Do I Really Need Medication for Anxiety? Your Diagnosis

Is it really necessary to take medication?

Hello, doctor.
I recently visited a psychiatrist because I often worry excessively about small things.
The doctor diagnosed me with anxiety disorder and prescribed Mirtazapine (30mg), instructing me to take 15mg before bed.
On the first day I received the medication, I researched a lot of information and became very concerned about potential lifelong side effects that could alter the secretion of substances in my brain.
I also wonder if I truly have an anxiety disorder or if I simply have a personality that tends to be anxious.
Is there really an abnormality in my brain's hormones? I would like to ask, if I do not actually have an anxiety disorder and take the medication, could it cause permanent damage and affect my learning (as I am still a student preparing for graduate school)? Is it not possible to conduct a blood test to confirm whether there are abnormalities in my serotonin levels?

Chen Da Wang, 20~29 year old female. Ask Date: 2019/02/15

Dr. Huang Xiaoxian reply Psychiatry

Dear King, thank you for your question.
You mentioned that many things make you feel worried.
Based on the physician's assessment, you have been diagnosed with anxiety disorder, and the medication prescribed to you is related to the serotonin reuptake mechanism.
In simple terms, the mechanism of the medication slows down the reabsorption of serotonin in your brain, thereby increasing its concentration, rather than stimulating its secretion or providing external serotonin.
The effects will gradually diminish after discontinuation of the medication.
Additionally, our brain has many protective screening barriers that external substances (including medications) must pass through before reaching the brain.
Mirtazapine is generally considered a relatively mild medication, and the dosage you are taking is on the lower end for adults, so there is no need to worry excessively.
As for measuring serotonin levels in the brain, it cannot be done through a blood test.
Clinically, it is rare to take brain tissue samples to determine serotonin levels due to the high risks involved.
I recommend that you continue taking the medication and carefully monitor for any discomfort, discussing any concerns with your prescribing physician to alleviate your worries.
Best wishes!

Reply Date: 2019/02/15

More Info

When it comes to anxiety disorders, the decision to use medication is often a complex one that involves a thorough understanding of your symptoms, the potential benefits and risks of medication, and your personal preferences. Based on your description, it seems you have been diagnosed with an anxiety disorder, and your doctor has prescribed Mirtazapine (15 mg) to help manage your symptoms.
Firstly, it's important to clarify what anxiety disorders are. They are characterized by excessive worry, fear, or apprehension that can interfere with daily functioning. While some individuals may have a predisposition to anxiety due to personality traits, such as being more prone to worry, this does not negate the possibility of an anxiety disorder. Anxiety disorders can result from a combination of genetic, biological, environmental, and psychological factors.
Regarding your concerns about medication, it is understandable to be apprehensive about the potential side effects and long-term implications of taking psychiatric medications. Mirtazapine is classified as an atypical antidepressant and is often used to treat anxiety and depression. It works by affecting neurotransmitters in the brain, particularly serotonin and norepinephrine, which play a crucial role in mood regulation.
While it is true that some medications can have side effects, it is also important to recognize that many individuals benefit significantly from them. The goal of medication is to alleviate symptoms, allowing you to engage more fully in therapy and daily activities. In many cases, medication can help stabilize mood and reduce anxiety, making it easier to address underlying issues through psychotherapy.

You mentioned concerns about potential permanent changes to your brain chemistry. Most research indicates that while medications can alter neurotransmitter levels, they do not cause permanent damage to the brain. However, it is crucial to work closely with your healthcare provider to monitor your response to the medication and make adjustments as necessary. If you experience side effects or feel that the medication is not helping, it is essential to communicate this with your doctor.

As for the idea of testing for serotonin levels, currently, there are no standard blood tests that can definitively diagnose anxiety disorders or measure neurotransmitter levels in a way that would guide treatment. The diagnosis of anxiety disorders is primarily based on clinical evaluation, including your reported symptoms and their impact on your life.

In conclusion, whether or not you need medication for anxiety depends on the severity of your symptoms and how they affect your daily life. If your anxiety is significantly impairing your ability to function, medication may be a helpful option. It is also important to consider combining medication with therapy, such as cognitive-behavioral therapy (CBT), which has been shown to be effective for anxiety disorders.
Ultimately, the decision to take medication should be made collaboratively with your healthcare provider, considering your specific situation, preferences, and treatment goals. If you have doubts or concerns, don't hesitate to discuss them with your doctor. They can provide you with more information and help you make an informed decision about your treatment plan. Remember, managing anxiety is a journey, and finding the right approach may take time and adjustments along the way.

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