Anxiety disorders are a mood disorder with good treatment outcomes and a good prognosis, so even if you are diagnosed with anxiety, there is no need to worry too much. Treatment for anxiety disorders usually includes medication and psychotherapy.
Medication
1.Benzodiazepines (also known as Valium)
(1) Advantages.
(1) Fast onset of action, mostly within 30-60 minutes.
(2) Anti-anxiety effect is certain.
(3) The price is generally relatively cheap.
(2) Disadvantages.
① short duration of effect, not suitable for long-term use in large quantities.
(2) Possible dependence. Anti-anxiety drugs, like a car too fast, with the foot on the brake, works but is not suitable for common use.
(3) commonly used drugs.
①Lorazepam (lorazepam): commonly used dose is 0.5-1.0mg 2-3 times a day.
②Alprazolam (Jiajing Valium): the commonly used dose is 0.4mg 2-3 times a day.
③Oxazepam tablets (Ufie): the common dose is 15mg 2-3 times a day.
These three drugs belong to the short and medium-acting Valium class of drugs, anxiolytic effect is good, the sedative effect is relatively weak, the impact on the daytime work is smaller. 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 the Valium class of drugs.
① intermittent dosing principle: temporary oral when anxiety is severe, not long-term large amounts.
② small dose principle: a small dose works without a large dose.
(3) The principle of regular medication changes: If the condition requires long-term use of Valium anti-anxiety drugs, 3-4 weeks to change to another Valium drug, which can effectively avoid the emergence of dependence. Note that when changing medication, the original medication is slowly reduced, and the new medication is slowly added, and after a period of time when the two medications are crossed, the original medication is withdrawn and the new medication is added to the therapeutic amount. If the patient is older, the dose of the drug is not large, and the therapeutic effect is good, it is possible not to change the drug. As long as the dose of Valium does not increase, it is within the normal range, and the therapeutic effect does not diminish, it can be considered that no dependence has arisen.
Personal clinical experience.
In the early treatment of anxiety disorders, it is necessary to use Valium-type anti-anxiety drugs in sufficient quantity as soon as possible in order to control anxiety as soon as possible, because it often takes 2-3 weeks for antidepressants to exert their anti-anxiety 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
If you use the metaphor of anxiety with a car going too fast, then antidepressants are loose throttle and 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.
Choice of medication.
①Generalized anxiety: my most commonly used drugs are: paroxetine (Celerity, Loyola, etc.), escitalopram (Lexapro, Prozac, etc.), duloxetine (Ospin, Symbalta), venlafaxine (Boloxin, Enos),.
②Panic attack: Paroxetine (Celerity, Loyola), Escitalopram (Lysop, Procter) are preferred, and the second-line drug is Clomipramine.
(iii) Social anxiety (social terror): first-line drugs are paroxetine, buspirone, second-line drugs are escitalopram, sertraline, venlafaxine.
Personal clinical experience is that paroxetine, escitalopram, and duloxetine are more effective, with slightly greater side effects of paroxetine and relatively less side effects of escitalopram and duloxetine.
The characteristics of these drugs are.
(1) Advantages.
① affirmative anti-anxiety effect.
(ii) Fundamental improvement of anxiety.
(3) Non-addictive, suitable for long-term use.
(2) Disadvantages.
The anxiolytic effect is slow and takes effect after 2-3 weeks, and it is often necessary to combine with Valium drugs for a short period of time. The doctor will usually consider the specific drug to be used according to the patient’s condition, physical condition, economic situation and other factors.
Caution.
①Anxiety may increase at the beginning of the medication, related to the side effects of the medication, and usually disappears after 2 weeks. If anxiety is obvious, add Valium in time to relieve anxiety.
②After 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.
③Side effects may occur while taking the 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.
④Individualized differences in psychiatric medications mean that different patients, with the same diagnosis, same age and gender, and similar physique, have significant differences in the effects of medication. The dose of medication that takes effect and the side effects of the medication can also be used with great variation. 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.
Combined with clinical experience with medication, review these drugs.
①Paroxetine tablets: trade name Sellett, Leyou, etc., belong to the SSRI class of drugs, acting on the 5-HT system, commonly used dose of 20-60mg/day, a single dose can be, anti-anxiety effect, 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 taking Celerity, take a quarter to half a tablet, and then increase it to 0.5-1 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 dose; individual patients will have transient hypertension, hypertensive patients need to monitor blood pressure, the shortcomings of this drug is the side effects are large, pay attention to the dose grasp when using the drug and the skill of adjusting the drug is critical.
②Escitalopram: 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.
It is also a dual-receptor drug, acting on both 5-HT and NE neurotransmitters, and the common dose is 60mg-120mg/day. The most important feature of this drug is that it has its advantages in the degree of dual-receptor action, with good antidepressant and anxiolytic effects, especially for patients with somatization symptoms and chronic pain. It is especially suitable for symptoms of somatization and chronic pain.
Venlafaxine: the trade name is Enos, Boloxin, and there are both extended-release and immediate-release formulations. It is a dual-receptor drug, acting on both 5-HT and NE neurotransmitters, with a common dose of 75-225mg/day, with good antidepressant and anxiolytic effects. Note that there is a possibility that anxiety will increase at the beginning of the drug, you need to add Valium, which usually lasts for two weeks mostly disappears.
Drugs like sertraline, Lanxai, Xipomol, fluoxetine, clomipramine, etc. are often used as the second tier of drugs.
3.Butrosterone, 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.
4.Other drugs
①Attenolol 12.5-25mg and propranolol 10-20mg can be considered for acute anxiety attack, which can improve the symptoms.
②Tricyclic antidepressants: 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.
It is a mixture of an antipsychotic and an antidepressant.
As for which drug is appropriate for each patient, it is necessary to consider the patient’s condition, previous medication experience, efficacy after taking the drug, 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 the patient and adjust the treatment plan at any time, so that the patient can gradually move towards recovery.
5.Chinese medicine treatment.
Chinese medicine dialectical treatment, acupuncture treatment and massage treatment have certain efficacy.
Psychotherapy
Psychotherapy refers to the clinician establishing a good doctor-patient relationship with the patient through verbal or non-verbal conversation, applying knowledge about psychology and medicine to guide and help the patient overcome and correct poor lifestyle, behavioral habits, emotional disorders, cognitive biases, and adaptation problems. Medication and psychotherapy are the two legs of helping patients with anxiety disorders recover, equally important, inseparable and essential. Bottom line: Psychotherapy is an interactive interpersonal process that is planned and implemented by professionals for the purpose of helping and curing people
So what is the most appropriate person to see for psychotherapy?
(1) There are some psychiatrists whose specialty is psychotherapy and who have received systematic training in psychotherapy, and it is most appropriate to find these psychiatrists to do psychotherapy because they are the most competent psychiatrists.
(2) Clinical psychologists, such as hospital psychotherapists, etc. Suitable psychotherapy for anxiety disorders are: supportive therapy, behavioral therapy, cognitive therapy, biofeedback therapy, etc.
(3) Chinese medicine psychotherapy: Based on the theory and practice of Chinese medicine, combined with the knowledge of modern psychology, it is a science that studies psychological phenomena, the laws of mental diseases and treatment. It is a combination of traditional Chinese medicine qigong therapy and western hypnotherapy and cognitive therapy, and through verbal and behavioral induction, the treated person enters a certain intermediate state of the process from wakefulness to sleep, and a certain “idea, concept” composed of verbal and behavioral information is formed by the therapist according to certain treatment needs. “TIP is an innovative Chinese psychotherapy method that has been developed through more than 20 years of clinical practice and has become a complete technical system. The unique advantage of TIP therapy, combined with our self-developed retrospective personality questionnaire, is that it can discover the personality problems of patients during their growth process, and allow the defective personality of anxiety patients to grow again during treatment, thus reshaping their personality, improving the personality susceptibility of anxiety patients, increasing the treatment compliance of anxiety patients, reducing the relapse rate, and potentially improving the prognosis of anxiety disorders from the root. This treatment is also in line with the characteristics of Chinese medicine that the treatment must be based on the root of the disease.
The following relaxation therapy is introduced to you.
Relaxation training is to achieve psychological relaxation through physical relaxation, relatively simple such as deep whistling method: anxiety when the eyes closed, slowly inhale through the nose, mouth and nose whistling, repeated three to five times, excessive tension, anxiety, first lightly close the eyes, the whole body relaxed, do several even and rhythmic deep whistling, repeatedly self-cue: “Do not rush “, “relax, relax”, after a few minutes, the emotions will be smooth. You can also use meditation: that is, consciously think of something that makes you very happy and relaxed, as real and specific as possible, can also make you relax.
Prognosis of the disease
The prognosis for anxiety disorders is often good. After treatment, the majority of patients will recover and resume their old smiles, with special attention needed: after the symptoms have subsided, it is recommended to take medication for about 1-2 years. For all types of anxiety disorders, it is necessary to insist on taking antidepressants for a certain period of time; please consult your doctor for stopping the medication and increasing or decreasing the dosage, and never adjust the medication regimen on your own to avoid aggravating the disease.
Opinions
1. Anxiety disorders are the most common mood disorders; they are treatable and preventable, and the prognosis is very good.
2, anxiety disorders need to be treated with medication under the guidance of a psychiatrist, and it is necessary to adhere to the medication for a period of time after the symptoms are relieved, and not to stop the medication on your own. In combination with psychotherapy, the effect is better for the recovery of anxiety disorders.
3.Duloxetine (Ospin, Cymbalta), paroxetine (Celerity, Loyola), escitalopram (Lysop, Procter), venlafaxine (Enos, Boloxin), etc. are the first-line drugs for anxiety disorders with excellent efficacy, and the early combination of valium drugs is more significant to improve anxiety as soon as possible.
4, it is recommended that the majority of patients learn more about various mental health general knowledge, so that early detection, early diagnosis and early treatment of the disease, to reduce the pain, is of great significance.