Managing Panic Disorder: Medication Interactions and Sleep Challenges

Drug interactions with anxiolytics?

Hello Doctor, I have anxiety and panic disorder.
It started about ten years ago, and I initially saw improvement with Lexapro, but since then, I have developed insomnia.
For over a decade, I have been living intermittently with panic and anxiety, using willpower and breathing exercises to cope.
I need to take sleeping pills at night.
Life has been very difficult.
Recently, my symptoms have worsened to the point of severe muscle tension, so I had to return to the psychosomatic clinic.
The doctor prescribed me Wellbutrin, which has helped a bit, but I feel extremely tired and unmotivated.
However, my sleep has improved slightly at night.
In the past, I took Sertraline and felt good emotionally, but my sleep was severely affected.
The doctor suggested I continue with Wellbutrin, which puts me in a dilemma.
Should I follow my body's feelings or listen to the doctor? Is it possible to take both? I still need to take Lunesta at night to sleep.
Thank you, Doctor, for taking the time to respond.
I appreciate it! 🙏

Amy, 50~59 year old female. Ask Date: 2023/10/06

Dr. Wu Enliang reply Psychiatry

It's highly recommended to discuss your questions thoroughly with your physician.
Dr.
Wu En-Liang.

Reply Date: 2023/10/06

More Info

Managing panic disorder, especially when it is accompanied by sleep challenges, can be quite complex and requires a multifaceted approach. Your experience with anxiety and panic disorder, along with the associated sleep disturbances, is not uncommon. Many individuals with anxiety disorders often report difficulties with sleep, which can exacerbate their overall condition.
First, it's important to understand the relationship between anxiety, panic disorder, and sleep. Anxiety can lead to hyperarousal, making it difficult to relax and fall asleep. This hyperarousal can manifest as racing thoughts, physical tension, and an inability to calm the mind, all of which can contribute to insomnia. Additionally, the fear of not being able to sleep can create a vicious cycle, where the anxiety about sleep itself leads to further sleep disturbances.

You mentioned that you have been using medications such as Lexapro (escitalopram) and have experienced some improvement, but still struggle with fatigue and sleep issues. Lexapro is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for anxiety and depression. While it can help alleviate anxiety symptoms, it may take time to find the right dosage and to see the full benefits. It's also worth noting that SSRIs can sometimes cause side effects, including fatigue, especially when first starting the medication or when the dosage is adjusted.

The use of sleep aids, such as the medication you referred to as "利福全" (likely referring to a sedative or hypnotic), can be beneficial for short-term management of sleep disturbances. However, reliance on sleep medications can lead to dependency and may not address the underlying issues related to anxiety and panic disorder. It's crucial to discuss with your healthcare provider the potential risks and benefits of continuing these medications, especially if you find yourself needing them regularly.

In terms of managing your symptoms, consider the following strategies:
1. Cognitive Behavioral Therapy (CBT): This form of therapy is effective for both anxiety and insomnia. CBT can help you identify and change negative thought patterns and behaviors that contribute to anxiety and sleep problems.

2. Relaxation Techniques: Incorporating relaxation techniques such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation can help reduce anxiety and promote better sleep.

3. Sleep Hygiene: Establishing a consistent sleep routine, creating a comfortable sleep environment, and avoiding stimulants (like caffeine) close to bedtime can improve sleep quality. Limiting screen time before bed is also beneficial.

4. Physical Activity: Regular exercise can help reduce anxiety and improve sleep quality. However, try to avoid vigorous exercise close to bedtime.

5. Medication Review: Since you are experiencing fatigue, it may be worth discussing with your doctor whether the current medication regimen is optimal for you. Sometimes, a combination of medications or adjusting dosages can lead to better outcomes.

6. Support Groups: Connecting with others who have similar experiences can provide emotional support and coping strategies.

Ultimately, it is essential to maintain open communication with your healthcare provider. Share your concerns about fatigue and sleep, and work together to find a treatment plan that addresses both your anxiety and sleep challenges. It may take time to find the right balance, but with persistence and the right support, improvement is possible. Remember, managing panic disorder is a journey, and it's okay to seek help along the way.

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