After prescribing medications to patients, psychiatrists are often asked questions such as “What are the side effects of this medication on me? Today, I will list a few common questions that I have been asked and explain them one by one. Soon after I arrived in Guangzhou, some of my patients asked me, “Doctor, will my body be ‘loose’ when I take these western medicines?” When I first heard this question, I didn’t understand it at all and asked the patient, “What do you mean by ‘loose’?” Only then did the patient tell me that, according to the Guangzhou concept, the word “dispersal” means that when a person takes western medicine for mental illness, it will cause damage to the body’s “vital energy”, resulting in a person’s mental and physical strength being “very weak” or frail. “or weakness, or even lasting damage. After I thought I had understood the problem correctly, I explained to the patient that all psychiatric drugs work by acting on the neurons of the central nervous system and the connections between neurons (the medical name is “synapses”), and that the inevitable result of this process is that the original functional activity of the central nervous system will change after taking the drug. This process inevitably results in changes in the original functional state of the central nervous system after the administration of the drug, causing temporary changes in the physiological and psychological activity to which the patient has been adapted for a long time or is in a stable state. Since these changes are related to drug therapy, and the patient cannot adapt to the changes that lead to a negative evaluation of the drug, the judgment of “psychiatric drugs have caused me to have a decrease in energy and physical strength” is generated, and the drugs used to treat the disease are considered to have a “dissipative” effect. The effect of psychotropic medications on the body is “scattered”. In particular, when taking antipsychotic or anxiolytic drugs with sedative-hypnotic side effects, side effects such as dizziness, poor memory, daytime sleepiness, or prolonged sleep time can be easily interpreted by patients as a reflection of the weakening of their constitution by the drugs. However, most of the adverse effects of these drugs are mild and short-lived, and patients adapt better to them as the duration of treatment increases. Moreover, as the duration of treatment increases, the therapeutic effects of the drugs become more and more obvious, causing a fundamental change in the person’s mental state toward a positive, uplifting, relaxed, and happy direction, and the person’s state will only get better, not worse. In addition, when the disease reaches a healing effect, the doctor will give priority to reducing or stopping the use of those drugs with heavy adverse effects, and the patient will be in a better state then. After explaining the above to the patient, most patients will understand and accept the doctor’s advice to take medication more rationally. However, some patients may refuse to take the medication or reduce the dose of the medication without permission because they are worried about the side effects, or they may turn to TCM, believing that TCM does not have the “dispersal” effect that they are looking for, or even believing that TCM does not have any side effects or adverse reactions. A problem associated with the aforementioned problem is that many patients believe that the psychiatric drugs they have been taking for a long time will become toxic or harmful substances that will permanently settle and accumulate in their bodies, becoming a major health hazard. To such patients I would explain: Know the process by which people drink alcohol? In fact, taking drugs and drinking alcohol are very similar: after alcohol enters the body, a significant part of it enters the central nervous system and affects the function of the brain, manifesting itself in a drunken state of confusion, unstable walking, incoherent speech and even abnormal behavior. At this point, alcohol is actually a psychoactive substance or drug that produces the above mental activity changes after intoxication. However, after a certain period of time, when the alcohol in the body is gradually metabolized and excreted, its effect on the central nervous system will disappear. This is why traffic police must draw blood from the suspect driver in the first place when investigating DUI or DWI, because after a little time, the concentration may not be enough for DUI or DWI after the alcohol has evaporated, metabolized and excreted. Similarly, people taking drugs that have an effect on the central nervous system are very similar to drinking alcohol, in that the drug must be metabolized or excreted in some way after its pharmacological effects, such as through the liver, through the kidneys or intestinal excretion, which is the reason why certain drugs must state: patients with liver impairment or kidney impairment, the drug dose should be reduced as appropriate. Therefore, no matter what kind of psychiatric medication is taken, as long as the medication is terminated, after a certain period of time, the medication in the body will be completely excreted, and there is no possibility of long-term residual medication in the body. As for the issue of Chinese medicine in the treatment of mental illness. I tend to say that although TCM represents the superior wisdom of the Chinese ancestors in the prevention and treatment of diseases, it is generally inferior to Western medicine in the treatment of mental illnesses, and this gap is most obvious during the acute treatment period. I would also argue that none of China’s four great inventions has a longer history than TCM, but the four great inventions spread throughout the world in a very short time, while TCM’s sphere of influence is still largely confined to the East Asian Chinese civilization sphere, and it has not made sufficient desirable progress in the treatment of major diseases. In discussing the widespread misconception that TCM has no toxic side effects, I would like to illustrate the case of “gentian diarrhea of the liver pill” that caused acute kidney failure in patients taking the medicine in Europe and the United States in the previous years. According to the tradition of Chinese medicine, no one would agree that a prescription medicine like Gentian and Liver Pill has toxic side effects. However, the fact that acute kidney failure continued to occur in patients taking the drug prompted scientists in Europe and the United States to analyze the toxic side effects of the drug and found that guanmutong contains nephrotoxic “aristolochic acid”, which can cause tubular necrosis. In fact, Chinese medicine, like Western medicine, has both therapeutic and non-therapeutic side effects when the therapeutic dose is reached, and some side effects can even lead to serious adverse drug reactions, such as acute kidney failure caused by aristolochic acid contained in gentian diarrhea liver pill is a typical example of such serious adverse reactions. Therefore, the belief that Chinese medicine has only therapeutic effects and no side effects is just a wishful fantasy of patients. Another common problem is the one involving fertility. Many patients are concerned about the likelihood of conceiving a malformed fetus while taking or even after stopping the medication, and some couples of childbearing age even ask me to give the exact percentage of malformed fetuses conceived after taking the medication. Although the professional literature on the teratogenic effects of psychiatric drugs has corresponding figures and corresponding assessments of the level of teratogenic risk, they are based only on the statistics of teratogenic probability without specific teratogenic causes and avoidance measures. Moreover, even for the same drug, the numbers reported in the literature vary from sample to sample and from time to time, and are not actually instructive for specific patients. For specific patients, the birth of a malformed fetus can only be an all or nothing outcome. In my opinion, for women, mature oocytes are large in size – mature follicles can be up to 20 mm in diameter. in this way, if a woman of childbearing age takes certain small molecule drugs, trace amounts of the drug may enter the follicle, and if that follicle joins with a sperm to form a fertilized egg, the drug in the follicle also forms part of the embryonic development process If that follicle unites with a sperm to form a fertilized egg, the drug in the follicle also forms part of the internal environment to which the embryo is first exposed during development. Therefore, in principle, those who can remain stable without medication should try to get pregnant after stopping medication. Of course, drugs taken by women during pregnancy are not necessarily teratogenic and may even have positive effects on the formation and development of the embryonic nervous system: for example, experimental animal studies conducted abroad in recent years have shown that exposure of female rats to escitalopram during the embryonic period significantly reduced the anxiety response of their fetuses when confronted with stress after birth, suggesting that the use of escitalopram by mothers during pregnancy has an inhibitory effect on the anxiety of the fetus when confronted with stress after birth. inhibitory effect. In male patients, the drug has little effect on the birth of malformed fetuses. Because the mature male germ cell sperm has almost no cytoplasm, it is very difficult for drug molecules to enter the cytoplasm of sperm even at higher doses of psychotropic drugs and certainly does not have a teratogenic effect on reproductive activity. The effect of psychotropic drugs on reproductive activity in men is reflected in two aspects: first, the suppression of libido or affect ejaculation, which is more obvious in patients taking SSRIs or SNRIs antidepressants. Secondly, the drugs affect metabolic activity resulting in abnormal blood lipids and blood glucose as well as obesity, resulting in a decrease in semen quality and causing male infertility problems. Therefore, sexual activity during medication in male patients leads to spousal pregnancy without increasing the risk of malformed fetuses. In the course of drug treatment, sometimes the doctor prescribes a dose of medication that exceeds the recommended dosage in the drug’s instructions or in the relevant textbook, which is called “overdose”. At this point, the patient or his or her relatives are often concerned about the safety of the medication and the need for the overdose, and ask the doctor why the overdose is necessary and the corresponding risks. Here is how I generally answer this question. First, the recommended dose of all psychiatric drugs is the safe dose that would have been used if the drug had been better than placebo in a double-blind controlled treatment trial prior to marketing, and not necessarily the effective dose that would have cured the disease. For example, the recommended dose of the antidepressant sertraline is 200 mg/day, but in practice we exceed this dosing standard when treating disorders such as OCD in adults. Doctors choose to overdose in pursuit of optimal efficacy, seeking to cure the disease rather than just improve it. Second, in almost all pre-marketing placebo-controlled treatment trials of psychiatric drugs, the study protocols specify that the cases selected are mild and simple cases. A better improvement in symptoms in patients treated with the drug than in those treated with placebo over a defined time period is the basis for marketing the drug. However, in clinical practice, doctors are treating more severe or complex cases, and it is difficult to achieve effective treatment with the recommended dose, not to mention that doctors are seeking not only effective but curative purposes, which is obviously difficult to achieve with the recommended dose. Third, because almost all of the new psychiatric drugs currently used by psychiatrists have been available for a relatively short period of time, most of them have been available for nearly 20 years, and the experience accumulated by each physician in the use of medications is relatively insufficient. Therefore, the quest to exceed the recommended dose is based on his personal experience: firstly he should ensure that the overdose is safe and does not cause substantial harm to the patient. Secondly, he is pursuing the goal of treating patients to achieve optimal efficacy, and is following his personal experience that overdosing must be better than treatment with the recommended dose of drugs. In fact, in the last decade or so, there has been a global trend toward increasing the doses of new psychiatric drugs prescribed by psychiatrists. This is partly a reflection of the fact that the previously recommended doses of medications do not meet the requirements and expectations of physicians to cure the disease or to achieve optimal outcomes. Psychiatric patients also often ask their doctors whether they can take several medications in combination, or whether they can take psychiatric medications in conjunction with physical illnesses such as colds, acute bronchitis, or acute gastroenteritis. My understanding is that these drugs are neither strong acids nor strong bases, and there is no chemical reaction in the gastrointestinal tract or body when they are mixed together. Moreover, relative to the volume of the human stomach, these drugs do not necessarily have the same disintegration time in the stomach, and even if they are mixed, it is unlikely that the molecules of different drugs will come into contact with each other or combine with each other, so it is natural that they will not endanger the health of the body and are unlikely to reduce the effectiveness of the drugs. In addition, relative to the mass of the adult body, these drugs are absorbed and distributed in the body, the chance of chemical reactions in body fluids is almost zero, so there is no need to consider the hazards of mixing drugs and taking them together. Moreover, if an acute physical illness requires medication, the duration of use of these drugs is relatively short, for example, only a few days to cure the disease, and there is no need to worry about the dangers of mixing drugs. I hope that my explanation of the above mentioned issues will help my patients to be more positive in accepting and cooperating with medication in order to obtain the best results.