Medicines to relieve anxiety and depression

Drugs currently clinically recognized as effective in relieving anxiety and depression disorders mainly include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), tricyclic antidepressants, and benzodiazepines There are four major categories of anti-anxiety drugs. In addition, there are also low-dose atypical antipsychotics used as synergists. However, there is no "optimal drug" that applies to everyone. All drugs must be used according to the doctor's advice after being evaluated by a regular psychiatrist. It is absolutely not recommended to buy drugs by yourself.

A while ago, I accompanied a friend to a specialist clinic for a follow-up consultation. I met a young girl who had just graduated and was squatting outside the clinic crying. She was holding the newly prescribed sertraline in her hand. She said that she had searched the Internet and said that taking it would make her stupid, gain weight, and not be able to have children in the future. She did not dare to take it. The director of the clinic came out to collect water and saw her. He knelt down and chatted with her for ten minutes and said, "My sister has been taking sertraline for half a year for postpartum depression. Now the baby is in kindergarten. Nothing will happen. You can take it for two weeks first. If you feel uncomfortable, come to me for treatment anytime."

The "Five Golden Flowers" (sertraline, fluoxetine, paroxetine, fluvoxamine, and citalopram) that many people are familiar with belong to the SSRI category and are currently the drug of choice for most newly diagnosed patients. The side effects are generally mild. Most people will only have mild nausea and drowsiness a week before taking the medicine, and they can get over it. But it is not suitable for everyone. I have met a patient who is a designer before. He was very anxious. After taking fluoxetine for three days, he felt restless. After a follow-up visit, he was switched to SNRI duloxetine, and the situation quickly stabilized. There have always been two tendencies in clinical medicine: one group of doctors likes to start at a low dose and slowly increase the dosage to minimize the patient's side effects; the other group will quickly increase the dose to the therapeutic window for patients with acute attacks and self-harm tendencies, believing that the sooner a stable blood drug concentration is reached, the sooner the patient can be rescued from danger. There is no absolute right or wrong, and it all depends on the patient's specific situation.

Speaking of which, the most controversial ones are benzodiazepines, such as alprazolam and lorazepam. A search on the Internet is full of posts saying "It is addictive, so don't touch it." Several young doctors I know rarely prescribe this type of medicine, fearing that patients may increase their dosage at home and become dependent on it if they take it for a long time. But there are also old directors who dare to prescribe it, especially for patients who have just been diagnosed and can't sleep all night, and have to stand up and walk twice after sitting for two minutes. They prescribe low-dose lorazepam 2-4 weeks before the antidepressant takes effect to help them cope with the most difficult time. During the period of suffering, "As long as you don't eat continuously for more than one month, the probability of addiction is not as high as if you drink milk tea every day, and it is better than the patient suffering from collapse and accident." I heard this from a director when I was in the outpatient clinic before. His words were rough but not rough.

There are also many people who got the medicine and read that it was "used to treat schizophrenia" on the instructions, and they exploded on the spot, thinking that the doctor had misdiagnosed it. In fact, in recent years, the use of low-dose atypical antipsychotics as synergists, such as quetiapine and aripiprazole, has become a very mature therapy. For those refractory patients who have failed to take two or three conventional antidepressants, they can often unexpectedly relieve symptoms. The dose is only 1/3 of the treatment for schizophrenia or even lower. There is no need to worry about "turning crazy" after taking them.

To be honest, many people do more homework before taking medicine than they do when buying the latest mobile phone. They are afraid of gaining weight, fear of memory loss, and fear of relapse when they stop taking the medicine. However, they forget that side effects are probabilistic, and what appears to others may not necessarily appear to you. I have seen a girl who gained 12 pounds after taking Paroxetine for three months, and a young man who lost 6 pounds after taking duloxetine due to poor appetite in the early stages. Some people were drowsy after taking the medicine, and some suffered from insomnia after taking it. These problems can be solved by promptly reporting to the doctor, adjusting the medicine, or using other medicines to alleviate side effects. The most taboo thing is to secretly reduce or stop the medicine on your own. Many people suddenly stop SSRI drugs and experience "electric shock" brain fog and dizziness, which are withdrawal reactions caused by indiscriminate withdrawal of medicines.

I was chatting with the nurse in the ward before, and she always said that many patients regard medicine as a life-saving elixir and think that they will be happy immediately after taking it. In fact, that is not the case at all. Medicines only help you bring your neurotransmitters back to normal levels, so that you don't have to feel like you are drowning every day, trying your best to take another breath. Only then will you have the energy to go to psychological counseling, exercise, and meet friends.

An old patient who had been taking the medicine for eight months told me that the change that impressed him most was when he was waiting at a traffic light after get off work one day. He looked up and saw a sycamore tree on the roadside. The leaves were swaying when the wind blew. He suddenly realized: Oh, it turns out that the leaves are green. Why did he always feel that the sky was gray before? You see, medicine will not directly give you happiness, it will just help you lift a corner of the gray cloth blocking your eyes.

After all, anxiety and depression are not some shameful "hypocritical diseases", and taking medicine is not a shameful thing. Just like you need to take antihypertensive medicine for high blood pressure, insulin for diabetes, and some medicine for emotional colds, why can't you take some medicine?