Managing Medication and Symptoms in Mental Health: Key Questions Answered

Q: Managing Medication and Symptoms in Mental Health: Key Questions Answered

Hello, Xiao Bi：<br>1. <br>Why is it that after experiencing autonomic nervous system dysfunction, I feel more dizzy and have chest tightness when using a computer or smartphone compared to before I got sick? Is it due to factors in the brain? The concept of psychosomatic disorder

Please consult regarding medication?

Hello, doctor.
Thank you for your previous response on https://adoctor.tw/article/106772 regarding the heart skipping a beat after every ten beats, which may indicate arrhythmia.
The cardiologist said there was nothing to worry about, but I should return to consult with the cardiologist.
I have seen a cardiologist in Taiwan, where I underwent an electrocardiogram, exercise stress test, and echocardiogram, and the cardiologist confirmed that my heart is fine.
However, since I am currently abroad and have seen a doctor here, I have encountered some language barriers that make it difficult to communicate my concerns in detail.
Therefore, I would like to ask a few questions:
1.
Why is it that after experiencing autonomic nervous system dysregulation, I feel more dizzy and have chest tightness when using a computer or smartphone compared to before I became ill? Is this due to factors related to the brain?
2.
After gradually reducing Alprazolam to once daily at a dose of 0.17 mg, should I change the reduction schedule to "once every two days" at 0.17 mg, or can I stop taking it altogether and resume only when necessary? (I have been taking it alongside Escitalopram for four weeks, and it has been effective.)
3.
Recently, I was taking Escitalopram 10 mg every night before bed and noticed I had more dreams and lighter sleep.
The doctor here suggested switching to taking it in the morning, but after taking it in the morning, I often feel dizzy one to two hours later.
What is the difference between taking Escitalopram in the morning versus at night? If I take it at night, how many hours before sleep should I take it for the best effect?
Thank you for your assistance, and I appreciate your clarification on these matters.
Thank you once again.

Xiao Bi, 40~49 year old female. Ask Date: 2016/06/15

Dr. Wu Enliang reply Psychiatry

Hello, Xiao Bi:
1.
Why is it that after experiencing autonomic nervous system dysfunction, I feel more dizzy and have chest tightness when using a computer or smartphone compared to before I got sick? Is it due to factors in the brain? The concept of psychosomatic disorders suggests that psychological conditions can affect the body.
Therefore, it is possible that dizziness and chest tightness are caused by anxiety.
2.
After gradually reducing Alprazolam to once daily at a dose of 0.17 mg, should I switch to taking it every other day at the same dose for further reduction, or can I stop the medication altogether and take it only when needed? (I have been taking it in combination with Escitalopram for four weeks, and it has been effective.) It varies by individual, but most people can discontinue the medication at such a low dose.
3.
Recently, I took Escitalopram 10 mg every night before bed and noticed I had more dreams and lighter sleep.
A physician here suggested switching to taking it in the morning, but after taking it in the morning, I felt dizzy one to two hours later.
What is the difference between taking Escitalopram in the morning versus at night? If taken at night, how many hours before sleep should I take it? It varies by individual; some people feel drowsy when taking it in the morning and prefer to take it at night, while others may sleep poorly at night and prefer morning dosing.
The dizziness and vivid dreams you mentioned can have many causes and may not necessarily be related to this medication.
Psychosomatic disorders can present with these symptoms.
As for taking it a few hours before bed, there isn't much difference; the most important thing is to take it.
If there are concerns about side effects, you could try taking half a tablet in the morning and half in the evening.

Reply Date: 2016/06/15

More Info

Managing mental health can be a complex journey, especially when it involves medication and the interplay of various symptoms. Your questions touch on several important aspects of this process, and I will address each one based on established medical knowledge and practice.

1. Why do I feel more dizzy and have chest tightness when using a computer or phone after autonomic nervous system dysregulation?
Autonomic nervous system (ANS) dysregulation can lead to a variety of symptoms, including dizziness and chest tightness. When you engage with screens for extended periods, your body may react differently due to heightened sensitivity in the nervous system. This can be attributed to several factors: prolonged screen time can lead to visual strain, which may exacerbate feelings of dizziness. Additionally, the ANS controls involuntary bodily functions, including heart rate and blood pressure, which can be affected by stress or anxiety, leading to sensations of chest tightness. It’s essential to take regular breaks from screens, practice good posture, and ensure proper lighting to minimize these symptoms.

2. Regarding the tapering of Alprazolam, should I switch to every other day at 0.17 mg, or can I stop entirely?
Tapering benzodiazepines like Alprazolam should be done cautiously to avoid withdrawal symptoms. The general recommendation is to reduce the dosage gradually rather than stopping abruptly, especially after long-term use. Switching to every other day at the same dose (0.17 mg) is a common approach to tapering. This method allows your body to adjust to lower levels of the medication. However, it’s crucial to consult with your prescribing physician before making any changes to your medication regimen, as they can provide personalized guidance based on your specific situation and response to treatment.

3. What is the difference between taking Escitalopram in the morning versus at night?
Escitalopram, a selective serotonin reuptake inhibitor (SSRI), can be taken at different times of the day depending on how it affects you personally. Taking it in the morning may help alleviate symptoms of depression and anxiety throughout the day, but some individuals may experience side effects like dizziness or increased anxiety shortly after taking it, as you noted. Conversely, taking it at night may help with sleep but could lead to grogginess the following day. The timing can also influence the medication's effectiveness and side effects. If you choose to take it at night, it’s generally recommended to take it at least a few hours before bedtime to allow the medication to take effect without interfering with sleep. Ultimately, the best approach is to monitor how you feel with each timing and discuss any concerns with your healthcare provider.

In conclusion, managing mental health medications requires careful consideration and communication with your healthcare provider. It’s essential to address any side effects or concerns you may have, as they can significantly impact your overall well-being. Regular follow-ups and open discussions about your treatment plan can help ensure that you are on the right path to managing your symptoms effectively. If you continue to experience significant issues or have concerns about your medications, seeking a second opinion or consulting a mental health specialist can provide additional support and guidance.

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