Autonomic Nervous System Disorders and Medication Side Effects

Autonomic Nervous System Dysregulation - Medication Side Effects

In recent months, due to work stress and physical discomfort (post-nasal drip, chest tightness, poor sleep, bloating, shoulder and neck pain), I sought treatment at a traditional Chinese medicine clinic.
The doctor indicated that I was too tense.
After a month of medication, there was no significant improvement, so I visited a psychosomatic medicine clinic (my first time seeing a psychosomatic specialist).
I paid out of pocket for an autonomic nervous system disorder test, and after the physician's consultation, it was confirmed that I had autonomic nervous system dysregulation.
I was prescribed medication for three days: after lunch: Revital 150MG + Anxiolytic 10MG, 0.5 tablets each time; before bed: Anban 0.5MG + Apo-Paroxetine 20MG + Bromazin tablets 3MG, 0.5 tablets each time.

On the first night, I took the medication at 10:00 PM and did not sleep well, feeling dizzy.
Around 5 AM, I suddenly felt my whole body trembling for about an hour.
The next morning, I felt better.
When I asked the doctor, he said there were no such side effects and advised me to continue taking the medication and observe.
After taking the afternoon medication, I felt my whole body tense and my head heavy.
After taking the medication for two more days, although there was some improvement, my body remained tense, I had no appetite, bloating, and my jaw would tremble.

Upon returning for a follow-up, the doctor switched my medication: after lunch: Ubiquinone 50MG + Anxiolytic 10MG + Daoxin 10MG, 0.5 tablets each (1 tablet of Daoxin); before bed: Anban 0.5MG + Esitalopram 5MG + Bromazin tablets 3MG, 0.5 tablets each.
After two days on the new regimen, I still felt a heavy head, significant anxiety, stomach pain, and jaw tremors.
My condition seemed worse than before seeking treatment.

Could this be a side effect of the medication, or am I feeling anxious and tense about taking the medication? Do you have any suggestions? Would it be better to stop the medication?

JANEY, 20~29 year old female. Ask Date: 2021/10/31

Dr. Zhang Gengjia reply Psychiatry

Dear Sir/Madam,
From your letter, it is clear that you are experiencing discomfort and distress due to suspected autonomic nervous system dysfunction and physical ailments.

1.
Facing an uncertain future, psychosomatic disorders, such as autonomic nervous system dysfunction, are common in modern society.
This is a chronic condition that requires long-term treatment for recovery.
2.
Psychosomatic disorders (autonomic nervous system dysfunction) are chronic illnesses characterized by episodes of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in physiology, it may take time to determine the most suitable medication, so please be patient and cooperate with your physician.
3.
Regarding pharmacological treatment, each primary medication requires 4 to 6 weeks to assess its efficacy.
If you experience any discomfort, it is advisable to note the duration and frequency of these symptoms.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment that does not require anesthesia, has a high safety profile, and does not necessitate hospitalization.
It can improve anxiety and depressive moods.
For patients with treatment-resistant depression or poor medication response, rTMS has shown significant improvement in depressive symptoms after treatment.

Please discuss your psychosomatic issues thoroughly with your physician during your follow-up appointment, as some symptoms may be related to the original condition, while others could be side effects of the medication.
Our clinic has outpatient services available Monday through Friday, both in the morning and afternoon.
We recommend that you consider visiting the clinic for a personal assessment of your symptoms, allowing for a collaborative discussion to determine the best course of action for you.
Wishing you mental and physical well-being.
Sincerely,
Dr.
Chang Geng-Jia
Department of Psychiatry

Reply Date: 2021/10/31

More Info

Understanding autonomic nervous system disorders and their treatment can be quite complex, especially when considering the various medications prescribed and their potential side effects. Based on your experience, it seems you are dealing with a combination of symptoms that may be linked to autonomic nervous system dysregulation, which can manifest as physical discomfort, anxiety, and other psychological symptoms.

Autonomic nervous system disorders can lead to a range of symptoms, including but not limited to, gastrointestinal issues (like bloating), respiratory discomfort (such as chest tightness), and musculoskeletal pain (like neck and shoulder tension). These symptoms can be exacerbated by stress, which appears to be a significant factor in your case. The autonomic nervous system is responsible for regulating involuntary bodily functions, and when it is out of balance, it can lead to a variety of distressing symptoms.

In your situation, you have been prescribed a combination of medications, including antidepressants and anxiolytics. Medications like paroxetine (an SSRI) and bromazepam (a benzodiazepine) are commonly used to treat anxiety and depressive disorders. While these medications can be effective, they also come with potential side effects. For instance, SSRIs may cause gastrointestinal disturbances, sleep issues, and increased anxiety in some individuals, especially during the initial weeks of treatment. Benzodiazepines, while effective for immediate relief of anxiety, can lead to sedation, dizziness, and in some cases, dependency if used long-term.

Your experience of feeling "heavy-headed," having tremors, and experiencing gastrointestinal discomfort after starting the medication could indeed be side effects of the drugs. However, it is also possible that your anxiety about taking medication is contributing to these sensations. This is not uncommon; anxiety can manifest physically, leading to symptoms that may feel like side effects but are actually rooted in psychological distress.

If you are considering stopping your medication, it is crucial to discuss this with your healthcare provider first. Abruptly discontinuing certain medications, especially SSRIs and benzodiazepines, can lead to withdrawal symptoms and a potential worsening of your anxiety and physical symptoms. Your doctor can help you devise a tapering plan if discontinuation is deemed appropriate.

In addition to medication, there are several strategies you might consider to help manage your symptoms:
1. Cognitive Behavioral Therapy (CBT): This form of therapy can help you address the thought patterns that contribute to your anxiety and teach you coping strategies.

2. Mindfulness and Relaxation Techniques: Practices such as deep breathing, meditation, and yoga can help reduce stress and promote relaxation.

3. Regular Physical Activity: Exercise is known to have a positive impact on mood and anxiety levels. Even light activities like walking can be beneficial.

4. Diet and Nutrition: Pay attention to your diet, as certain foods can exacerbate gastrointestinal symptoms. A balanced diet rich in whole foods may help improve your overall well-being.

5. Sleep Hygiene: Establishing a regular sleep routine and creating a restful environment can improve sleep quality, which is often disrupted in individuals with anxiety.

6. Support Groups: Connecting with others who are experiencing similar challenges can provide emotional support and practical advice.

In conclusion, while medications can play a vital role in managing autonomic nervous system disorders and associated anxiety, they are often most effective when combined with lifestyle changes and therapeutic interventions. It is essential to maintain open communication with your healthcare provider to find the best approach tailored to your needs. If you feel that your current treatment is not working, do not hesitate to seek a second opinion or explore alternative treatment options. Your health and comfort are paramount, and there are many avenues to explore for relief and recovery.

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