Do I Need to Change My Anxiety Medication? Treatment Options

Does anxiety require a change in medication?

Hello doctor, I am a 23-year-old woman who has been suffering from severe depression.
For some inexplicable reason, I find myself unable to speak, like a mute, which makes my life very painful and often leaves me in a state of anxiety.
Six months ago, I would say less than five sentences a day.
I really want to talk, but I just can't seem to do it comfortably, even with my family.
After taking medication for nearly two months, my condition still fluctuates.
When I feel good, I can speak normally, and that makes me very happy.
However, I often experience these ups and downs.
I have noted down the triggers for my episodes, but they seem too strange; for instance, one time I felt chest tightness and couldn't speak after looking at a Foodpanda menu.

One peculiar pattern I have noticed is that around 5 to 6 PM, I inevitably start to lose my ability to speak, even though I was able to express myself normally in the morning.
At that time, I was taking one Wellbutrin in the morning, and when my anxiety turns me mute in the late afternoon, I rely on a tranquilizer, Anxiolytic, to help me speak.
In the evening, I take one Lexapro.

I would like to ask the esteemed doctor for help: why can I speak normally in the morning but become anxious and unable to speak after the evening? Please, could you give me some advice? Should I increase my medication dosage, or should I switch to another antidepressant? I want to return to my normal self because being able to talk is an essential part of my daily life, and it brings me not just distress but real suffering.
If I could speak normally, I would feel so happy.
Thank you, doctor.

I also have another question: is the principle behind being able to speak when taking a tranquilizer the same as when I can speak freely while on an antidepressant? Thank you, doctor.

ru, 20~29 year old female. Ask Date: 2021/04/27

Dr. Xue Gengming reply Psychiatry

It is recommended that you discuss the above situation with your attending physician to determine if further examinations are necessary.
Thank you, and wishing you good health!

Reply Date: 2021/04/27

More Info

It's understandable that you're feeling overwhelmed and frustrated with your current situation regarding anxiety and medication. Your experience of being unable to speak at certain times of the day, particularly in the late afternoon, is indeed concerning and can be quite distressing. Let's break down your situation and explore potential treatment options.

Firstly, it's important to recognize that anxiety disorders can manifest in various ways, including physical symptoms like chest tightness and difficulty speaking. These symptoms can fluctuate throughout the day, which seems to be the case for you. The fact that you can communicate well in the morning but struggle in the late afternoon suggests that there may be specific triggers or patterns associated with your anxiety.

Regarding your current medication regimen, it appears that you are taking a combination of medications, including a selective serotonin reuptake inhibitor (SSRI) and a benzodiazepine. SSRIs, like the one you mentioned (likely escitalopram or a similar medication), are commonly prescribed for anxiety and depression as they help to increase serotonin levels in the brain, which can improve mood and reduce anxiety over time. On the other hand, benzodiazepines, such as the one you referred to (likely alprazolam), are fast-acting medications that can provide immediate relief from anxiety symptoms but are not intended for long-term use due to the risk of dependence.

Your question about whether to adjust your medication is crucial. If you find that your current regimen is not effectively managing your symptoms, particularly the inability to speak, it may be worth discussing with your healthcare provider. Here are some considerations:
1. Medication Adjustment: It may be beneficial to reassess your current dosages or explore alternative medications. For instance, if you are experiencing significant fluctuations in your anxiety, your doctor might consider increasing the dose of your SSRI or switching to a different one that may be more effective for you. Other SSRIs like sertraline or fluoxetine could be options to discuss.

2. Therapeutic Approaches: In addition to medication, cognitive-behavioral therapy (CBT) has been shown to be effective for anxiety disorders. CBT can help you identify and challenge negative thought patterns and develop coping strategies for anxiety-provoking situations. This could be particularly helpful in addressing the specific triggers that lead to your speech difficulties.

3. Lifestyle Modifications: Incorporating regular physical activity, mindfulness practices, and relaxation techniques can also support your mental health. These strategies can help reduce overall anxiety levels and improve your ability to cope with stressors.

4. Understanding Medication Mechanisms: Regarding your question about the difference between the effects of benzodiazepines and SSRIs, it's important to note that while both can help with anxiety, they work through different mechanisms. Benzodiazepines provide immediate relief by enhancing the effect of a neurotransmitter called GABA, which has a calming effect on the brain. SSRIs, on the other hand, take longer to work (usually several weeks) but help to stabilize mood and reduce anxiety over time by increasing serotonin levels.

5. Monitoring and Communication: Keep a journal of your symptoms, noting when they occur and any potential triggers. This information can be invaluable for your healthcare provider in determining the best course of action. Open communication with your doctor about your experiences, including the timing of your symptoms and the effectiveness of your current medications, is essential for finding the right treatment plan.

In conclusion, it is crucial to have a thorough discussion with your healthcare provider about your current symptoms and medication regimen. They can help you determine whether a dosage adjustment, a change in medication, or additional therapeutic interventions are necessary. Remember, finding the right balance in treatment can take time, and it's important to be patient with yourself throughout this process. Your goal of wanting to communicate freely and feel like your normal self is entirely achievable with the right support and treatment.

Similar Q&A

Managing Anxiety: Balancing Medication and Therapy for Recovery

Hello, doctor. When I was in the ninth grade, I became anxious and started experiencing obsessive thoughts due to certain issues. I visited two psychiatric clinics during my first and second years of high school (both had follow-up visits, but they were not long-term). Later, I d...

Dr. Tang Jiahong reply Psychiatry
Hello. Of course, you can discuss dosage issues with your physician. If your condition is stable, the dosage usually will not be increased unless there are specific reasons. Regarding psychological testing, you might want to consider why you wish to cancel it. After all, it is ju...

Managing Panic and Anxiety: Can You Skip Medication for Self-Adjustment?

Doctor, I have been diagnosed with panic disorder and anxiety. The doctor prescribed me Cloene (clonazepam) and Mesyrel (trazodone) to take at bedtime, but I noticed that the side effects include drowsiness, dizziness, nervousness, and mental confusion. I'm concerned that th...

Dr. Chen Wenyu reply Psychiatry
Hello, Regarding the medications you are taking and the timing of their administration, these two drugs have sedative and antidepressant effects. Taking them before bedtime is intended to induce sleepiness. If you take a sedative or sleep medication and do not sleep, it is natu...

Managing Anxiety Symptoms: Treatment Options and Coping Strategies

Hello, Doctor. I have been experiencing symptoms of anxiety for nearly ten years. I have undergone psychological counseling and was diagnosed with anxiety disorder. I received short-term therapy from a counselor, but I didn't notice significant improvement, so I stopped the ...

Dr. Zhang Gengjia reply Psychiatry
Hello, A-Tian: Having suffered from anxiety disorder for over ten years must have significantly impacted your daily life. In recent years, the prevalence of anxiety disorders has been on the rise, leading many to seek professional medical care or pharmacological treatment. There...

Understanding Medication Adjustments for Adjustment Disorder

Since last year, I have often felt depressed, anxious, and lacking in confidence due to work stress. I consulted a psychiatrist, and the diagnosis was adjustment disorder. I have been taking Anxiolytics and Antidepressants daily for over six months, but my mental and physical con...

Dr. Li Zhengfeng reply Psychiatry
Hello: Adjustment disorders may worsen due to various factors even while on stable medication. In some cases, it may be necessary to increase medication to control the condition; however, incorporating non-pharmacological treatments could also be an option. To improve your condit...