Xanax: Dosage, Diagnosis, and Mental Health Insights

Medication issues

1.
I was prescribed Xanax 0.25 mg by my psychiatrist for the past two days, but I feel like the dosage might be too low since I haven't noticed much difference.
I've heard that the medication takes effect quickly, or does it typically take two weeks to three months to be effective?
2.
Does being prescribed Xanax indicate that my condition is severe?
3.
I only mentioned my emotional state to the doctor but forgot to mention that I seem to experience auditory hallucinations (sometimes I hear multiple voices or conversations in my head while trying to sleep).
Is this considered an auditory hallucination? Additionally, I have experienced dissociative episodes a few times before starting the medication, and my mood swings are quite significant, resembling bipolar disorder.
I forgot to mention these three issues to my doctor, but I plan to discuss them next time.
What might my situation indicate?
4.
I told my doctor that I might have traits of borderline personality disorder, and I reviewed the DSM-5 criteria, which I almost meet.
However, he mentioned that a psychological evaluation is needed for a proper diagnosis.
If a formal diagnosis is required, isn't it only psychiatrists who are qualified to provide that? Don't therapists only engage in conversation? Or am I misunderstanding this? Thank you.

Enen, 10~19 year old female. Ask Date: 2021/02/20

Dr. Lin Mianzhang reply Psychiatry

Hello,
1.
Xanax has a rapid onset of action, typically taking about half an hour to take effect.
If you do not feel its effects, it may be due to an insufficient dosage.

2.
Xanax is used for the quick relief of anxiety symptoms.
Because of its fast-acting nature, patients often prefer it, and some physicians also favor its use.
Prescribing this medication indicates that you have anxiety, but it does not imply that your condition is severe.
However, it is important to note that due to its rapid and potent effects, there is a high risk of addiction.
It only addresses the symptoms and does not treat the underlying issues, so it is recommended to take it only when necessary.
Long-term use can lead to dependence and an increasing dosage requirement.
3.
If the sounds occur before or after sleep, it is common and does not necessarily indicate hallucinations.
However, if you hear them while fully awake, it is something to be cautious about, as it may indicate hallucinations.
Regarding emotional fluctuations, a physician should evaluate in person to determine if it reaches the level of bipolar disorder; it cannot be simply assessed based on your description.
4.
You are correct that borderline personality disorder is diagnosed by a psychiatrist.
Some psychological counselors may also have the ability to assess it, but only a physician can issue a formal diagnosis.
However, diagnosing any personality disorder (including borderline personality disorder) often requires long-term follow-up to confirm, making it difficult to diagnose based on just one or two outpatient visits.
Therefore, continued follow-up appointments are necessary to reach a definitive conclusion.
Wishing you peace and health!

Reply Date: 2021/02/20

More Info

Understanding Xanax: Dosage, Diagnosis, and Mental Health Insights
Xanax (alprazolam) is a medication commonly prescribed for anxiety and panic disorders. It belongs to a class of drugs known as benzodiazepines, which work by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain. This results in a calming effect, making it effective for managing anxiety symptoms. However, it is essential to understand its proper use, potential side effects, and the implications of its prescription.

1. Dosage and Effectiveness: You mentioned that you have been prescribed Xanax 0.25 mg for two days but feel that the dosage may be too low since you haven't noticed significant changes. Xanax typically has a rapid onset of action, often taking effect within 30 minutes. However, the effectiveness can vary based on individual factors such as metabolism, the severity of anxiety, and overall health. While some individuals may feel relief quickly, others might require a higher dose or a longer duration of treatment to experience the full benefits. It is crucial to communicate with your healthcare provider about your concerns regarding the dosage. They may adjust your prescription based on your response to the medication.

2. Severity of Condition: The prescription of Xanax does not necessarily indicate that your condition is severe. It is often used to manage anxiety symptoms effectively, and many patients with varying degrees of anxiety may be prescribed this medication. The decision to prescribe Xanax is based on your specific symptoms and how they affect your daily life. It is essential to view this medication as a tool to help manage your anxiety rather than a definitive measure of the severity of your condition.

3. Hallucinations and Mood Swings: You mentioned experiencing auditory hallucinations, such as hearing voices while trying to sleep. This could be a cause for concern, especially if these experiences occur when you are awake. Hallucinations can be a symptom of various mental health conditions, including severe anxiety, depression, or other psychiatric disorders. It is vital to discuss these experiences with your healthcare provider during your next appointment, as they can provide a more accurate assessment and determine if further evaluation is necessary. Additionally, your mention of mood swings resembling bipolar disorder should also be addressed with your doctor, as they can help clarify your diagnosis and treatment options.

4. Diagnosis of Personality Disorders: Regarding your concerns about having borderline personality disorder (BPD) traits, it is true that a comprehensive evaluation is necessary for an accurate diagnosis. While psychiatrists can diagnose mental health conditions, psychologists and licensed therapists can also provide valuable insights and assessments. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) outlines specific criteria for diagnosing personality disorders, and a thorough evaluation often requires multiple sessions to understand the individual's history and behavior patterns. It is not uncommon for mental health professionals to work collaboratively, where a psychiatrist may prescribe medication while a therapist provides psychotherapy.

In conclusion, it is essential to maintain open communication with your healthcare provider about your symptoms, medication effects, and any concerns you may have. Mental health treatment is often a collaborative process that may involve medication, therapy, and lifestyle adjustments. If you feel that your current treatment plan is not adequately addressing your needs, do not hesitate to seek a second opinion or discuss alternative options with your provider. Your mental health is a priority, and finding the right balance of treatment is crucial for your well-being.

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