Anxiety is the most common symptom in psychiatric clinical work, and it can be found in a variety of psychiatric disorders, such as depression, schizophrenia, and obsessive-compulsive disorder, among others. Learning more about anxiety, including medication, is of great interest to the majority of patients and their families.
So what is anxiety? Anxiety is an unpleasant, distressing emotional state accompanied by a somatic experience of discomfort.
There are many types of anxiety, and the following methods are commonly used for clinical classification.
1. According to the clinical manifestations of the patient, anxiety is often classified as
(1) Generalized anxiety: In the absence of obvious triggers, patients often appear to be excessively worried and nervous and afraid, but the nervousness and fear often have no clear object or content. In addition to this, patients often have physical symptoms such as dizziness, chest tightness, panic, shortness of breath, dry mouth, frequent urination, urinary urgency, sweating, tremor, etc. This anxiety usually lasts for several months.
(2) Acute anxiety attack (also known as acute panic attack): When there is no fearful situation in the normal daily life environment, the patient suddenly appears with 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, difficulty in whistling, sweating, and general shaking, which usually lasts from a few minutes to several hours. Attention! The appearance of this type of anxiety is episodic.
Acute anxiety attacks have a high rate of mis-treatment, and it is not uncommon for patients to have cardiac imaging, which both delays treatment and causes a waste of medical resources.
2.According to the severity of the condition, anxiety can be divided into.
(1) Mild anxiety (anxiety reaction): Most of them are physiological anxiety, often caused by major events in life, such as exams, interviews, promotion, job changes, etc. Sometimes they can be relieved by self-adjustment.
(3) Moderate anxiety (excessive anxiety)
(3) Severe anxiety (anxiety disorder): It is pathological anxiety.
3. According to the presence or absence of causative factors, anxiety can be divided into
(1) Primary anxiety: refers to the anxiety caused by the intrinsic biological pathogenesis. Anxiety disorders are primary anxiety, mostly severe or moderate anxiety.
(3) Secondary anxiety: Anxiety caused by environmental or psychological factors, such as test anxiety, depression with anxiety, obsessive-compulsive disorder with anxiety, etc.
Medication for anxiety
After anxiety symptoms appear, patients should go to a psychiatric hospital as soon as possible to clarify the type of anxiety and take appropriate treatment. In case of secondary anxiety, anti-anxiety medication should be taken along with systematic treatment of the primary disease.
Medications used to treat anxiety are often divided into the following types.
Benzodiazepines (also known as tranquilizers)
(1) Advantages.
(1) Fast onset of action, mostly within 30-60 minutes
②Anxiolytic effect is sure
(3) The price is generally relatively cheap
(3) Disadvantages.
① temporary use, not suitable for long-term use in large quantities
(2) The possibility of dependence. Tranquilizers anti-anxiety, like a car too fast with the foot on the brake, works but not for common use.
(3) commonly used drugs: lorazepam (lorazepam), Jiajing Valium (also known as alprazolam), Oxazepam tablets (also known as Ufie), these three drugs belong to the medium-acting Valium class of drugs, anxiolytic effect is good, the sedative effect is relatively weak, the impact on the daytime work is less. In fact, all Valium drugs can be anti-anxiety, only the side effects and effects vary, the above three drugs are more commonly used.
Common sense: where the drug is followed by a certain diazepam or a certain zolam, are Valium drugs.
(4) How to use Valium drugs.
① intermittent dosing principle: temporary oral when anxiety is severe, not long-term large quantities.
② small dose principle: small doses work without large doses
(3) 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. Note that when changing medication, 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 therapeutic amount. If the patient is older, the dose of medication is not large, and the therapeutic effect is good, the medication can be changed without changing, as long as the dose of Valium does not increase, is within the normal range, and the therapeutic effect does not diminish, it can be considered that no dependence has arisen.
Attention! If you stop using Valium, please slowly reduce the dose to stop, do not stop suddenly, otherwise it is very easy to cause withdrawal reactions and aggravate the disease.
2.Antidepressants
If you use the metaphor of anxiety with a car going too fast, then antidepressants are the throttle release, which can fundamentally improve anxiety because the cause of anxiety is closely related to the changes of neurotransmitters in the brain, and antidepressants can improve the imbalance of neurotransmitters in the brain, thus relieving anxiety and treating it fundamentally.
Commonly used drugs: I personally use more commonly, the first drugs considered for use are
SSRI’s: paroxetine, escitalopram.
SNRI’s: venlafaxine, duloxetine.
(1) Advantages.
①Anxiolytic effect is sure
(2) Fundamental improvement of anxiety
(3) Non-addictive, suitable for long-term use.
(3) Disadvantages: ①Anxiolytic effect is slow, 2-3 weeks after the onset of effect, can be combined with short-term use of Valium drugs.
(2) The price is expensive.
I generally consider which drug to use according to the condition, physical condition, economic and other circumstances.
Note!
(1) The anxiety may be aggravated at the beginning of the medication, but it usually disappears after 2 weeks, so be careful to start with a smaller dose and increase it slowly.
(3) After the symptoms are relieved, it is recommended to take the medication for about 1 year. Please consult with your doctor for stopping the medication and increasing the dosage, and do not adjust the medication plan by yourself.
(3) Side effects may occur while taking the medication, so please keep in touch with your doctor and do not panic. Generally speaking, most side effects will disappear after 2 weeks because your body has already adapted to them. If the side effects are not tolerated by the patient, please contact your doctor to adjust the treatment plan.
(4) Psychiatric drugs have individualized differences: This means that different patients, even if they have the same diagnosis, the same age and sex, and similar physical condition, will have significant differences in the effect of drug treatment, the dose of the drug that works, and the side effects of the drug will also be very different, so patients should pay attention to keeping in touch with their doctors when taking medication, and solve problems in a timely manner. Solve it.
A few comments on these drugs.
(1) Paroxetine tablets: trade name Sellett, Leyou, etc. The commonly used dose is 20-60mg/day, a single dose is sufficient, the anti-anxiety effect is outstanding, and is the drug of choice for the treatment of five anxiety disorders. It should be noted that the side effects of the drug are slightly greater, with some sedative effect, some patients may experience transient hypertension, hypertensive patients need to monitor blood pressure.
(3) Escitalopram: good anti-anxiety effect, small side effects is its advantage, suitable for the elderly and patients with cardiovascular disease, the price is expensive, is not yet part of the public reimbursement drugs.
(3) Venlafaxine: There are both extended-release and immediate-release formulations, both domestic and imported. The drug is a dual-receptor action drug, antidepressant and anxiolytic effect. Note that it is possible that anxiety may increase at the beginning of the drug, usually lasting two weeks mostly disappears.
(4) Duloxetine: there are slow-release preparations and immediate-release preparations, both domestic and imported, which are also dual-receptor action drugs, and have their advantages in the degree of dual-receptor action. The antidepressant and anxiolytic effects are better.
Like sertraline, Lanxai, Xipomol, fluoxetine, I often use as the second tier of drugs.
3, buspirone, tandospirone
Belongs to the 5-HT-1A receptor agonist, good effect on generalized anxiety, no dependence, the disadvantage is that the effect is slow, 2-3 weeks to take effect, if the patient has first taken Valium drugs, the effect is more than satisfactory. It can be used in combination with antidepressants.
4.Other drugs
(1) acute anxiety attacks can be considered to take propranolol (insulin) 10-20mg, temporary use, can improve the symptoms.
(3) tricyclic drugs: such as chlorpromazine, amitriptyline, etc., the efficacy is good, the price is also cheaper, but the side effects are large, is no longer the drug of choice.
(3) Dextran: I do not use this drug, it is a mixture of an antipsychotic and an antidepressant.
As for which drug is appropriate for each patient, we should consider the patient’s condition, previous medication experience and the effect after taking the drug, the patient’s tolerance of the drug, the side effects, and the patient’s economic situation, and then make a decision after comprehensive consideration, and then follow up with the patient to adjust the treatment plan at any time, so that the patient can gradually move towards recovery and let the smile bloom on the face of each family member.