Managing Anxiety and Sleep Issues: Insights on Medication Adjustments

Fuanyuan tablets + issues with anxiety and restlessness?

Hello doctor, I have been taking 30 mg of Mirtazapine before bed and 0.25 mg of Clonazepam in the morning and afternoon, along with 10 mg of Propranolol three times a day.
For almost a month, I have been experiencing sudden sleepiness in the afternoon, and I have not had any panic attacks or sudden anxiety while doing anything.
My primary care physician agreed to reduce the dosage of Clonazepam to 0.25 mg (stating that the sudden sleepiness is my issue).
As a result, I encountered the following problems: I switched to taking half a tablet at noon, and initially, I did not feel sleepy in the afternoon, but after a few days, I started to experience sudden sleepiness again.
Occasionally, I feel anxious and restless in the morning (once it happened around 10 or 11 PM before I took Mirtazapine).
I am unclear whether I should reduce the dosage every 7 days or every 14 days over the course of a month.
My primary care physician mentioned that withdrawal symptoms are mild and that stopping the medication abruptly would not cause any issues, but I seem to react differently.
On the 9th day, I did not take the medication at noon and felt normal initially, but on the 10th day, I suspect I did not sleep well the night before, leading to feelings of anxiety and restlessness in the afternoon.
After a short nap, I felt fine, but when I woke up in the morning to buy breakfast, I easily experienced anxiety and restlessness.
What is going on? After taking my medication with breakfast, the effects had not yet started, but my anxiety and restlessness decreased by 50-70%.
In the afternoon, I still suddenly fall asleep.
I am starting to wonder if I need to take Clonazepam in the morning occasionally to avoid sudden sleepiness.
Additionally, since I can only take Clonazepam or antiarrhythmic medication, how should I manage my anxiety and restlessness? I keep thinking whether my anxiety and restlessness are due to my own issues that have not completely resolved or if they are a reflection of medication withdrawal.

Nìmíng, 30~39 year old female. Ask Date: 2017/04/17

Dr. Ding Shuyan reply Psychiatry

Hello, you should ask your attending physician about this.
I do not recommend asking detailed treatment-related questions to doctors you have never met online.
There are many reasons for this, including medical ethics, and there are even concerns about potential legal issues in healthcare.
Additionally, if you take responses from online doctors to discuss with your physician, I suspect very few doctors would not be frustrated by that! Such online inquiries cannot replace an in-person consultation, and even though the boundaries may be blurry, this is something we should keep in mind.
Wishing you all the best, Dr.
Ding Shuo-Yan.

Reply Date: 2017/04/17

More Info

Managing anxiety and sleep issues can be quite challenging, especially when it involves adjusting medication. From your description, it seems you are experiencing a complex interplay of anxiety symptoms, sleep disturbances, and medication side effects. Let's break down your situation and explore some insights on how to manage these issues effectively.

Firstly, it’s important to understand that medications like Fluoxetine (福安源錠) and Propranolol can have varying effects on individuals, particularly when it comes to anxiety and sleep. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat anxiety and depression, while Propranolol is a beta-blocker that can help manage physical symptoms of anxiety, such as rapid heartbeat. The combination of these medications can sometimes lead to unexpected side effects, including drowsiness or sudden sleepiness, as you've experienced.

Medication Adjustments
1. Gradual Dose Reduction: Your doctor’s recommendation to reduce the dosage of Fluoxetine is a common practice, especially if you are experiencing side effects. However, the rate at which you reduce the dosage is crucial. A general guideline is to decrease the dose gradually, often by 10-25% every 1-2 weeks, depending on how you respond. Since you mentioned feeling anxious when adjusting your medication, it might be beneficial to maintain a consistent dose for a longer period before making further reductions. This allows your body to stabilize and minimizes withdrawal symptoms.

2. Monitoring Symptoms: Keep a detailed journal of your symptoms, including your anxiety levels, sleep patterns, and any side effects you experience after changing your medication. This information can be invaluable for your healthcare provider in determining the best course of action.

3. Timing of Medication: The timing of when you take your medications can also impact your symptoms. If you find that taking Fluoxetine in the morning helps reduce daytime anxiety, it may be worth discussing with your doctor the possibility of adjusting the timing of your doses.

Managing Anxiety and Sleep
1. Cognitive Behavioral Therapy (CBT): Consider engaging in CBT, which is a highly effective treatment for anxiety and sleep disorders. CBT can help you identify and change negative thought patterns and behaviors that contribute to anxiety and sleep disturbances.

2. Relaxation Techniques: Incorporate relaxation techniques into your daily routine. Practices such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation can help reduce anxiety and improve sleep quality.

3. Sleep Hygiene: Establish a consistent sleep routine by going to bed and waking up at the same time every day. Create a calming bedtime environment, limit screen time before bed, and avoid stimulants like caffeine in the afternoon and evening.

4. Physical Activity: Regular physical activity can significantly reduce anxiety levels and improve sleep quality. Aim for at least 30 minutes of moderate exercise most days of the week, but try to avoid vigorous exercise close to bedtime.

5. Diet and Nutrition: Pay attention to your diet, as certain foods can impact your mood and sleep. A balanced diet rich in whole grains, fruits, vegetables, and lean proteins can support overall mental health.

Understanding Your Symptoms
The feelings of anxiety and sudden sleepiness you are experiencing could be related to several factors:
- Medication Side Effects: As you adjust your medication, your body may react in unpredictable ways. The drowsiness could be a side effect of Fluoxetine or a result of your anxiety levels fluctuating.

- Anxiety Symptoms: It’s also possible that your anxiety is manifesting in physical ways, such as sudden sleepiness or feelings of unease. This can happen when your body is in a heightened state of stress.

- Withdrawal Effects: If you are reducing your medication, withdrawal symptoms can include increased anxiety or changes in sleep patterns.

Conclusion
It’s essential to maintain open communication with your healthcare provider throughout this process. They can help you navigate the complexities of medication adjustments and provide support for managing anxiety and sleep issues. Remember, it may take time to find the right balance, and it’s okay to seek additional support, whether through therapy or lifestyle changes, to improve your overall well-being.

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