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Summary
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A reader is worried that a husband has stopped prescribed immunosuppressant medication after a liver transplant. He insists he no longer needs it, and they wonder whether other motives are involved.
The response treats the medication decision as potentially life-threatening and says the husband’s physicians need to know promptly so they can assess the situation.
It suggests expressing concern and inviting him to an appointment, while acknowledging that the reader may alert the doctors if he refuses; the possible motives discussed are not established by the account.
Question
Reader · Identity withheldMy husband has decided to stop taking his immunosupressents (liver transplantee) It has been 11 years since he had the transplant. He tells me that he is 100% sure that he doesn’t need them. I am concerned that he is doing this for other reasons than just to prove he doesn’t need them to live.
\nIt is difficult as he is not displaying the usual signs of suicidal intentions but something is just not right. I don’t know who to talk to or how to get him help. He just says, I am doing this because it is my body and I don’t believe I need these pills anymore.
\nI feel like he is using his medication as a self destruct button. I am the only one that knows he is doing this. If his family knew they would go crazy, I believe it would drive him further away. I am worried.
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Answer
Mark Vigil Dombeck, Ph.D.Any time that a patient ignores doctor’s orders regarding medication prescriptions is a time for alarm. However, the situation you describe may be an especially important alarm, inasmuch as my non-physician understanding is that organ transplantees are vulnerable to rejection syndromes where their own immune system attacks the transplanted tissues and destroys them. If this is true, then your husband’s actions are either suicidally motivated or delusional (in the sense of wish fulfillment pipe dreams, not of schizophrenia), and potentially lethal.
\nThe distinction between motivations is important inasmuch as it helps you and your husband’s doctors to know how to help him. If he has become suicidal, then depression may be a factor in his decision, and that depression really quite urgently needs to be identified and treated.
\nIf he is delusional, then he really needs a dose of reality testing, and (if I’m wrong and there is some psychosis occuring) perhaps some antipsychotic medication would be in order. By way of reality testing, perhaps his physicians can show him (or at least describe to him) cases where transplantees went off their medications and were harmed?
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Either way, the quite possibly life-threatening situation with your husband needs to be brought to the attention of his physicians so that they can work out what is happening and offer a treatment plan.
\nAsk your husband to come with you to a doctor’s appointment. Share with him how concerned you are, what your fears are, and that you love him. If he refuses, you are still within your rights to alert your husband’s doctors to his condition so that they can decide if it is necessary and wise to intervene against his will (e.g., in a case where sducidal motivations are prominent).
\nUltimately, a determined and persistent sucidal person cannot be stopped. However, often times, someone who has become suicidal can be treated for depression, and that is enough to lessen suicidal urges (or at least forestall them for a time).
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