Dear Therapist:

Our 18-year-old daughter was prescribed medication for depression and we think that it makes a real difference for her. Unfortunately, she starts and stops taking it pretty much whenever she wants. We have discussed this with her therapist but get the sense that the therapist doesn't want to waste the whole session talking about medication compliance. That being said we are concerned that this might be unhealthy for her and certainly is not good for her mood. It might just be part of the depression that she becomes so disinterested in taking it—she is disinterested in so many things. We are hoping you can provide some information about this as well as some guidance on how to get her to take her medicine consistently. Thank you. 

Response:

You speak of your sense that your daughter’s medication is very helpful for her. I wonder whether she feels similarly. It can be easier for others to notice mood changes in us than it is for us to see these in ourselves. When someone is depressed, their entire perception is often skewed. It can be difficult for them to acknowledge positive effects. This is especially true while the person is not compliant with treatment (attending therapy sessions, following through with therapeutic techniques, taking medication). Of course, this is the time when they most need to recognize, and avail themselves of, treatment.

If your daughter does recognize that the medication helps her, what stands in the way of her compliance? Are there side effects that she wants to avoid? Is she concerned about any stigma associated with medication use? If so, do these disadvantages outweigh the advantages? Although you may be able to objectively identify advantages and disadvantages of her medication compliance, these can be less clear to your daughter. We are all guilty of assigning too much importance to something that affects us emotionally. Typically, the stronger that we feel about something, the less objective we can be.

You mention that your daughter’s therapist doesn’t want to waste the whole session discussing medication compliance. This may be due to previous attempts to discuss this having been rebuffed. Your daughter may be averse to medication without having a clear sense as to why. Perhaps the therapist believes that dealing with related issues can help your daughter to better address the medication issue. Or the therapist may believe that other issues are as—or more—important than medication compliance.

One possible goal (in therapy or otherwise) is to help your daughter clearly identify the benefits and drawbacks of medication compliance. One way of doing this is to help her to compare her symptoms—both emotional and behavioral—when she is on her medication to when she is not. She could focus on her general mood in addition to specific feelings and actions.

I don’t know how long your daughter has been on medication, or what her patterns are of compliance and non-compliance. There may be specific triggers or times of week, month, or year that affect her general mood—and the likelihood that she will take her medication. These are all possibilities that she is hopefully addressing in therapy. Your daughter is young, and use of psychiatric medication may be a new concept for her. Hopefully, she will be able to come to a clear and appropriate understanding of the benefits of treatment, and will become a happy, well-adjusted adult.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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