General anxiety is the most common type of emotional state based on worry and fear, often associated with specific events, and the anxiety disappears when the event is resolved, called physiological anxiety.
When the severity of the anxiety is clearly inconsistent with the objective event or situation, or when it lasts too long, it becomes pathological anxiety, called anxiety symptoms, and if it meets the relevant diagnostic criteria, it is diagnosed as anxiety disorder, also called anxiety disorder.
There are many types of anxiety disorders, and according to the clinical manifestations of the patient, anxiety is often divided into.
1. Generalized anxiety: In the absence of obvious triggers, patients often experience excessive worry and nervousness and fear, but the nervousness and fear often have no clear object or content. In addition, patients are often accompanied by dizziness, chest tightness, panic, shortness of breath, dry mouth, frequent urination, urgent urination, sweating, tremor and other somatic symptoms, and this anxiety usually lasts for several months.
2. Acute anxiety attack: When there is no fearful situation in the normal daily life environment, patients suddenly appear extreme fearful tension, accompanied by a sense of near death or loss of control, along with obvious symptoms of the vegetative nervous system, such as chest tightness, panic, dyspnea, sweating, general shaking, etc., generally lasting from a few minutes to several hours. Seizures start suddenly, quickly reach the peak, the seizure consciousness.
3, phobia: the core manifestation of phobia and acute anxiety attacks are the same as panic attacks. The difference is that the anxiety attack of phobia is caused by some specific places or situations, the patient is not in these specific places or situations will not cause anxiety.
Mood disorders in which anxiety symptoms are the main clinical manifestation often contain two groups of symptoms.
1. Emotional symptoms Patients feel that they are in a nervous, anxious, fearful, scared, and worried internal experience. What is the nervousness and fear? Some people may be able to clearly state the object of fear, while others may not be able to say what they are afraid of, but they just feel afraid.
2, physical symptoms Patients are often accompanied by autonomic hyperfunction, such as panic, shortness of breath, dry mouth, sweating, trembling, flushing, etc. Sometimes there is also a sense of near death, the heart is uncomfortable, feel like they are going to die, and in serious cases, there is a sense of loss of control.
Anxiety disorder is a mood disorder with a good treatment and prognosis, so even if you are diagnosed with anxiety disorder, there is no need to worry too much. Treatment for anxiety disorders usually includes medication and psychotherapy.
Medication.
1. Benzodiazepines (also known as Valium)
Advantages: fast-acting, mostly within 30-60 minutes; anti-anxiety effect is certain; generally cheaper.
Disadvantages: short duration of effect. Possibility of dependence. Not suitable for long-term use in large quantities.
Commonly used drugs: lorazepam (lorazepam): the common dose is 2-3 times a day, 0.5-1.0mg each time; Jiajing Valium (alprazolam): the common dose is 2-3 times a day, 0.4mg each time; Oxazepam tablets (Ufie): the common dose is 2-3 times a day, 15mg each time, these three drugs belong to the short and medium-acting tranquilizers, anxiolytic effect is good, the sedative effect is relatively weak These three drugs belong to the short and medium-acting tranquilizers, which have good anti-anxiety effects and relatively weak sedative effects, and have less impact on daytime work. In fact, all Valium drugs can be anti-anxiety, only the side effects and effects vary, the above three drugs are more commonly used.
How to use Valium drugs.
Intermittent medication principle: temporary oral when anxiety is severe, not long-term large quantities.
The principle of small doses: small doses work without large doses
The principle of regular medication change: If the condition requires long-term use of Valium anti-anxiety drugs, change to another Valium drug in 3-4 weeks to effectively avoid dependence. When changing medications, the original medication should be slowly reduced, and the new medication should be slowly added, and the two medications should be crossed for a period of time before withdrawing the original medication and adding the new medication to the treatment amount. If the patient is old, the dose of medication is not large, and the efficacy is good, you can also not change the medication, as long as the dose of Valium does not increase, within the normal range, and the efficacy does not diminish, you can assume that there is no dependence.
In the early treatment of anxiety disorders, it is necessary to use anxiolytic drugs as soon as possible in order to control anxiety as soon as possible, because it often takes 2-3 weeks for antidepressants to have anxiolytic effects, and if the anxiety symptoms are not controlled as soon as possible, it will have a negative impact on the recovery of the disease. Valium medications can be slowly reduced to discontinued after 4-6 weeks of use.
If you stop using Valium, please slowly reduce the dosage to stop, do not stop suddenly, otherwise it is very easy to cause withdrawal reactions and aggravate the disease.
2.Antidepressants
Then antidepressants can improve anxiety fundamentally because the cause of anxiety is closely related to the imbalance of neurotransmitters in the brain, and antidepressants can improve the imbalance of neurotransmitters in the brain, thus relieving anxiety and treating anxiety fundamentally. The guidelines for the treatment of anxiety disorders in the United States and China clearly state that
Generalized anxiety: the first-line treatment drugs are: paroxetine (Celerity), escitalopram (Lexapro), venlafaxine (Boloxin, Enos). The second-line drug of choice is duloxetine.
Panic attacks:The first-line drugs are paroxetine (Celerity), escitalopram, and the second-line drug is clomipramine.
Social anxiety (social terror): first-line drugs are paroxetine (Celert), buspirone, second-line drugs are escitalopram, sertraline, venlafaxine.
First-line drugs mean the first choice with clear efficacy; second-line drugs are the second choice if the first-line drugs do not work well. The treatment guidelines show that Celerity is the first-line drug for all kinds of anxiety, and it is the drug of choice for all kinds of anxiety. Next in line are escitalopram, duloxetine and venlafaxine, which also work well.
The characteristics of these drugs are.
Advantages: positive anti-anxiety effect; radical improvement of anxiety; non-addictive and suitable for long-term use.
Disadvantages: anti-anxiety effect is slow, 2-3 weeks after the onset of action, often need to be combined with short-term Valium drugs, the price is expensive.
The doctor will generally consider the specific drug to be used based on the patient’s condition, physical condition, economic situation and other factors.
Treatment considerations.
1. The anxiety may increase at the beginning of the medication, which is related to the side effects of the medication and usually disappears after 2 weeks. Pay attention to the small dose at the beginning of the medication, and slowly increase the dose. If anxiety is obvious, add Valium in time to relieve anxiety.
2. After the symptoms are relieved, it is recommended to take the medication for about 1-2 years. Please consult your doctor for discontinuation and dosage increase, and do not adjust your medication regimen on your own.
3.Side effects may occur during medication, do not panic and consult your doctor promptly. Generally speaking, most of the side effects will disappear after 2 weeks, because the body has already adapted to them. If the side effects are not tolerated by the patient, ask the doctor to help adjust the treatment plan.
4. Individualized differences in psychiatric medications refer to the fact that different patients, with the same diagnosis, same age and gender, and similar physique, have significant differences in the effects of drug therapy. The dose of the drug that works, and the side effects of the drug can also use a great difference. Patients should pay attention to keep in touch with their doctors when taking medication, solve problems in time, and don’t be afraid of the side effects of medication, they can figure out how to solve it together.
Clinical experience with medication.
1, paroxetine tablets: trade name Sellett, Leyou, etc., belongs to the SSRI class of drugs, acting on the 5-HT system, the common dose is 20-60mg/day, a single dose can be, the anxiolytic effect is outstanding, is the first choice of drugs for the treatment of all types of anxiety disorders, because it is really effective, especially in the treatment of anxiety disorders more prominent, when other drugs are not effective, switch to Sellett can still be effective. Therefore, in the guidelines for the treatment of anxiety disorders, it is clearly stated that it is the drug of choice for all kinds of anxiety disorders. A little experience in its application: When you start to take Celete, take half a tablet, and then increase it to 1 tablet after a few days. If you discontinue the medication, reduce the dosage slowly, and do not stop using Serotek at once. Individual patients have a certain sedative effect after taking the drug, can be put into the evening dose, usually in the morning; individual patients will have a transient hypertension, hypertensive patients need to monitor blood pressure.
2, Escitalopram: trade name Lysop, Bailout, also belongs to the SSRI class of drugs, acting on the 5-HT system, the common dose is 10-20mg/day. Anti-anxiety effect is good, the advantages of its small side effects, especially for the elderly and patients with cardiovascular disease use, the price is expensive.
3, venlafaxine: trade name Enos, Boloxin, there are extended-release preparations. The drug is a dual receptor effect of the drug, the role of 5-HT and NE two neurotransmitters, commonly used dose is 75-225mg / day. Antidepressant and anxiolytic effects are good. Note that there may be anxiety will increase at the beginning of the drug, you need to add Valium, which generally lasts two weeks mostly disappear.
4, duloxetine: the trade name Xinbaida, Ospin, is also a dual receptor principle of action of the drug, the role of 5-HT and NE two neurotransmitters, the common dose is 60mg / day, the biggest feature of this drug is the extent of the role of dual receptors has its advantages, antidepressant, anxiolytic effect is relatively good.
Drugs like sertraline, Lanxai, Xipomol, fluoxetine, clomipramine, etc. are often used as the second tier of drugs.
5.Butrocyclone, tandospirone
It is a 5-HT-1A agonist with good effect on social anxiety and no dependence. The disadvantage is that the effect is slow, 2-3 weeks.
6, acute anxiety attack can be considered to take propranolol (insulin) 10-20mg, temporary, can improve the symptoms.
7, tricyclic drugs: such as chlorpromazine, amitriptyline, etc., the effectiveness of the drug is good, the price is also cheaper, but the side effects are large, is not the drug of choice.
8, Dailixin: not commonly used this drug, the efficacy of general, pharmacological advantages are not great, it is an antipsychotic drugs and an antidepressant mixture of products.
As for which drug is appropriate for each patient, it is necessary to consider the patient’s condition, previous medication experience, the efficacy of the medication, the patient’s tolerance of the drug and side effects, and also consider the patient’s economic situation to make a decision after comprehensive consideration. It is also necessary to closely follow up with the patient and adjust the treatment plan at any time, so that the patient can gradually move towards recovery.
Psychotherapy.
Psychotherapy refers to clinicians establishing a good doctor-patient relationship with patients through verbal or non-verbal conversation, and applying knowledge about psychology and medicine to guide and help patients overcome and correct poor lifestyles, behavioral habits, emotional disorders, cognitive biases, and adaptation problems. Medication and psychotherapy are the two legs to help patients with anxiety disorders recover. Medication is essential to send charcoal in the snow; psychotherapy is the icing on the cake that will lead to further recovery and is also very important.