Perspectives On Psychotropic Medication Use Among Young Adults Who Have Exited Public Systems of Care

Purpose: Young adults with mood disorders often benefit from psychotropic medications to assist in managing their disorders. Yet, use of these medications declines during the transition to adulthood, especially among youth leaving public systems of care (McMillen & Raghavan, 2009). More information is needed to understand how young adults are thinking about medications in order to ensure they are provided with the most appropriate treatments during this period of vulnerability. To begin to address this gap, we asked the following research questions: 1) What are the perspectives of young adults toward psychotropic medications?; 2) How do they describe the effects of the medications?; 3) How do they talk about the process of getting medication treatment as they transitioned to adulthood?

Methods: The sample consisted of fifty-two young adults ages 18-25 who were diagnosed with a major mood disorder and had utilized psychiatric medication at some point in their lifetime (71% female; 63% youth of color; Mean age=20.90, SD=2.05). All participants had utilized mental health services and at least one additional public system (e.g., foster care) prior to age 18. Semi-structured interviews were conducted using an interview guide with six core questions about the mental health service use experiences during and after the transition to adulthood. Codebook development involved two analysts working through an iterative process with a sub-sample of transcripts (n=5). Initial codes were discussed and modified through a process of constant comparison (Boeije, 2002) of quotations, codes and grouped codes. Additional transcripts were analyzed using the codebook, adding and modifying codes as needed. Authors discussed and grouped codes through an iterative process.

Results: When asked what had helped them most in transitioning to adulthood with a mental disorder, many young adults identified medications as critical. But, they also talked about wanting “more than medications” to manage their mental disorder with treatment that also incorporated therapy and case management. Young adults talked in detail about how medications help them manage their disorder: sub-dimensions included cognitive, emotional, social and instrumental. They commented on the role of medications in helping them think: “they make my mind right”, in controlling their emotions: “meds level me out”, and in maintaining social relationships and employment. The process of getting appropriate care was frustrating for some who described a phenomenon of “trial and error” medications, where they were prescribed many medications with frequent changes. Psychiatrists were often presented in a negative light as providers who “did not understand” them, viewed them as an “experiment”, and were only influenced by self-interest.

Conclusions/Implications: Young adults in this study saw the benefits of medications but expressed significant reservations about the process of medication treatment. Findings align with previous work with younger adolescents on how medications work (Floersch et al, 2009) and how youth view experiences of psychiatric treatment (Lee et al, 2006). Providers working with young adults need to actively solicit their experiences of medication treatment and assist them in advocating for psychiatric care that meets their needs, as they are increasingly managing their mental disorders on their own.