Anxiolytic depressants are used for anxiety, depression, hypochondriasis, obsessive-compulsive disorder, phobia, dysthymia, somatization symptoms (also called functional symptoms, where the body has many inexplicable symptoms, but no evidence of corresponding organic pathology is found), disorders of plant nervous function, functional symptoms associated with organic pathology, etc.
Precautions for anti-anxiety depressants.
The diagnosis of the patient’s anxiety disorder mentioned in the article is fine, and the medication prescribed by the doctor is also generally fine (sometimes the dose is a bit on the small side). Even though the dose is fine, the patient sometimes takes the medication intermittently which inevitably affects the efficacy of the medication, and of course the combination of different medications is also important. This time, I received the patient specifically advised to take the medication regularly according to the doctor’s prescription, do not take off and miss (if the effect is not satisfactory, you should find a doctor to adjust), and at the same time give several times the formal psychological guidance is also helpful (1 hour each time, including hypnosis relaxation training).
In general, if anti-anxiety or depression medication is effective, do not change the medication too often, especially if it is not obvious when you first take it for 1-2 weeks and there are no obvious side effects (a little discomfort after taking the medication at first is allowed), there is no need to change the medication immediately. Even if you need to change the medication or adjust the dose after 1-2 months of taking it for various reasons, it should be decided by your doctor. Moreover, there are 7-9 commonly used anti-anxiety depressants, none of which has an absolute advantage.
Some people are very worried about drug side effects, although the instructions list a number of possible side effects, but in fact the incidence is very low, just like a person who wants to take a car to a certain destination, if always worried about a car accident, then still dare to take the car? (So the side effects of regular medications are like being in a car accident, the probability is very low). My common method is to start with a small amount of anti-anxiety medication (1/4 or 1/2 capsule to start with) and gradually increase the amount to the therapeutic dose, which not only avoids the slight discomfort at the beginning of the medication, but also allows the patient’s mind and body to have an adaptation process. The actual effect: 98% of the patients are able to persist in taking the medication.
Drug adjustment and discontinuation should seek the doctor’s advice: what specific drugs to use, how to combine? In the middle of adjusting the dose or switching varieties, or when to reduce or stop the medication, should seek the advice of the doctor during the visit.
How long do you usually take it?
At least six months of anti-anxiety or depression medication for milder cases, and at least 1-2 years or even for life for more severe cases. After 6-12 months of treatment, if the condition is obviously improved, the mood is relatively calm, there is no subjective discomfort, you can do what you should do, you can study, work and play, interpersonal interactions are generally normal, in most cases you can sleep well (no sleeping pills), you can eat well, then continue to take the medication for another 3-6 months, depending on the situation, you can gradually reduce and stop the medication.
Some patients ask: After stopping the medication, how long does it take to have a child? Expert: After 2 months.
How to stop the medication?
A first stop the auxiliary Chinese medicine, B stop the sleeping pill, C take the main anti-anxiety-depressant alone for 1 to 2 months, D and then reduce the main anxiety-depressant by half for 1 to 3 months, if there is still no aggravation of symptoms, then you can stop it completely. ABCD process, no matter which step to reduce the medication, once the symptoms reignite or aggravate, you should stop stop stopping the medication or reduce the dosage, and then see the doctor for follow-up, if necessary, back to the previous level of Dose and regimen of medication.
Do not adjust the dose or change the medication at will: if the medication is matched and the dose is right, the effect is usually seen 2-4 weeks after the medication is used, and the effect should be more obvious after 8 weeks. Generally speaking, like anti-anxiety or depression drugs once you start taking, if you have a better effect after 4 weeks, you should continue to take it, no need to arbitrarily adjust the dose or change the drug. If you take off the medication or stop taking it at will, the total time of taking the medication may be much longer.
(Kindly remind: if you are taking the medication well, with no obvious side effects, and the effect is okay, and you have not taken it for too long (<3 months), especially if you have just taken it for 1-2 weeks, even if it has not started to work, if another doctor wants to switch you to another anti-anxiety depression medication without asking, you have the right to get a justifiable explanation from the other doctor. (Otherwise, you have the right to refuse and to keep certain doubts.)
Some patients run out of medication and then go to buy it, inevitably stopping it for a few days, leading to a relapse or aggravation of symptoms that have already been relieved. Therefore, it is recommended that you should always play ahead and go to the hospital to buy medication before there is still a week’s supply of medication.
What should I do if I have discomfort at the beginning of the medication?
Some patients may feel more uncomfortable after taking the medication at the beginning (1-3 weeks) (new symptoms may appear instead of the original ones, such as dizziness, confusion, gastrointestinal discomfort, increased insomnia or anxiety, or drowsiness, daytime sleepiness, fatigue, etc.). If there is a significant increase in discomfort or obvious allergic reactions (allergies: rash, local redness, itching, etc.) (even if it is only a small amount at the beginning), you may want to stop the drug immediately and then go to the nearest doctor to reflect the new situation (if there is an allergic rash, you may also want to see a dermatologist), and the doctor will decide what to do next. I usually deal with: first stop taking the drug and then reduce the half, that is, let the patient stop taking 4-6 days and then take from a smaller amount to see (such as the original starting to take 1/2 grain, then reduce to 1/4 grain and try again; the original starting to take 1 grain, then reduce to 1/2 grain to take), some reactions are not so obvious, 4-6 days later and then gradually increase the amount to the original starting amount; if half the amount to take after still have obvious discomfort, then it If you still have significant discomfort after reducing the dosage by half, then you can stop using it and find a doctor to try again with a new similar drug.
There are also patients who have difficulty taking almost all medications, what should I do?
If there is an allergic reaction (allergic rash): it is best to stop the medication in time, but some mild itching of the skin, dizziness, gastrointestinal discomfort, etc., are generally not considered allergic.
If you have a common cold, diarrhea, or low-grade fever while taking anxiolytics, you do not need to stop the medication. In case of surgery, high fever, severe diarrhea, etc., it can be temporarily discontinued after consulting the doctor in charge.
How long does it take to work?
Roughly 1-3 weeks, with some taking it for 4-6 weeks before it really takes effect. Therefore, 2 weeks is often a hurdle. Some patients have not seen any real effect after 2 weeks of taking it, and they feel weak and unsure. Unless the side effects are too great, it is best to continue to take the medicine until 4-6 weeks.
There are 4 types of weaknesses in the drug.
1, the drug strength is relatively weak, such as only with glutathione, bupropion, tandospirone or dalexin.
2, the appropriate variety of drugs, but the dose is not added to enough (according to the weight and degree of disease), such as sertraline or venlafaxine only 1 capsule / daily (should be 2 or more), although the duration of enough, it is difficult to stop the drug.
3, the single drug dose is sufficient, but the lack of necessary adjuvant drugs.
4.The choice and combination of drug varieties are not reasonable.
Why can not stop one of the drugs?
There is another common situation, the patient has been taking the medication according to the doctor’s prescription regularly, the dose is also sufficient, the symptoms disappeared significantly during the medication, the doctor let gradually reduce the dose after the symptoms are aggravated, the drug added back, and then obviously see good. The patient’s symptoms disappeared significantly during the period of taking the medication, and the symptoms worsened after the doctor asked to gradually reduce the dosage, and then the medication was added back, and the patient became significantly better. In my personal experience, the patient’s psychological, cognitive and thinking patterns (including certain factors in the external environment) have not really changed, and the medication is simply to relieve the symptoms. Therefore, many patients must supplement their medication with systematic psychotherapy and make great efforts to adjust their internal psychological problems before they can finally solve the underlying problems.
But psychological guidance or self-adjustment, how easy it is! It requires a strong and persistent motivation to change within the patient himself, as well as a lot of mental, courageous, financial, energy and human resources.
For milder psychological problems, if self-adjustment is in place, medication and a full-time counselor can be dispensed with. Or under the guidance of the counselor to do self-psychological adjustment, you can also temporarily do not take medication. If you can’t return to the normal state after 1-3 months of self-adjustment, you may need medication or psychological counseling.
At the same time, the support and cooperation of family members and related members around you is also very important.
Why can’t you stop taking medication?
There is another extreme case, with any medicine, even if the medicine is also very strong, the effect is still very bad, often because the negative psychological emotions are too strong (no formal effective venting) or the external pressure on the patient is too great, and the patient can not avoid or very difficult in the resistance. Our experience is that short-term strong psychological intervention is necessary and important at this time.
Why can’t we stop medication number three?
Therefore, if the medication is weak, if the patient does not take the medication regularly, if the patient does not have the necessary psychological support, if the patient does not want to spend real effort and energy to adjust even if the psychological support is done (it depends on the comprehensive level of the psychological counselor and humanistic qualities), and if the external environment is really unfriendly, the patient may not be able to return to the normal psychological and physical state, and the medication is just a top medicine, and cannot be stopped. (This is true no matter what kind of anti-anxiety and depression medication you take). It seems that it can be said to be drug dependence, but is it the fault of the medication and psychological support?
Why can’t you stop taking your medication #4?
Regardless of the situation, it is difficult to stop the medication, do not simply blame the drug ineffective or drug addiction, but with the help of experienced doctors, realistically analyze and identify a variety of possible specific causes, and then adjust the treatment or psychological guidance program targeted. The reality is often not ideal, such as the patient’s resources are too weak or too little, or he is unwilling to do a long course of psychological diversion after only 1-4 psychological diversions, or simply unwilling to do psychological diversions, and so on, I will not expand carefully.
Weakening after a period of strong drug effect: Some patients have a good effect for a short period of time (e.g. 1-3 months), but then the effect seems to weaken and some of the relieved symptoms are aggravated. It may be necessary to increase the dosage of drugs, but more importantly, it is necessary to cooperate with a pertinent and systematic psychological guidance is ah!
Do not change doctors and counselors too often.
No matter where you see a doctor, do not change the doctor and counselor too often (not that you can’t switch, of course). If you do not understand or have doubts, you may want to ask the original doctor. If there is a change in your condition, you should also follow up with your original primary care doctor. If, after several visits and contacts, you are not satisfied with a doctor’s service (perhaps in terms of human qualities or professional skills), or if a doctor politely suggests to the patient that he or she should seek another doctor who is more skilled, etc., the patient may wish to switch to another doctor.
The strength and dosage of anti-anxiety medication should also be adjusted depending on the condition. Moreover, the patient’s condition may change and fluctuate. From the conceptual and therapeutic point of view, plant nerve dysfunction is basically equivalent to neurosis.
Is it possible to use Chinese medicine or psychological guidance alone?
If the anxiety-depression or neurosis is mild, it may be effective alone, but if the condition is severe or of long duration, I am afraid that the effect of using Chinese medicine or psychological guidance alone may be reluctant. It is advocated that Western medicine should be the mainstay, supplemented by Chinese medicine. At the same time, psychological guidance and drugs complement each other.
What about those who do not want to use western medicine?
There are some patients who come to me and I find that she or he usually takes anti-anxiety and depression medication very irregularly, and the patient also tells me whether it is OK to use Chinese medicine. I know that the patient is not ready to take Western medicine regularly for a long time, and even after my explanation, she or he still has a lot of concerns about taking Western medicine, so I will discuss with the patient, and if she or he is willing to take Chinese medicine, she or he may try using Chinese medicine alone for 2-4 months; if she or he does not want to take Chinese or Western medicine, she or he may not take it for a while. If after a few months of observation, the symptoms are still heavy, there is really no way to come back to me to prescribe it. Pay attention to less alcohol in general.
Medication can quickly and effectively relieve various anxiety and depression and somatization symptoms, but psychological guidance may sometimes be more important than taking medication, because medication cannot change the psychological and personality traits of the visitor. Counseling or psychological interview (including counseling or psychotherapy) should be a relatively quiet and closed room where the counselor does the appropriate psychological interview with the visitor for 30-60 minutes each time (consent should be obtained from the visitor after more than 60 minutes), 1-2 times a week or once every few weeks, and must be charged separately. Reasonable fees are a sign of respect for the mental work of the psychology teacher, and free of charge should be for a reason; cheap is not good enough. For those with milder problems or those dealing only with emotional problems, several sessions of psychological counseling are sufficient, while those with more serious problems or perhaps personality level adjustments may require dozens or hundreds of sessions. A hospital psychologist who spends 10-20 minutes simply asking questions and writing prescriptions is generally not considered psychological counseling. According to the current national standard, even if the psychological consultation can only charge 60-100 yuan/hour (this standard can not compensate for the brain value of high-quality psychological consultation), so most psychologists are willing to see the doctor and prescribe drugs, the willingness to really devote themselves to pure psychological consultation is not high, see a variety of high-cost psychological training is naturally not high motivation (so the general level can be imagined, the national standard forced low fees, how to How to improve the quality of brain work services?) The quality of services for mental work can be improved. Nevertheless, there are still some psychologists in the psychology department (but they are usually only willing to see patients normally, not to do general counseling, unless the visitor is reasonable and says sincerely that he/she is willing to make up for the extra mental work).
How to find the right counselor?
In addition to going to the hospital psychology department, so more to look for outside the hospital, the level of these counselors outside the hospital also varies, but more capable people outside the hospital system. Hospital charges are too low 60-100 / hour, psychologists are not motivated to talk about the motivation to spend a lot of money and energy to actively participate in a variety of psychological training at a high fee? You may want to search for “local city name of counselor” on Baidu, how the level of counselors, need to contact and examine the heart. The qualification of counselor is not easy to obtain, there is a basic training and examination certification, but to become a qualified and praised excellent counselor, is very, very difficult, personal growth background, my basic quality quality, professional teachers under the supervision of the systematic analysis of personal growth history and supervision of psychological cases, psychological team participation, enthusiasm and persistence, etc. are very important factors, and need The accumulation of time and practical work. Therefore, how can patients or families get high-quality psychological services if they do not take the trouble to look for them, and even if they do, if they are unwilling to spend financial resources and energy to cooperate?
When can medication be reduced and stopped?
The first category is forced discontinuation of medication: when the side effects are too great to tolerate, when there is an obvious conflict between certain emerging diseases and the current medication, when the medication is unavailable, or when there is no money to buy the medication. Some patients are easily influenced by people around them and stop taking their medication.
The second category is the reduction and discontinuation of medication after the symptoms have significantly improved: I often tell patients to take at least six months or more than a year of medication.
Can you stop taking the drug immediately after six months and a year?
No. When I say at least six months, I don’t say how long it actually takes! It could be six months, or it could be more than a year or three years.
When can I stop taking the medication?
If after 1-3 months of taking the medication, just as soon as they feel normal, some patients think they are well, without consulting the doctor, they can’t wait to stop the medication, the symptoms can easily reappear (not really cured, so called rekindling), the relevant anti-anxiety depression drugs have to start taking again, recalculating the time to take the medication. This will take longer and cost more money and manpower.