Where does it come from and how do we combat it?

Some people with chronic conditions, myself included, face the burden of pill fatigue. My experience goes something like this: I am prescribed medication and told I will need to take it for anywhere from three years through the rest of my life. For any number of reasons, I may hit a lull, a period when adherence to my medication slips. Subsequently I can experience withdrawals, flare-ups, and face the possible consequence that my treatments are rendered ineffective—all of these factors can lead to detrimental health outcomes. 

Often, I am able to get back into the swing of things, but this can take weeks or even months. While I am beyond thankful there are medications to keep me stable, I wanted to unpack these lulls—otherwise known as ‘pill fatigue’, ‘medication holidays’, ‘regimen fatigue’, and ‘treatment non-adherence’—and investigate how to remedy them.

You may be asking: what exactly is pill fatigue? Pill fatigue is when a person loses motivation to take their medication, typically due to what's known as a ‘high pill burden’. This phenomenon occurs when the person becomes overwhelmed with the number of medications they are prescribed or the frequency at which they have to take them. This can be especially prevalent in those with multi-morbidities, as they are typically juggling many different treatments and medications. Pill fatigue is not often talked about but impacts millions of people around the globe. It is estimated that approximately 50% of patients do not take medication as prescribed and therefore do not experience the full benefits of the recommended intervention. Pill fatigue reflects the burden of chronic illness and the impact that human error can play in medication management among both patients and doctors.

Individual health is complex and involves many factors. Doctors don't always recognise when their patients are experiencing treatment non-adherence; when they do, they sometimes blame a patient for taking a 'medication vacation' and accuse them of laziness. While patients do play a role in their medication adherence, many practitioners believe that blaming a patient for medication mismanagement is an outdated practice that should no longer be accepted. Further, doctors prescribe complex medical treatments without considering the work involved in medication management, the financial strain of medicine costs, or the social burden of consistently adhering to treatment plans. In order to reduce the occurrence of pill fatigue, it is crucial to consider the role of physicians as much as patients. 

For instance, a patient could be prescribed four pills daily from the gastroenterologist (two in the morning, two at night); one from the endocrinologist (to be taken on its own and on an empty stomach); pain medication every six hours (on a full stomach); one pill to increase energy and focus (needs to be taken before 11am); one pill twice daily for anxiety; and sublingual immunotherapy for severe chronic allergies (essential to be taken at the same time each day)—all to be taken on top of baseline medications such as birth control and multivitamins. What’s worse is this list doesn't even include additional medications that need to be taken for flare-ups! If you find reading that schedule overwhelming, imagine following it.

While this is not the experience for all patients, it is for some. A person's experience with pill fatigue is unique––it may develop with the prescription of a single medication or not be an issue at all to someone prescribed 20. Social support systems, physicians, and healthcare systems are key factors that affect the experience of an individual. The prevalence of pill fatigue highlights larger issues within healthcare systems: they are an example of the barriers created when there is poor healthcare coordination and inadequate access to care. It is important to note that not all people with chronic conditions can afford or access treatment, which adds an additional burden on top of the condition itself. I am privileged to be able to afford my medication and yet I still deal with pill fatigue. Are there any solutions to this dilemma? 

Unfortunately, there is no one way to fix such a complex problem. While pill fatigue may not be resolved overnight, there are steps to be taken by patients and doctors and there are support systems that may help. Mayo Clinic suggests coming prepared with a note-taking system to check you understand, and can look back on, any information received at medical appointments. Physicians should promote a blame-free environment when assessing medication adherence and provide patients the resources necessary for successful self-management. Using the “Teach-Back” method, doctors can ensure that patients are able to repeat back to them the directions and reasoning for taking their medications in their own words. 

Finally, I want to share the tips I have learned through my personal experience that have helped me combat moments of pill fatigue. While by no means am I a medical professional, I am someone who has struggled with medication non-adherence over the years. 

1. Alarm systems and checklists can be your best friend. Instilling a consistent routine for taking medication has been extremely beneficial for me. I have an alarm that is set to go off every day at 10am to help taking my medication become second-nature.

2. Remind yourself why you are taking these medications. I track my medications and the reasons why I take them both in a notebook and on my phone so that, if I'm ever having doubt, I can quickly remind myself of their importance. If I’m truly no longer happy with taking a particular medication, that’s ok too; I just need to let my provider know so we can take the next steps accordingly.

3. Tell other people that you’re on medication. Although it may feel uncomfortable talking about medication, social support can make a huge difference. This doesn’t mean your friend needs to ask you everyday if you took your meds. It is about taking ownership of your experience—allow yourself space to have the conversation and be willing to depend on loved ones for support. Accountability is key for me.

4. Check if there are coupons or discounts available for your medications. Whether it's for birth control, EpiPens, or thyroid medication, there are coupons or vouchers available for many pharmaceuticals! (Please note that this will not be the case in all healthcare systems.)

5. Journal your thoughts. Trying to understand my feelings (for example, frustration) and where they come from has helped me a lot. It's important to not place blame on myself when I’m already struggling because doing so will only hinder me further.  

While this is by no means a cure-all, it may provide a little bit of perspective and advice. As the list of tips demonstrates, medication non-adherence is a result of more than just ‘being lazy’—it is a consequence of a complex and incoherent medical system that puts a lot of responsibility on often unwell individuals. The healthcare system must do more to support the many people struggling to manage their health on a day-to-day basis.