Concerns About Neurology Medications: Risks, Dependency, and Diagnosis Clarity

Medications..?

Due to discomfort in my head and poor sleep quality, my previous doctors prescribed medications such as Lyrica, Mirtazapine, and Zolpidem, claiming they could help with sleep.
I have a few questions for the physician:
1.
Will these medications alter my brain or personality and cause any irreversible effects?
2.
I only took them for one to two weeks and then stopped, but I noticed that while taking them, I felt significantly drowsy, and without them, my sleep worsened.
However, people around me have warned about the dangers of these medications, making me fear that they might change my brain or lead to dependency, which makes me hesitant to take them again.
After all, it’s my brain, and I don’t want to lose my sense of self due to medication.
Am I being overly anxious, or are medications that affect the brain truly that frightening?
3.
It seems that doctors in Taiwan easily prescribe medications; I’ve seen patients on nearly ten different medications and encountered a doctor who prescribed five medications during a first visit.
Are these medications like candy? Why is it so easy to be prescribed a large number of them? Will short-term and long-term use have an impact on the brain? How do doctors clarify whether the diagnosis is due to the illness itself, the effects of the medications, or a combination of both? Do doctors know what they are treating? Some patients switch doctors after feeling overwhelmed by continuous prescriptions, but how can the new doctor treat the patient without knowing what medications they were previously on? In the end, both the doctor and the patient are left confused about what is happening.
Isn’t this a tragedy of our times? I apologize for my emotional outburst.

Xiao Zhi, 30~39 year old female. Ask Date: 2022/09/26

Dr. Jiang Junyi reply Neurology

Hello Mr.
Hsiao-Chih,
You mentioned, "Do these medications change the brain and personality, causing any irreversible conditions?" The medications you referred to, including Fuquan, Muxing, and Lianduomian, are all classified as benzodiazepines, which are Schedule IV controlled substances.
These types of medications are typically metabolized and eliminated after discontinuation.
Clinically, they are primarily used for short-term management, particularly for sleep disorders.
I recommend first improving sleep hygiene: try to avoid napping during the day, refrain from consuming coffee outside of morning hours, and avoid smoking and alcohol, as both can lead to fragmented sleep.
Additionally, it's best to keep distracting items, such as televisions, out of the bedroom.
Ensure that your sleeping environment is dark and quiet.
Maintain a regular sleep schedule, going to bed and waking up at the same time every day, including weekends.
Avoid exercising or eating large meals 2-3 hours before bedtime to prevent interference with sleep quality.
If you are experiencing multiple issues, I suggest the following medical principles: consider changing your physician for a different treatment perspective, seek a nearby hospital with an emergency department for integrated medical information, and understand the purpose and timing of each medication.
For related concerns, it may be beneficial to consult a sleep medicine specialist for further discussion, evaluation, and treatment.
Wishing you good health, peace, and happiness.
Dr.
Jiang, Neurology Department, Taoyuan Hospital

Reply Date: 2022/09/26

More Info

Your concerns regarding the medications prescribed for neurological issues, particularly those affecting sleep and cognitive function, are valid and reflect a common apprehension among patients. Let's address your questions and concerns systematically.

1. Impact of Medications on the Brain and Personality: The medications you mentioned, such as Rivotril (Clonazepam), Mirtazapine, and others, belong to classes that can affect neurotransmitter systems in the brain. Benzodiazepines, like Rivotril, are primarily used for anxiety and sleep disorders. While they can be effective in the short term, long-term use may lead to tolerance, dependence, and withdrawal symptoms. In some cases, prolonged use can result in cognitive impairment, particularly in older adults. However, these effects are often reversible upon discontinuation of the medication. It’s crucial to have a thorough discussion with your healthcare provider about the risks and benefits of these medications, especially if you are concerned about irreversible changes.

2. Dependency and Fear of Losing Self: It’s understandable to feel anxious about the potential for dependency on medications that affect the brain. Many patients share similar fears, especially when they notice significant changes in their sleep patterns or cognitive function. While some medications can lead to dependency, not all patients will experience this, especially with short-term use. It’s important to differentiate between physical dependence (which can lead to withdrawal symptoms) and psychological dependence (where one feels they cannot function without the medication). If you are feeling overly anxious, it may be beneficial to explore non-pharmacological interventions for sleep and anxiety, such as cognitive-behavioral therapy (CBT), mindfulness practices, or lifestyle changes that promote better sleep hygiene.

3. Prescription Practices and Concerns About Overmedication: Your observation about the ease with which medications are prescribed is a concern shared by many patients and healthcare professionals. In some healthcare systems, there may be a tendency to prescribe multiple medications, particularly when patients present with complex symptoms. This can lead to polypharmacy, which increases the risk of drug interactions and complicates the clinical picture. It’s essential for healthcare providers to conduct thorough assessments and consider non-pharmacological options before resorting to medication. If you feel uncomfortable with the number of medications prescribed, it is within your rights to seek a second opinion or to discuss your concerns with your current provider. A collaborative approach to your treatment plan can help ensure that you are receiving the most appropriate care.

4. Clarifying Diagnosis and Treatment: The process of diagnosing neurological conditions can be complex, as symptoms often overlap between different disorders and can be influenced by medications. Healthcare providers typically rely on a combination of patient history, clinical examination, and diagnostic tests to determine the underlying cause of symptoms. If there is uncertainty about whether symptoms are due to the condition itself or the medications, it may be necessary to reevaluate the treatment plan. Open communication with your healthcare team is vital; they should be aware of all medications you are taking and any changes in your symptoms.

In conclusion, while medications can play a crucial role in managing neurological and psychiatric conditions, it is essential to approach their use thoughtfully. If you have concerns about your treatment, do not hesitate to discuss them with your healthcare provider. They can help you weigh the risks and benefits, explore alternative treatments, and ensure that your care is tailored to your individual needs. Remember, you are an active participant in your healthcare journey, and your voice matters.

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