Managing Depression and Generalized Anxiety: Medication Concerns and Alternatives

Q: Managing Depression and Generalized Anxiety: Medication Concerns and Alternatives

Hello, netizen： <br>Question 1： Can I reduce the dosage of my antidepressants? The first doctor has prescribed： morning and evening, 12.5 mg of Clomipramine (克憂果) 1 tablet; at bedtime： 0.5 mg of Zolpidem (讚安諾) 1 tablet, 50 mg of Mirtazapine (美舒鬱) 1 tablet, and 1 mg of Buspirone (

Mild Depression Generalized Anxiety Disorder

Currently, the health insurance app shows a diagnosis of mild depression and generalized anxiety disorder.
From what I've seen online, mild depression doesn't necessarily require medication, and some people can recover on their own.
However, the doctor I consulted prescribed me a lot of medications.

Question 1: Can I take fewer antidepressants? The first doctor prescribed:
- Morning and evening: Clomipramine 12.5 mg, 1 tablet
- At bedtime: Zolpidem 0.5 mg, 1 tablet
- Mirtazapine 50 mg, 1 tablet
- Buspirone 1 mg, 1 tablet
Question 2: The second doctor prescribed:
- Dinner: Paroxetine 100 mg, 0.5 tablet, 1 tablet
- At dinner: Venlafaxine 30 mg, 1 tablet
- At bedtime: Venlafaxine 30 mg, 1 tablet
- Quetiapine 25 mg, 0.5 tablet
That doctor said these medications, along with those prescribed by another doctor, can be taken together for better results.
I want to ask: Is this really okay? Is it too much medication? I'm a bit worried that withdrawal will be very painful later on.

Luo, 20~29 year old female. Ask Date: 2020/10/30

Dr. Wu Enliang reply Psychiatry

Hello, netizen:
Question 1: Can I reduce the dosage of my antidepressants? The first doctor has prescribed: morning and evening, 12.5 mg of Clomipramine (克憂果) 1 tablet; at bedtime: 0.5 mg of Zolpidem (讚安諾) 1 tablet, 50 mg of Mirtazapine (美舒鬱) 1 tablet, and 1 mg of Buspirone (悠然錠) 1 tablet.

Answer: You can reduce the dosage, but it is important to assess your clinical condition.
Please discuss this with your physician.
Question 2: The second doctor prescribed: at dinner, 100 mg of Venlafaxine (憂解) 0.5 tablet, 30 mg of Paroxetine (萬優停) 1 tablet; at bedtime: 30 mg of Paroxetine (萬優停) 1 tablet, and 25 mg of Quetiapine (腦樂靜) 0.5 tablet.
That doctor said that taking these medications along with those prescribed by another doctor would enhance the effect.
I would like to ask: is this really okay? Won't this be too much medication? I'm a bit worried that withdrawal will be very painful.

Answer: If you add the medications from the other doctor, it indeed seems excessive, as it would result in four different antidepressants.
I recommend that you return for a follow-up and discuss your concerns with your physician.
Dr.
Wu Enliang

Reply Date: 2020/10/30

More Info

Managing depression and generalized anxiety disorder (GAD) can be a complex process, especially when it comes to medication. Your concerns about the number of medications prescribed and their potential side effects are valid and deserve careful consideration.

Understanding Your Diagnosis
Firstly, it’s important to clarify that both mild depression (often referred to as "light depression") and GAD can vary significantly in their severity and impact on daily life. While some individuals may experience improvements through lifestyle changes, therapy, or self-management strategies, others may require medication to help manage their symptoms effectively.

Medication Overview
From your description, it appears that you are currently prescribed multiple medications, including:
1. 克憂果 (Citalopram) - An SSRI (selective serotonin reuptake inhibitor) commonly used to treat depression and anxiety.

2. 讚安諾 (Alprazolam) - A benzodiazepine often prescribed for anxiety; it can be effective for short-term relief but may lead to dependence if used long-term.

3. 美舒鬱 (Mirtazapine) - An antidepressant that can help with sleep and appetite but may cause weight gain.

4. 悠然錠 (Buspirone) - An anxiolytic that is often used for chronic anxiety and has a lower risk of dependence compared to benzodiazepines.

5. 憂解 (Duloxetine) - An SNRI (serotonin-norepinephrine reuptake inhibitor) that can help with both depression and anxiety.

6. 萬優停 (Venlafaxine) - Another SNRI, effective for anxiety and depression.

7. 腦樂靜 (Quetiapine) - An atypical antipsychotic that can be used for mood stabilization and anxiety.

Concerns About Polypharmacy
Your concern about taking multiple medications is understandable. Polypharmacy, or the use of multiple medications, can increase the risk of side effects and drug interactions. It’s crucial to have a healthcare provider who is aware of all the medications you are taking and who can monitor your response to them.
1. Can you take fewer medications? - It is possible to manage depression and anxiety with fewer medications, especially if your symptoms are mild. However, this should be done under the guidance of a healthcare provider. They can help you taper off medications safely and monitor for any withdrawal symptoms or return of anxiety/depression.

2. Is it safe to combine these medications? - The combination of medications prescribed by different doctors can be concerning. While some combinations can be effective, others may lead to increased side effects or interactions. It’s essential to have a primary care physician or psychiatrist who can coordinate your care and ensure that the medications prescribed are safe to take together.

Withdrawal and Discontinuation
Your worry about withdrawal symptoms is valid, especially with medications like benzodiazepines and certain antidepressants. Tapering off these medications should always be done gradually and under medical supervision to minimize withdrawal symptoms.

Alternatives to Medication
If you feel that medication may not be the best option for you, or if you wish to explore alternatives, consider the following:
1. Psychotherapy: Cognitive-behavioral therapy (CBT) is particularly effective for both depression and anxiety. It can help you develop coping strategies and address negative thought patterns.

2. Lifestyle Changes: Regular exercise, a healthy diet, and adequate sleep can significantly impact your mood and anxiety levels. Mindfulness practices, such as meditation or yoga, can also be beneficial.

3. Support Groups: Engaging with others who have similar experiences can provide emotional support and practical advice.

4. Consultation with a Pharmacist: A pharmacist can provide valuable insights into your medications, including potential interactions and side effects.

Conclusion
In summary, managing depression and GAD often requires a multifaceted approach that includes medication, therapy, and lifestyle changes. It’s crucial to communicate openly with your healthcare providers about your concerns regarding medications and to work together to find the best treatment plan for you. If you feel overwhelmed by the number of medications or their side effects, do not hesitate to seek a second opinion or ask for a medication review. Your mental health is paramount, and there are many paths to achieving stability and well-being.

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