Psych patient refuses medication but can't tell me why...what now?

  1. 0 I have a patient who has been diagnosed with clinical depression and anxiety, understands the diagnosis, is alert, oriented and otherwise reasonable in demeanor but absolutely flat out refuses to take an antidepressant to help themselves. I've asked this person why they won't (side effect concerns? cost?) and this patient cannot tell me why other than "everything I read about them says they don't work or is negative and I do have good days here and there." This patient is not trying to be difficult, attention seeking by non-compliance - he really does not know why he is so opposed except the basis of what he has read on the internet or in magazines. He even admitted he knows people who have been or are on SSRI's or SNRI's that have been helped by them. Before seeking treatment he said he used over the counter and natural type products but things just got worse. I don't know how to get through to him or even if I can. I've told him more people are likely to write about a negative experience than a positive one and studies have shown the medications are effective but he continues to refuse. Any suggestions?
  2. Visit  Marshall1 profile page

    About Marshall1

    Joined Nov '09; Posts: 918; Likes: 765.

    12 Comments so far...

  3. Visit  twinkerrs profile page
    6
    Accept his decision and work on how he is going to cope with the depression. He has made his decision and there really is nothing you can do but provide him with info.
  4. Visit  MrChicagoRN profile page
    4
    Respect their decision, but continue to support, and to teach.
    Acknowledge that the meds may or may not work, but they certainly won't work if not taken.

    Ask them what they plan to do to address their depression, and suggest they consider trialling the medications as an adjunct to whatever other modalities they will be utilizing.
    Meriwhen, marydc, elkpark, and 1 other like this.
  5. Visit  Whispera profile page
    3
    He did tell you why--because he's heard negative things and that they don't work. That's a huge reason. Isn't it a good enough reason to you? It's good enough to him! If it's set in his mind, you're not likely to overcome it, but the suggestions others have listed might help some, especially if nothing else works...
    psu_213, elkpark, and Meriwhen like this.
  6. Visit  nursedanny614 profile page
    0
    I would educate him on as much as you know on the medication. If her still refuses then document it and notify the doctor I suppose.
  7. Visit  pamnock profile page
    0
    I educate, discuss the decision, and notifiy the physician if the patient still refuses.
  8. Visit  Meriwhen profile page
    2
    As long as he's legally competent and not court-ordered to receive medications, he can refuse as much as he likes. Just like everyone else has said, all you can do is keep educating, document the refusals, and notify the prescriber.

    When I have a patient that refuses medication even after education, I tell them that I respect their decision...but that I still have to continue to offer the medication to them each time it's due because it's my job. That helps them feel less like I'm nagging them.
    elkpark and Whispera like this.
  9. Visit  gatigress profile page
    0
    Keep educating him on the fact that there are many meds out there, and like others said find other ways to help him cope. Does he have a hobby or did he have a hobby? Find something out from him that he used to see as important in one part of his life and start talking to him about everything and anything that he is interested in. Once you have a good relationship maybe he would be open to at least trying a type of medication. I know many women have weight gain worries and many people do worry about side effects and having to be dependant on meds to make it through the day, Also if he is younger he may have worries about his libido and that is important to many.
  10. Visit  lasair profile page
    1
    It is his choice - respect that - work with him in other ways to manage depression and reduce stress.
    elkpark likes this.
  11. Visit  sharpeimom profile page
    0
    My husband has suffered from clinical depression and extreme anxiety since grad school. He's on meds for both and has been for about a decade and a half. He also meditates several times a day plus when I tell him he seems hyper. It really seems to help calm him down and makes him less depressed. Occasionally, he'll gripe about having to take an antidepressant and if he's really reluctant to take it, I have discovered that if he'll just take an extra Buspar, he'll usually relax enough to take his Zoloft. He has Buspar ordered 1 bid and he may take as many as 2 more per day PRN. He is fine as long as he takes his meds, meditates regularly, eats regular meals, and gets enough sleep. One late night and he's a mess! Something that might be an issue that no one has thought of is how meds taking was regarded in his birth family. My husband was reared in a Christian Science-believing family and for him to be able to take any meds was a huge hurdle. I'm sorry about the italics and terrible spacing. My new computer has windows 8 and it's being difficult!
  12. Visit  Orca profile page
    2
    The patient is not required to give you a reason for not taking medications. Except in cases in which forced medications are court ordered (invariably antipsychotics), the patient has the right to refuse for any reason or no reason. In the case you mentioned, the patient is concerned about side effects and efficacy, both valid concerns. All you can do is educate. The ultimate decision of whether to accept medication therapy rests with the patient.
    elkpark and Meriwhen like this.
  13. Visit  4Bnut profile page
    0
    Quote from Marshall1
    I have a patient who has been diagnosed with clinical depression and anxiety, understands the diagnosis, is alert, oriented and otherwise reasonable in demeanor but absolutely flat out refuses to take an antidepressant to help themselves. I've asked this person why they won't (side effect concerns? cost?) and this patient cannot tell me why other than "everything I read about them says they don't work or is negative and I do have good days here and there." This patient is not trying to be difficult, attention seeking by non-compliance - he really does not know why he is so opposed except the basis of what he has read on the internet or in magazines. He even admitted he knows people who have been or are on SSRI's or SNRI's that have been helped by them. Before seeking treatment he said he used over the counter and natural type products but things just got worse. I don't know how to get through to him or even if I can. I've told him more people are likely to write about a negative experience than a positive one and studies have shown the medications are effective but he continues to refuse. Any suggestions?
    It may be a sexual issue, meaning with SSRs, it decreases or can cause a person not to orgasam.
  14. Visit  Meriwhen profile page
    1
    Quote from 4Bnut
    It may be a sexual issue, meaning with SSRs, it decreases or can cause a person not to orgasam.
    Possibly. That's one of the reasons patients are not usually very forthcoming with sharing. There are ways to minimize/eliminate sexual issues though...but only if the prescriber knows about the issue in the first place.

    Regardless, it's a a valid reason for them to refuse. Almost any reason a patient gives will be valid, right down "I just don't want to take it and that's that." They don't need to explain the why or how justifying it.

    Doesn't mean the nurse shouldn't continue trying to educate the patient, because they should continue to educate. But refusal shouldn't be looked at as a test with a "right" or "wrong" answer.
    elkpark likes this.


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