medication may seem an impossible task. However difficult medication management is, it is still a crucial part of any treatment plan and is necessary for any hope of stability and/or recovery. Hopefully, the above suggestions will help you and your loved ones to develop a management plan that works for you.

About the Author

Michele Soloway has dealt with bipolar disorder from a very young age. Her grandmother, mother, brother, herself, and her teenage son all have the disorder. She also lost her sister to suicide because of bipolar disorder. Michele has a blog for bipolar survivors at http://www.bipolarcentral.com/bipolarsurvivorblog, and is also a contributing writer to www.bipolarcentral.com and www.borderlinecentral.com.

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