Navigating Medication Hesitation in Mental Health Treatment

Hesitation in taking medication?

Hello Doctor, I have been experiencing irregular episodes of rapid heartbeat (90 bpm while lying down, 100-120 bpm while sitting) and chest tightness.
I went to the emergency room where blood tests and X-rays indicated that my heart is fine.
Subsequently, I visited a general psychosomatic clinic where my autonomic nervous system (sympathetic and parasympathetic values) was assessed.
I was prescribed Leeyo and Clonopam.
The first time I took 5 mg of Leeyo before bed, it caused me to have insomnia all night, along with nausea and tremors.
After consulting with the clinic's pharmacist, I switched to taking it during the day and reduced the dosage to 2.5 mg, which I took for 1-2 weeks without any issues.
Later, I went to a cardiology clinic for follow-up tests (24-hour Holter monitor, exercise ECG, etc.) and a neurology clinic for sleep center evaluation regarding my early awakening issues.
Concerned about affecting the measurement data, I decided to stop the medication on my own.
After the tests, it was found that I have severe obstructive sleep apnea.
I am currently trying to use a CPAP machine for sleep, but I still experience insomnia (having difficulty falling asleep), although if I sleep without it, I fall asleep quickly but wake up early (around 2-3 AM), feeling very sleepy yet unable to fall back asleep.
I then visited a psychiatric department at the hospital, where I was prescribed Epram 10 mg, StilNOX 10 mg, and Alpraline 0.5 mg.

1.
The doctor mentioned that Epram and Leeyo have similar effects, and that Leeyo should be okay.
However, he switched my medication, but the prescribed dosage is 10 mg.
I am somewhat apprehensive about the initial 5 mg of Leeyo due to its side effects, and now I am hesitant about taking 10 mg of a similar medication.
Should I consider going back to Leeyo, even though it wasn't prescribed by the doctor?
2.
A friend shared that their family member experienced sleepwalking while taking StilNOX, which was quite alarming, so I am also hesitant to take this medication.

3.
Obstructive sleep apnea is not ideally treated with sedative medications, as they can exacerbate the condition.
However, is it acceptable to use a CPAP machine along with these types of sedative medications?
4.
Currently, I am practicing breathing through my nose while lying down, but it feels somewhat difficult.
I have seen an ENT specialist and have slight nasal congestion, so I am worried that combining the CPAP machine with sedative medications might lead to suffocation.

Thank you, Doctor, for patiently reading this and providing guidance.
I really appreciate it.

Ben, 40~49 year old female. Ask Date: 2022/02/12

Dr. Wu Enliang reply Psychiatry

1.
A friend mentioned that the doctor said Epram and Leeyo have the same effect, and Leeyo should be fine.
However, the doctor prescribed me a different medication at a dosage of 10mg.
I am a bit apprehensive about the initial 5mg of Leeyo since this new medication is similar, and I'm concerned about the potential side effects of this dosage.
I'm hesitant about whether to go back to Leeyo, but this isn't what the doctor prescribed...
A: I suggest you ask your doctor during your next visit.
2.
A friend shared that their family member experienced sleepwalking while taking StilNOX, which was quite frightening, so I'm also hesitant to take this medication.
A: Some people do experience sleepwalking with this medication.
If that happens, it is not suitable for you.
3.
Sleep apnea is not very compatible with sedative medications, as it can exacerbate the condition.
However, is it okay to use a ventilator along with these sedative medications? A: It is advisable to avoid sleeping pills as much as possible.
If necessary, choose sedatives that have less impact on respiration.
4.
Currently, I am practicing breathing through my nose while lying down with my mouth closed, but it feels somewhat difficult.
I have seen an ENT specialist and have a slight nasal congestion, so I'm worried that using a ventilator along with sedative medications might lead to suffocation.
A: It should not lead to suffocation.
- Dr.
Wu Enliang

Reply Date: 2022/02/12

More Info

Navigating medication hesitation in mental health treatment can be a challenging experience, especially when dealing with anxiety, sleep disorders, and the potential side effects of medications. Your situation reflects a common dilemma faced by many individuals seeking mental health treatment, particularly when it comes to the use of controlled substances and their impact on overall well-being.

Firstly, it’s important to understand that medications like Leeyo (which is likely a brand name for a medication such as escitalopram) and Clonopam (clonazepam) are often prescribed to manage anxiety and related symptoms. However, as you’ve experienced, these medications can have varying effects on individuals. The side effects you described, such as insomnia, nausea, and tremors, are not uncommon, and they highlight the need for careful monitoring and communication with your healthcare provider.

1. Medication Concerns: Your hesitation regarding the dosage of Epram (escitalopram) is understandable, especially given your previous experience with Leeyo. It’s crucial to discuss your concerns with your doctor. They can provide reassurance about the safety and efficacy of the prescribed dosage. Often, doctors start at a lower dose and gradually increase it based on the patient’s response. If you feel uncomfortable with the prescribed dose, express this to your doctor; they may be able to adjust the dosage or suggest an alternative medication that you feel more comfortable with.

2. StilNOX and Sleepwalking: Your apprehension about StilNOX (zolpidem) is valid, particularly if you’ve heard anecdotal reports of sleepwalking or other unusual behaviors. While StilNOX can be effective for short-term management of insomnia, it is essential to use it under close supervision, especially if you have a history of sleep disturbances. Discuss your concerns with your doctor, who may suggest alternative treatments for sleep issues that do not carry the same risks.

3. Sleep Apnea and Sedative Medications: You are correct in noting that using sedative medications in conjunction with a CPAP machine for sleep apnea can be risky. Sedatives can exacerbate respiratory issues, particularly in individuals with obstructive sleep apnea. It’s crucial to have a thorough discussion with your healthcare provider about the potential risks and benefits of combining these treatments. They may recommend a sleep specialist to help manage your sleep apnea more effectively while considering your mental health needs.

4. Breathing Techniques and Nasal Congestion: Practicing breathing techniques can be beneficial, especially if you are experiencing nasal congestion. Addressing the nasal congestion with appropriate treatments, such as nasal sprays or antihistamines, may improve your breathing and overall comfort. It’s great that you are proactive about your health; however, ensure that any new treatments are discussed with your healthcare provider to avoid potential interactions with your current medications.

In summary, navigating medication hesitation requires open communication with your healthcare provider. It’s essential to voice your concerns about side effects, medication dosages, and the interplay between your mental health medications and any other health conditions, such as sleep apnea. Your doctor can help you weigh the risks and benefits of each medication and adjust your treatment plan accordingly. Additionally, exploring non-pharmacological interventions, such as cognitive behavioral therapy (CBT) for anxiety and sleep hygiene practices, can also be beneficial in managing your symptoms without relying solely on medication. Remember, you are not alone in this journey, and seeking support from healthcare professionals is a vital step toward achieving better mental health and overall well-being.

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