Managing Anxiety and Sleep Disorders: Medication Concerns and Alternatives

Q: Managing Anxiety and Sleep Disorders: Medication Concerns and Alternatives

Hello everyone： Keppra (levetiracetam) can be somewhat habit-forming. <br>If your condition is stable, you should be able to gradually adjust and taper off, but do not reduce it while experiencing anxiety. <br>Dr. <br>Wu En-Liang.

Drug Information

Hello Doctor, I was diagnosed and recovered in mid-May, but I still have issues with my sense of smell and taste, along with some other symptoms.
I may have developed acute anxiety disorder due to excessive worry (which was diagnosed at the hospital).
I have been unable to sleep for ten consecutive days, regardless of morning or night, and I also experience gastroesophageal reflux, bloating, loss of appetite, dry mouth, and occasional unexplained panic attacks.
Later, I visited a sleep clinic, where the doctor also indicated that my problems were due to anxiety.
In the first week, the doctor prescribed Mirtazapine and Clonazepam (2 mg).
On the third day of taking Mirtazapine, I experienced dizziness throughout the day, so I only continued with Clonazepam.
In the second week, a substitute doctor suggested reducing Clonazepam by half and adding Lorazepam (0.5 mg), but I started having difficulties falling asleep and experiencing shallow sleep again.
In the third week (this week), the doctor said that the reduction was too rapid and changed my prescription to Lyrica (half a tablet) and one Clonazepam, to be taken for two weeks.
Throughout this process, the doctor has consistently advised against self-discontinuation or reduction of medication.
However, I am a bit concerned about the potential for addiction.
Recently, I occasionally feel very tired and as if I could fall asleep naturally, but because the doctor instructed me not to reduce or stop the medication on my own, I am hesitant to try sleeping without the medication.
Therefore, I would like to ask the doctor if these medications have a risk of addiction (as it seems I will need to take them for a while, but the doctor thinks it is inappropriate to discuss a tapering plan when I am still not well).
Additionally, is it really not advisable to try to sleep naturally without medication during treatment? (Could there be withdrawal symptoms or similar issues?) Thank you for your clarification.

Ms. Lin, 30~39 year old female. Ask Date: 2022/06/18

Dr. Wu Enliang reply Psychiatry

Hello everyone: Keppra (levetiracetam) can be somewhat habit-forming.
If your condition is stable, you should be able to gradually adjust and taper off, but do not reduce it while experiencing anxiety.
Dr.
Wu En-Liang.

Reply Date: 2022/06/18

More Info

Managing anxiety and sleep disorders can be a complex and multifaceted issue, especially when medications are involved. Your concerns about the medications you are taking, their potential for addiction, and the possibility of trying to sleep without them are valid and deserve careful consideration.

Firstly, it’s important to understand the medications you mentioned: Mirtazapine, Clonazepam, and Escitalopram. Mirtazapine is an antidepressant that is often used to treat anxiety and depression, and it can also help with sleep due to its sedative effects. Clonazepam, on the other hand, is a benzodiazepine that is primarily used for anxiety and seizure disorders. It has sedative properties but carries a risk of dependence, especially with long-term use. Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety disorders. While SSRIs can help improve mood and anxiety, they can sometimes exacerbate sleep issues in some individuals, particularly when starting the medication or adjusting the dosage.

Your experience of feeling dizzy and having difficulty sleeping after taking Mirtazapine is not uncommon. Many patients report side effects when starting or adjusting dosages of psychiatric medications. It’s crucial to communicate these side effects to your doctor, as they may need to adjust your treatment plan accordingly.
Regarding your concern about addiction, it is true that benzodiazepines like Clonazepam can lead to physical dependence if taken for an extended period. This means that if you suddenly stop taking the medication, you may experience withdrawal symptoms, which can include increased anxiety, insomnia, and other physical symptoms. This is why your doctor has advised against reducing or stopping the medication on your own. It’s essential to follow your doctor’s guidance and discuss any concerns you have about the duration of your treatment and the potential for dependency.

As for trying to sleep without medication, it is possible to explore non-pharmacological approaches to improve sleep. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a highly effective treatment that focuses on changing thoughts and behaviors related to sleep. Techniques may include sleep hygiene education, relaxation techniques, and cognitive restructuring to address anxiety about sleep. These methods can be beneficial and may help you regain the ability to sleep without relying solely on medication.

Additionally, lifestyle changes can also play a significant role in managing anxiety and improving sleep quality. Regular physical activity, a balanced diet, and mindfulness practices such as meditation or yoga can help reduce anxiety levels and promote better sleep. Establishing a consistent sleep schedule, creating a relaxing bedtime routine, and optimizing your sleep environment (e.g., reducing noise and light) can also contribute to improved sleep quality.

In summary, while medications can be an essential part of managing anxiety and sleep disorders, it’s crucial to work closely with your healthcare provider to monitor their effects and adjust your treatment plan as needed. Discuss your concerns about addiction and the possibility of trying to sleep without medication openly with your doctor. They can help you navigate these challenges and may suggest alternative therapies or lifestyle changes that can support your mental health and improve your sleep. Remember, you are not alone in this journey, and there are many resources available to help you find the right balance for your health and well-being.

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