Chelsea O’Donnell Wasn’t Taking Her Medication Before She Went Missing: Why Do So Many With Mental Illness Stop Their Meds?

TV personality Rosie O’Donnell with her daughter, 17-year-old Chelsea O’Donnell. (Photo: WireImage)

On Aug. 11, Chelsea O’Donnell disappeared from home with her six-month-old therapy dog. The 17-year-old daughter of TV personality Rosie O’Donnell has an undisclosed mental condition. What was particularly worrying to her loved ones: Chelsea had stopped taking her medication as prescribed and was “in need of medical attention,” according to a statement made by the family’s rep.

Just hours after Rosie reached out to her Twitter followers for help locating Chelsea earlier this week, the teenager was found in a home near Barnegat Township, New Jersey, on the evening of Aug. 18, with a 25-year-old man who she reportedly met on Tinder and who in the past had been convicted of heroin possession.

Chelsea’s mental illness hasn’t been revealed, and the details surrounding why she left home are still emerging. But the story of someone with a psychiatric condition discontinuing his or her medication is a common one. Pop culture has portrayed or referenced the tangled web of discontinuing medication countless times, recently in films like Silver Linings Playbook and TV shows like Homeland.

Chelsea O’Donnell was found this week after being missing for several days. (Photo: Rosie/Twitter)

So, why do so many go off meds voluntarily? There are several reasons patients discontinue taking medication, or are reluctant to start.

Many with mental illness don’t see their symptoms as issues.

According to Simon Rego, PsyD, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York, this is a struggle for health care providers. “The very nature of the illness can cause the patient to view symptoms as unproblematic,” he tells Yahoo Health.

“Take someone who is manic-depressive,” he explains. “The nature of the state of mania is that the person has a ton of energy. They feel like they can change the world, they’re functioning on very little sleep, they often feel very creative. From the outside looking in, others can see this is problematic, but they can’t. Taking medication would be a buzzkill for them.”

Related: Study Finds 1 in 5 Americans Lives With a Mental Illness

Every mental illness has its own issues, though. “You can also look at something like schizophrenia,” Rego says. “Someone who suffers from that may not feel they need medication. They may lack insight into their beliefs, and don’t see them as distorted — that the government is spying on them, that aliens are watching them, or so on.”

These are the primary effects of the typical pills, according to psychologist Karla Ivankovich, an adjunct professor at the University of Illinois at Springfield, which include antidepressant, anti-anxiety, anti-psychotic, and mood-stabilizing medications, among others. Patients with mental disorders often cite feeling numb, or “like a zombie,” Ivankovich tells Yahoo Health — but the secondary effects can be just as potent reasons for stopping, too.

The side effects of these drugs can take a huge toll.

“For those with mental illness, medications can be life-altering, allowing the individual to function at a level commensurate with their peers,” Ivankovich says. “And while many of the side effects resolve within a matter of days, some are significant and lasting for certain individuals.”

Side effects vary from medication to medication, and range from relatively mild issues like dry mouth and dry skin, to more significant problems like loss of libido, irregular heart rate, weight gain, and headaches.

But Rego says, oftentimes, the side effects are extremely discouraging and embarrassing for patients hoping for more normality, particularly weight gain and low sex drive. “It really does cause them to reconsider the cost-benefit ratio of taking it.”

Part of the cost of taking a given medication is admitting that a mental illness is present.

Mental illness still carries a stigma.

According to Ivankovich, society still has a long way to go in fully accepting mental illness.

“This alone can make it difficult to encourage patients to remain on their meds,” she says. “Historically, stigma has been associated with noncompliance. Medication adherence, formerly know as ‘medication compliance,’ has always been lower for people with mental illness, ranging somewhere between 30 and 66 percent.”

Refusing the appropriate medication can lead to serious consequences, including relapses and hospitalizations. “This leads to poor health outcomes, and that exacts a cost on the already-taxed healthcare system,” Ivankovich says. “On top of that, those who are non-adherent are at risk for homelessness, incarceration, and violence. Recent data suggests that those with mental illness are using emergency rooms in record numbers.”

Problems resulting from relapse include minor health or psychiatric concerns, but also include more severe consequences “like some of the tragedies we have seen in the media,” says Ivankovich. Think the mass shootings and random killings that have made headlines.

Unfortunately, non-adherence also arises for a simpler reason.

Many do not realize how important it is to take medications as prescribed.

“In my experience with medications in general, many just have trouble taking them as directed,” Rego says. “People think, ‘Oh, I don’t need to take it that rigidly,’ or they adjust on their own — and then they’re reluctant to disclose this to their providers.”

Ivankovich agrees: Way too many are missing the basic importance of taking a medication as it is prescribed. “They feel as if, when symptoms are resolved, medications are no longer needed,” she says. “Now, lots will read this and think, ‘It’s your responsibility, just take the medication.’ But the fact that noncompliance is so high is a strong indicator that patients do not understand the importance.”

Related: 12 Celebrities Who Are Helping End the Stigma of Mental Illness

And it’s not just a problem for those with a mental illness. Think about it: “Do you remember your physician saying to take all of your medications, possibly antibiotics, and then a few days in, you feel better?” Ivankovich says. “You decide that the medication has done its job, you are cured and you are now fine?”

This is the thinking of many patients, no matter the issue being treated. “If you discontinue an antibiotic, it wreaks havoc on the immune system and can weaken the body’s ability to fight off disease later,” Ivankovich says. “In the case of psychotropics, it’s no different.” You’re not getting the benefit, and symptoms will return.

A therapeutic dose of the appropriate medication to treat a mental illness can be life-changing. “It can return someone to a level of functioning previously enjoyed,” Ivankovich says. “But when taking a therapeutic dose, people can have a false sense of well-being and lack of true understanding for the efficacy of the medication.”

This means a person on a drug for a mental illness may not feel they even have a condition anymore. “They don’t realize the medication is effectively doing its job,” Ivankovich says. “They don’t feel they have a condition at all. As a result, they determine that the medication is no longer necessary.”

Unfortunately, adjusting the dose or suddenly withdrawing from such a medication can spell trouble. In order for these medications to work effectively, the appropriate dose needs to be taken everyday, says Ivankovich. If not, the risk of relapse is very real.

What can we do to help encourage those with mental illness to take medications as prescribed?

Medication adherence isn’t always easy to determine, since it’s based on self-reporting in many clinics. Ivankovich says a multidisciplinary-team approach would be best, but isn’t available to most based on the current setup of the health care system, which only allows for limited visits with counselors, psychologists, and psychiatrists.

That said, Rego says some providers are using crafty approaches. “With advancing research and technology, there are now devices that can tell how compliant a patient has been by listing how many times the lids on pill bottles have been opened,” he says, explaining some doctors will even count out the pills taken in a large supply to determine patient adherence. “However, if someone really wants to hide that they aren’t taking their medications, they often can.”

Prevention and education are key. “The patient has to be a participant in their care, and they need to be educated and understand the ramifications of their illness,” Ivankovich says. “They need to be encouraged to communicate with their providers when they may consider ceasing meds.”

And if a loved one has mental illness and you think they may not be taking their medications, you can help. “First, keep the lines of communication open,” says Rego. “If you suspect, you’re probably onto something. Try not to approach them in a way that will put them on the defensive, but rather be encouraging.”

Rego says you can also alert that person’s health care provider prior to a visit. “You can call, and say you’re not sure whether or not they’ll bring up a medication change at the appointment,” he says. “But you’ve seen something, you care, and you want them to know.”

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