Managing Anxiety and Sleep Issues: Medication Consultation Insights

Q: Managing Anxiety and Sleep Issues: Medication Consultation Insights

Hello： 1. <br>Currently, both Anxiolytic and Rifampicin are at low doses, and they should be able to be discontinued once the condition improves. <br>2. <br>After improvement, it is advisable to stabilize for one to two weeks before gradually tapering off the medication, which sh

Medication consultation

Hello Doctor, my husband has been experiencing anxiety, worry, and sleep disturbances due to some events that occurred last year.
After encouragement from family and friends, he began seeing a psychiatrist in November.
The doctor prescribed the following medications: 1.
Xanax (Alprazolam) 0.5 mg, to be taken once at bedtime; 2.
Rivotril (Clonazepam) 0.5 mg, to be taken once at bedtime; 3.
Rhythmol (Propafenone) 10 mg, to be taken twice daily, morning and evening.
He sometimes reduces the dose to half due to concerns about drug dependence.
Recently, he has been waking up around 1 or 2 AM and unable to fall back asleep, with racing thoughts.
During his follow-up appointment yesterday, the doctor added Effexor (Venlafaxine) 30 mg, to be taken as 15 mg at bedtime, and changed Rivotril to half a tablet taken in the morning and evening.
My questions are:
1.
Are Xanax and Rivotril controlled substances, and is it difficult to stop taking them once started?
2.
If his anxiety and sleep improve, can he reduce the dose on his own?
3.
Will taking half a tablet of Rivotril in the morning make him feel sluggish during the day?
4.
He hadn't started taking Effexor yet, but when he woke up around 1 AM and took it at 3 AM, he was able to fall asleep again.
However, he woke up feeling sleepy again until noon.
Could taking Effexor so late cause him to sleep until noon? If he takes it earlier at bedtime, will it prevent him from sleeping in so late? I'm quite worried since he needs to work during the weekdays.
Thank you, Doctor.

Niming, 40~49 year old female. Ask Date: 2017/11/04

Dr. Liang Sunyuan reply Psychiatry

Hello: 1.
Currently, both Anxiolytic and Rifampicin are at low doses, and they should be able to be discontinued once the condition improves.
2.
After improvement, it is advisable to stabilize for one to two weeks before gradually tapering off the medication, which should increase the chances of successful discontinuation.
3.
Individual responses to medication can vary; indeed, some people may experience decreased energy during the day when taking Rifampicin.
4.
Taking Antidepressants before bedtime is indeed preferable.
If there are still concerns, it is recommended to return for a follow-up appointment and discuss them with the physician in person.

Reply Date: 2017/11/04

More Info

Dear Concerned Individual,
Thank you for reaching out with your questions regarding your husband's anxiety and sleep issues. It’s clear that both of you are navigating a challenging situation, and I appreciate your proactive approach to seeking information about his medication and overall well-being. Let’s address your concerns one by one.

1. Dependency on Controlled Substances: Both Zolpidem (known as "贊安諾") and Risperidone (referred to as "利福全") are indeed classified as controlled substances. Zolpidem is primarily used for short-term management of insomnia, while Risperidone is an antipsychotic that can also help with anxiety and mood stabilization. The concern about dependency is valid; however, when these medications are used as prescribed by a healthcare professional and for a limited duration, the risk of developing a dependency can be minimized. It’s essential to follow the doctor’s guidance and not to abruptly stop taking these medications without consulting them first.

2. Adjusting Medication Doses: If your husband feels that his anxiety and sleep issues are improving, it is crucial to discuss any changes in medication with his healthcare provider. While some patients may feel comfortable reducing their doses, this should always be done under medical supervision. The doctor can provide a tapering schedule that minimizes withdrawal symptoms and ensures that his mental health remains stable.

3. Morning Drowsiness from Risperidone: Taking half a dose of Risperidone in the morning may lead to some drowsiness, especially if he is sensitive to the medication. It’s important to monitor how he feels after taking it. If he experiences significant drowsiness that interferes with his daily activities, it may be worth discussing with his doctor. Adjustments can be made to the timing or dosage to help him maintain alertness throughout the day.

4. Timing of Medications and Sleep Patterns: The timing of medication can significantly impact sleep quality and daytime alertness. If your husband took the new medication (Sertraline, referred to as "憂癒平") late at night, it could indeed contribute to him waking up later in the day. Ideally, medications intended to aid sleep should be taken at least 30 minutes to an hour before bedtime. If he is concerned about waking up late for work, it would be wise to discuss with his doctor the best time to take this medication to align with his work schedule.

In addition to medication management, it may be beneficial for your husband to explore non-pharmacological approaches to managing anxiety and sleep issues. Cognitive Behavioral Therapy (CBT) has been shown to be effective for both anxiety and insomnia. Techniques such as mindfulness, relaxation exercises, and establishing a consistent sleep routine can also help improve sleep quality.

Lastly, encourage open communication between your husband and his healthcare provider. Regular follow-ups can help ensure that his treatment plan is effective and adjusted as needed. It’s essential to prioritize his mental health while also considering the impact of medication on his daily life.

I hope this information provides clarity and reassurance as you navigate this journey together. Wishing you both the best in managing these challenges.

Sincerely,
Doctor Q&A Teams
Medical Expert

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