Drugs to relieve depression and anxiety

Currently, drugs that are clinically recognized as effective in relieving depression and anxiety are mainly divided into three categories: antidepressants, short-acting anti-anxiety drugs, and synergists. However, all drugs are psychotropic prescription drugs and must be prescribed by a regular psychiatrist after assessing the degree of symptoms and basic physical conditions and used according to the doctor's instructions. , there is no "miracle drug" that is suitable for everyone - it is the consensus of the academic community to prioritize medication during moderate to severe depression and anxiety attacks. However, whether mild to moderate symptoms require immediate medication, doctors from different schools have great differences in their considerations. The long-term prognostic effect of medication alone is usually weaker than that of medication combined with psychological intervention.

I just went to a follow-up visit last week with a friend who was diagnosed with moderate anxiety and depression. She has been taking Sertraline for three months. When she first went to the hospital for the first time, she held my hand and gasped for a long time. Now after seeing the doctor, she can hold my hand and squat on the stall at the entrance of the hospital to eat grilled sausages. She can also complain about missing two days of medicine in the past two weeks, and she feels dizzy for a long time as if there is a small disco ball hidden in her head.

Attitudes towards this type of medicine on the Internet are extremely polarized nowadays. On one side are the fearful people who say "taking medicine is equivalent to having a mental illness, and the side effects are so severe that it will damage the brain. You should never take it", and on the other hand there are the mythical people who "have been feeling emo lately and don't want to move, so I quickly prescribed some happy pills and felt great immediately after taking them." What's interesting is that both of these views can find corresponding supporting evidence in clinical practice, but they only account for a small half of the truth.

The "happy drugs" that everyone often refers to are SSRI antidepressants, which are often referred to as the "five golden flowers" in clinical practice: sertraline, fluoxetine, paroxetine, fluvoxamine, and citalopram. The principle of this type of drug is to increase the concentration of serotonin in the brain. Many people think that taking it will make them happy out of thin air. In fact, this is not the case at all. My friend said that it is more like lifting the wet quilt that covers the emotions. Before, even winning a prize felt boring. Now when I eat delicious sausages and see a beautiful sunset, I can really feel happy. It is not like watching the world through a layer of glass like before. But its shortcomings are also obvious: it takes 2-4 weeks to slowly take effect. In the first week, most people will experience nausea, dizziness, and loss of appetite. A small number of people will also experience side effects of sexual dysfunction. Many people feel uncomfortable after taking it for two or three days and stop taking it directly. On the contrary, they are prone to more uncomfortable withdrawal reactions.

Compared with antidepressants that require "slow heating", short-acting anti-anxiety drugs such as benzodiazepines are "emergency special forces". The most common ones are alprazolam and lorazepam. When you have a panic attack, put half a tablet under the tongue, and you can calm down in ten or twenty minutes. I once met a client who suffered from panic disorder. He always carried 7 tablets of Laura prescribed by the doctor in his bag. He said that last time he suddenly couldn't breathe on the subway and felt like he was going to die. After taking half a tablet, he could talk to people normally as soon as he got to the next stop. However, this type of medicine must not be taken for a long time. If you take it continuously for more than two weeks, you may become addicted. Therefore, doctors generally only prescribe a small amount of emergency medicine and will not let you take it as daily medicine.

If you not only have emotional problems, but also have headaches and backaches every day, and feel uncomfortable all over the body but no organic problems can be found, the doctor may prescribe you SNRI drugs, such as venlafaxine and duloxetine. These drugs act on both serotonin and norepinephrine, and are more effective for patients with physical symptoms. For some more complex situations, doctors may prescribe low-dose mood stabilizers or atypical antipsychotics as synergists, such as low-dose quetiapine. Many people are frightened when they see the word "antipsychotic." In fact, small doses are only used to help stabilize your mood and improve sleep. They are far from the dosage used to treat schizophrenia, so don't scare yourself.

As for the controversial point of "whether to take medicine for mild to moderate symptoms", doctors with different orientations do have different opinions: Most evidence-based doctors will recommend that if you have sleep disorders and impaired social functions (such as being unable to go to work or school, or struggling to wash up), you should give priority to taking medicine to improve your condition. , to prevent symptoms from getting worse; doctors who prefer integrated treatment may recommend trying cognitive behavioral therapy or mindfulness intervention for 4-8 weeks first. If the adjustment cannot be made, then consider medication. After all, many studies have shown that the effect of medication and placebo is not significant in patients with mild to moderate depression and anxiety. Among the clients I have come into contact with, there are some who slowly stopped taking medication for half a year and are now in a very stable state, and there are also some who are unable to tolerate even three different medications, and finally adjusted back to their state by exercising twice a week and practicing mindfulness. There is really no unified standard answer.

Seriously, don’t think of these medicines as a scourge, and don’t think of them as a magic elixir that can solve all problems. They are essentially crutches - when you fall and break your leg and cannot stand up, holding on will only make the injury worse. Use the crutches for a while, and then slowly throw them away when your own legs are stronger. The most taboo thing is to blindly search for information and buy random medicines, or ask a doctor for the same medicine after hearing what others say is good. Everyone's physical condition and symptoms are very different. What works for others may have severe side effects on you. Finding a reliable psychiatrist and following the doctor's advice is better than anything else. Oh, by the way, don’t drink alcohol or strong tea while taking the medicine. If the side effects are so severe that you can’t stand it, don’t bear it. Go directly to the doctor to adjust the medicine. There is no need to endure it yourself.