Managing Mood Disorders and Medication Concerns in Psychiatry

Q: Managing Mood Disorders and Medication Concerns in Psychiatry

Hello, dear netizen： When your classmates are moving ahead, you feel a lot of pressure and negative emotions about not being able to keep up with them and facing health issues. <br>I can sense the conflicting feelings in your words： Should you take Anliflu? Should you undergo med

Emotional adjustment and medication issues?

Dear Dr.
Liao,
First of all, I want to express my heartfelt gratitude for your thoughtful responses to my previous inquiries; I truly appreciate it!
Regarding my condition: Obsessive-Compulsive Disorder (OCD) / Depression.
I have a few questions I would like to ask:
1.
With the upcoming academic assessment, you suggested that I consider taking 0.25 mg of Anxiolytic medication.
However, I found in the medication leaflet that it may cause irreversible side effects such as impaired judgment and tardive dyskinesia.
I am uncertain whether I should take this medication, as you mentioned that the decision is ultimately mine.
I would like to hear your advice on this matter.
2.
I have heard that untreated OCD can lead to brain atrophy, while medication can promote neural regeneration.
Is this accurate? Is it possible to recover from OCD without medication?
3.
Recently, I have been feeling quite down.
I have spent a significant amount of money on retaking classes, yet I often find myself unwell and taking leave (this is my second year).
I feel like I am wasting money.
Seeing my classmates study consistently adds to my stress and envy.
I used to aim for my first-choice university and gifted classes, but now my grades are poor.
What once seemed like a promising future now feels chaotic.
At nineteen, I have not yet entered university, and I am concerned about the side effects of the medication; I really want to stop taking it.
I feel like my world is in a terrible state and very painful.
What should I do?
I apologize for the lengthy message, and I appreciate your time in reading and responding.

Z, 10~19 year old female. Ask Date: 2021/12/08

Dr. Liao Dinglie reply Psychiatry

Hello, dear netizen: When your classmates are moving ahead, you feel a lot of pressure and negative emotions about not being able to keep up with them and facing health issues.
I can sense the conflicting feelings in your words: Should you take Anliflu? Should you undergo medication treatment for obsessive-compulsive disorder (OCD)? Should you stop taking medication? Perhaps there are some feelings you haven't expressed: "I don't like myself," "I don't want to go to class today," "I don't want to retake the exam." These thoughts can leave you feeling exhausted; it's not just about OCD, but also about your emotional distress.
Here are my responses to your questions:
1.
"Taking Anliflu": I want to say that OCD is one of the conditions in psychiatric treatment where medication has the most significant effect.
The benefits of medication outweigh the drawbacks.
A quarter of a 5mg dose of Anliflu is actually a very low dosage; it can help with poor attention and conflicting thoughts, but at such a low dose, the doctor likely believes that you primarily need to rely on your own adjustments.
The medication helps reduce "intrusive thoughts," similar to the concept of an "electric assist bicycle"—it's not fully electric! As for "persistent motor disorder," in my over twenty years of practice, I have never seen it caused by Anliflu, so I suggest you don't worry too much about this point; otherwise, it may become another "intrusive thought."
2.
"Not using medication and letting OCD heal on its own": Given the immense pressure of academic advancement you are currently facing, I believe that spending time contemplating medication choices is not a good idea.
To put it metaphorically, it's like asking, "Should I take the train from Taipei Main Station, or can I walk there?" While other methods are feasible, most of the time, medication is a quicker solution to the problem.
3.
"Feeling terrible about yourself": At this point, I must mention Confucius.
He exhibited some obsessive-compulsive symptoms (like "not sitting unless the mat is straight, not eating unless the food is cut properly"), didn't he? Yet, he had a strong sense of assurance and depth about his life's realm.
If a person dislikes themselves, it can be very painful because one cannot escape oneself.
At this stage, you may feel that your progress is lagging behind your classmates.
However, life is long, and at the right time, you will catch up.
There is an advantage to moving slowly: you won't stray too far in the wrong direction.
Maintain your patience, and life will naturally lead you to the next level.
I wish you growth through adversity and, ultimately, the fruitful rewards of your efforts.
Dr.
Liao Ding-Lie

Reply Date: 2021/12/08

More Info

Managing mood disorders, particularly obsessive-compulsive disorder (OCD) and depression, can be a complex and challenging journey, especially when considering medication options and their potential side effects. Your concerns are valid, and it's important to approach this situation with careful consideration and professional guidance.

1. Medication Concerns: You mentioned that your doctor suggested adding a low dose of Anxiolytic (安立復) to your regimen. It's crucial to weigh the benefits against the potential side effects. While some medications can cause side effects such as impaired judgment or tardive dyskinesia (a movement disorder that can be irreversible), these risks often depend on individual factors, including dosage, duration of use, and personal health history. If you feel uncertain about starting this medication, it’s advisable to have an open discussion with your doctor about your concerns. You might also consider seeking a second opinion from another psychiatrist to explore alternative treatment options that may have a more favorable side effect profile.

2. Impact of Medication on Brain Health: The notion that OCD can lead to brain atrophy if untreated is a topic of ongoing research. Some studies suggest that chronic untreated OCD may be associated with changes in brain structure and function. However, the idea that medication can "regenerate" neurons is more nuanced. While certain medications, particularly SSRIs (selective serotonin reuptake inhibitors), can help alleviate symptoms and may promote neuroplasticity (the brain's ability to adapt and change), they are not a guaranteed solution for everyone. Choosing not to take medication is a personal decision and can lead to recovery for some individuals through therapy and lifestyle changes, but it may also prolong suffering for others. Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is an effective non-pharmacological treatment for OCD that can lead to significant improvements.

3. Academic Pressure and Self-Perception: It’s understandable to feel overwhelmed by academic pressures, especially when comparing yourself to peers. The transition to adulthood and the pressures of academic performance can be daunting, particularly when dealing with mental health issues. Remember that everyone's journey is unique, and setbacks do not define your worth or potential. It’s essential to practice self-compassion and recognize that mental health challenges can impact performance. If you feel that the pressure is too much, consider discussing your situation with a trusted adult, counselor, or therapist who can help you navigate these feelings and develop coping strategies.

4. Feeling Overwhelmed and Seeking Change: The feelings of hopelessness and frustration you’re experiencing are common among individuals dealing with mood disorders. It’s important to acknowledge these feelings and seek support. Whether through therapy, support groups, or talking to friends and family, sharing your experiences can help alleviate some of the burdens. If you’re considering stopping medication due to side effects, consult your psychiatrist first. They can help you taper off safely and explore alternative treatments that may suit you better.

5. Future Considerations: As you contemplate your future, remember that many people take non-linear paths to success. Not attending university immediately or facing academic challenges does not diminish your potential. Focus on small, achievable goals and celebrate your progress, no matter how minor it may seem. Engaging in activities that bring you joy and fulfillment outside of academics can also help improve your overall well-being.

In conclusion, managing mood disorders requires a multifaceted approach that includes medication, therapy, lifestyle changes, and support from loved ones. It’s crucial to maintain open communication with your healthcare providers and advocate for your needs. Remember, you are not alone in this journey, and there are resources and support systems available to help you navigate these challenges.

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