Anxiety relief medication

There is currently no universal "optimal choice" for clinically used drugs to relieve anxiety. The commonly used categories mainly include benzodiazepines, antidepressants, and non-benzodiazepine anti-anxiety drugs. All drugs are prescription drugs and must be used according to the doctor's advice after evaluation by a professional psychiatrist. The risks of purchasing and taking them on your own far outweigh the benefits.

Last month, I met a 27-year-old Internet operation girl at the outpatient clinic. She worked on projects until two o'clock in the morning for three months in a row. Later, her heart beat faster and she couldn't breathe as soon as she entered the conference room. In severe cases, her hands shook so much that she couldn't even hold a pen. She browsed Xiaohongshu and saw someone saying that Alprazolam was an "anxiety savior", so she bought a bottle through channels. She took half a tablet before the meeting and it really calmed her down. However, the cost was that she was groggy all afternoon. During the docking event, she missed the core needs of the customer and lost a million-dollar project. When she came to see me, her eyes were swollen like walnuts.

You may have also heard the rumor that "taking one pill will relieve anxiety". Let me pour cold water on them first: benzodiazepines such as alprazolam and lorazepam are national second-class psychotropic controlled substances, and strict control is not unreasonable. Its advantage is that it works quickly and can relieve symptoms of anxiety and panic in 15 to 30 minutes. It is suitable for emergencies. However, if you take it continuously for more than 4 weeks, the risk of addiction will increase significantly. I have seen many patients unable to sleep after taking two tablets. When they stop taking the medicine, their hands shake, sweat, and their whole body feels uncomfortable. The withdrawal reaction is ten times more uncomfortable than quitting smoking. There was a student who was taking the postgraduate entrance examination before. He took alprazolam for three months. When he finally took one tablet during the mock exam, his hands still shook. He increased the dosage and felt sleepy. In fact, it completely disrupted the review rhythm.

Many patients are confused when they first get a prescription: "I am anxious but not depressed, how can I be prescribed antidepressants?" In fact, SSRI antidepressants such as sertraline and paroxetine have long become the first-line drugs for chronic anxiety. Like benzodiazepines, it has an immediate effect and usually takes 2 to 4 weeks to take effect gradually, but it is not addictive. It is suitable for patients with generalized anxiety who feel like a stone is weighing on their hearts all year round and always think the worst when everything happens, or for patients with depression accompanied by anxiety symptoms. Many people worry that they will become stupid or dependent after taking it. In fact, most of the side effects are transient. You may feel a little nauseous and sleepy in the first week after taking it. I used to be a class teacher at a key high school. I always felt that the decline in students' grades was all my own responsibility. Before class, I had to wait in the corridor for ten minutes before entering the classroom. I took sertraline and psychological counseling for half a year. Now I can lead the graduating class. Occasionally, when I am stressed, I don't have to sleep all night like before.

There is also a "mild version" that many people are not familiar with. Non-benzodiazepine anti-anxiety drugs such as buspirone and tandospirone are non-addictive, do not make people sleepy, or affect reaction speed. However, they take effect more slowly and take 3 to 4 weeks to see the effect. They are suitable for patients whose anxiety is not particularly severe but who cannot get better over and over again, especially those who usually need to drive or do delicate operations. Taking this drug will not affect their normal work.

I have talked about this topic with many counselors who do cognitive behavioral therapy. Their view is that as long as the anxiety has not reached the level of damage to physiological functions, psychological intervention should be given priority - after all, drugs only regulate the level of neurotransmitters such as 5-hydroxytryptamine and γ-aminobutyric acid. Ping, it cannot solve the real root causes of anxiety: you are anxious about PUA in the workplace, and taking medicine can prevent you from shaking hands and insomnia, but it cannot help you deal with the boss who is looking for trouble every day; you are anxious because of the pressure of repaying loans, and taking medicine can help you sleep well, but it cannot help you increase your salary. I actually very much agree with this point. In clinical practice, we never just prescribe medication to patients. We usually recommend that patients also receive psychological counseling or actively adjust their life rhythm.

Speaking of this, some people must ask, are "natural anti-anxiety products" such as St. John's wort extract sold online safer? This is actually quite controversial. European and American naturopathic schools highly recommend this type of plant-derived ingredients, believing that they have few side effects and are suitable for people with mild anxiety. However, the common clinical view in China is that its active ingredients are unstable and will interact with many common drugs such as birth control pills, anticoagulants, and anti-epileptic drugs, affecting the efficacy of the drug. If you really want to take it, you must ask a doctor first, and don’t buy it blindly.

I have been a psychiatrist for almost 8 years, and I have seen too many people go to extremes: they either regard anxiety medicine as a scourge, and would rather take it until they have a panic attack and call 120 than refuse to take it, or they treat it as a panacea, and just take one pill when they have some troubles. In the end, relying on it only makes it more troublesome. To put it bluntly, there is no standard answer for which medicine to choose. Whether you have acute panic or chronic anxiety, whether you have any underlying diseases, whether you usually need to drive or do work with high concentration, and even your tolerance for side effects, all of these will affect the final prescription. Good medicines used by others may be completely useless or even counterproductive for you.

Oh, by the way, the previous operations girl sent me a message last week, saying that she took Sertraline for two months as prescribed by the doctor, went to jazz dance two nights a week, and quit her job last month to find a job without overtime. Now she has not even touched the first-aid medicine she had in her bag before. You see, in many cases, it’s never that little pill that can pull you out of the quagmire of anxiety, right?