Anxiety Medication Changes: Struggling with Increased Insomnia

Q: Anxiety Medication Changes: Struggling with Increased Insomnia

Hello： Anning capsules are a short to intermediate-acting benzodiazepine (BZD) medication. <br>After discontinuation, some individuals may indeed experience withdrawal symptoms such as anxiety, restlessness, and rebound insomnia. <br>However, if you resume taking Anning capsules,

After medication for anxiety, insomnia has worsened?

I have anxiety and panic.
I have already sought treatment from a psychiatrist, who prescribed me one capsule of Yongkangxu (安寧膠囊) in the morning and evening.
Before bed, I take half a capsule of Daomeisleep (導美睡) and one capsule of Lifuqquan (利福全).
I have been taking these medications for over 45 days.
During my last outpatient visit, the doctor adjusted my medication and advised me to stop taking the evening capsule of Yongkangxu.
However, two days later, I noticed that I felt very uneasy and my anxiety increased (similar to a panic attack).
At around 10:30 PM, I took half a capsule of Daomeisleep and one capsule of Lifuqquan.
About 30 minutes later, I felt very drowsy, but when I lay down, I felt restless.
I reported this to my doctor, who suggested that I return to taking the Yongkangxu capsule at the original times and come back for further medication adjustments.
I feel like all my previous treatment has reset to the beginning.
Am I now afraid every night about whether I will be able to fall asleep? Is this a sign that my condition is worsening? Or is it that the medication is not effective enough?

Jiang oo, 30~39 year old female. Ask Date: 2020/11/09

Dr. Wang Yaoting reply Psychiatry

Hello: Anning capsules are a short to intermediate-acting benzodiazepine (BZD) medication.
After discontinuation, some individuals may indeed experience withdrawal symptoms such as anxiety, restlessness, and rebound insomnia.
However, if you resume taking Anning capsules, you may still experience heightened anxiety.
The likelihood of insufficient drug concentration is low, as taking the medication for a few days to a week will stabilize the drug levels.
Although you are concerned about having to restart treatment, I still recommend discussing your worries with the physician you originally consulted, as they are the most familiar with your condition.
I hope this answers your question :)

Reply Date: 2020/11/09

More Info

It sounds like you are experiencing a challenging time with your anxiety and medication adjustments. It's important to understand that changes in medication, especially for anxiety and related disorders, can lead to fluctuations in symptoms, including increased anxiety and insomnia.
When you were prescribed the 安寧膠囊 (Anxiolytic capsules) and other medications, they were likely intended to help manage your anxiety and improve your sleep. However, when your doctor adjusted your medication regimen by removing the evening dose of the 安寧膠囊, it is not uncommon for patients to experience a rebound effect, which can include heightened anxiety and difficulty sleeping. This is particularly true for benzodiazepines, which are often used for anxiety and can lead to withdrawal symptoms when the dosage is altered or stopped abruptly.

Your experience of feeling more anxious and having trouble sleeping after the medication adjustment suggests that your body may be reacting to the change. The fact that you felt a sense of calm after taking the 导美睡 (Doxepin) and 利福全 (Rifampicin) but still experienced anxiety when trying to sleep indicates that your anxiety may not be fully managed with the current regimen. It’s also possible that the medications you are taking may not be adequately addressing your specific symptoms, or that the dosage may need to be adjusted.

It's crucial to communicate openly with your healthcare provider about your symptoms. Since you mentioned that you feel like your treatment has reset, it’s essential to express this to your doctor. They need to know how the changes are affecting you so they can make informed decisions about your treatment plan. It may be beneficial to discuss the possibility of reinstating the evening dose of the 安寧膠囊 or exploring other medication options that could provide better symptom control without causing excessive sedation or anxiety.

In addition to medication, consider incorporating non-pharmacological strategies to help manage your anxiety and improve your sleep. Techniques such as cognitive-behavioral therapy (CBT), mindfulness meditation, and relaxation exercises can be effective in reducing anxiety symptoms. Establishing a regular sleep routine, avoiding stimulants before bedtime, and creating a calming sleep environment can also help improve your sleep quality.

Lastly, it’s important to remember that medication adjustments can take time to stabilize. While it may feel overwhelming now, many patients find that with the right adjustments and support, their symptoms improve over time. Keep advocating for yourself and your mental health, and don’t hesitate to seek a second opinion if you feel your concerns are not being adequately addressed. Your well-being is paramount, and finding the right balance in your treatment is key to managing anxiety effectively.

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