Managing Anxiety and Medication: Insights for Patients with Lumps

Q: Managing Anxiety and Medication: Insights for Patients with Lumps

Hello, Xiao Ke： Since you have already seen three doctors who all believe it is a lymph node issue, you should not worry too much about it. <br>It is advisable to accept that you tend to be anxious and not to focus too much on whether you are touching that lymph node. <br>Remind

Inquiries about emotional and medication issues?

Hello Doctor, about a month and a half ago, I noticed a lump under my left neck near the clavicle.
Its size hasn't changed significantly, remaining less than one centimeter, and it feels somewhat flat (it seems to fluctuate in size and consistency, sometimes feeling soft and sometimes hard).
I have seen two ENT specialists and one surgeon, all of whom told me it is just a lymph node.
However, I tend to get anxious easily and keep pressing on that lump, which leads me to think negatively.
As a result, I have lost almost 10 kilograms in a little over a month due to decreased appetite.
I later consulted a psychiatrist who prescribed Lexapro 10mg and Eurodin (both to be taken at bedtime).
I would like to ask you the following questions:
1.
The psychiatrist mentioned that I have generalized anxiety and catastrophic thinking, but the lump is a real concern for me.
Every time I touch it, I become very worried.
Do you have any better suggestions?
2.
I feel that the medication hasn't improved my condition much.
I can fall asleep at night, but I often have vivid dreams and shallow sleep, waking up easily.
I usually wake up around 4 or 5 AM (often dreaming about the lump, such as being in a consultation or undergoing tests).
Am I reliant solely on medication for improvement? Are there other techniques I can train myself in?
3.
The doctor told me that I cannot stop taking Lexapro 10mg on my own, as it may cause side effects.
Is this true?
I apologize for the disturbance and appreciate your guidance.

Xiao Ke, 30~39 year old female. Ask Date: 2018/03/26

Dr. Liang Sunyuan reply Psychiatry

Hello, Xiao Ke: Since you have already seen three doctors who all believe it is a lymph node issue, you should not worry too much about it.
It is advisable to accept that you tend to be anxious and not to focus too much on whether you are touching that lymph node.
Remind yourself to shift most of your attention to other events in your daily life.
Your sleep quality can serve as an indicator of recovery; if you are sleeping well and soundly, it indicates that your anxiety is gradually improving.
If you wake up at night, try not to feel too frustrated.
Instead, calmly lie in bed; even if you do not fall back asleep immediately, your body and brain will still get some rest.
The discontinuation of medication is usually done gradually after symptoms have improved for a period of time, so it is recommended to cooperate closely with your outpatient physician.
Most symptoms of anxiety and depression can be improved.
Wishing you a speedy recovery.

Reply Date: 2018/03/26

More Info

Managing anxiety, especially when it is linked to physical symptoms such as lumps or swollen lymph nodes, can be challenging. Your situation, where you have identified a lump in your neck and have been experiencing significant anxiety about it, is not uncommon. Let's address your questions one by one.

1. Understanding Your Anxiety and the Lump: It is understandable that you are feeling anxious about the lump you discovered. The fact that multiple doctors have assessed it and concluded that it is likely a lymph node is reassuring. Lymph nodes can fluctuate in size and consistency based on various factors, including infections or stress. Your anxiety may be exacerbating your focus on this lump, leading to a cycle of worry and physical tension. It might be beneficial to practice mindfulness techniques or cognitive behavioral therapy (CBT) strategies to help manage your thoughts. These approaches can help you reframe your thinking about the lump and reduce your anxiety.

2. Sleep and Medication Concerns: It is common for individuals taking medications like Lexapro (escitalopram) to experience changes in sleep patterns, including vivid dreams or shallow sleep. While medication can be helpful, it is not the only solution. You might consider implementing sleep hygiene practices, such as establishing a regular sleep schedule, creating a calming bedtime routine, and minimizing screen time before bed. Additionally, relaxation techniques such as deep breathing exercises, progressive muscle relaxation, or guided imagery can help improve sleep quality. If you continue to have issues, discussing these side effects with your prescribing physician is essential, as they may adjust your medication or suggest alternatives.

3. Stopping Medication: It is crucial to follow your psychiatrist's advice regarding the discontinuation of Lexapro. Stopping antidepressants suddenly can lead to withdrawal symptoms, which may include mood swings, irritability, dizziness, and flu-like symptoms. If you feel that the medication is not working for you, it is important to communicate this with your doctor. They can help you taper off the medication safely if necessary and explore other treatment options, including therapy or different medications.

In summary, managing anxiety, especially when it is tied to physical health concerns, requires a multifaceted approach. While medication can be a valuable tool, incorporating lifestyle changes, therapy, and mindfulness practices can enhance your overall well-being. If your anxiety persists or worsens, consider seeking further evaluation from a mental health professional who can provide tailored strategies to help you cope with your concerns. Remember, you are not alone in this, and there are effective ways to manage both your anxiety and your physical health concerns.

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