Managing Side Effects of Anxiolytics: A Guide for Patients and Families

Side effects of tranquilizers?

Hello doctor, my family member has been experiencing anxiety, restlessness, and panic, along with frequent feelings of rapid breathing and shortness of breath.
The psychiatrist initially prescribed Lorazepam 0.5 mg to be taken as needed.
Since my family member is very sensitive to medications, they only took half a tablet and did not take it every day.
Recently, during a follow-up appointment, due to symptoms of anxiety and rapid breathing on that day, the doctor advised to take half a tablet three times a day with meals (totaling 1 mg).
However, after taking it four times, they began to experience side effects such as dizziness, generalized weakness, decreased appetite, and emotional instability.
Sometimes, they still felt short of breath.
They decided to stop the medication, thinking that the side effects would subside once the drug wore off.
However, without the medication, the dizziness, fatigue, and lack of appetite persisted for three days, and then feelings of agitation emerged.
Concerned about withdrawal symptoms, they resumed taking half a tablet, but the side effects continued.
Now, due to the intolerable side effects, emotional instability, irritability, and frequent feelings of shortness of breath, thoughts of wanting to die have also occurred.
My family member is currently taking Zolpidem as a sleep aid (but without significant side effects).
We believe that both Lorazepam and Zolpidem are anxiolytics; although they do not take them simultaneously, they may still prolong feelings of dizziness and weakness.
We would like to ask the doctor: how should Lorazepam be taken in this situation? Should we revert to taking it as needed, or continue with half a tablet once a day, or is there a better approach?

Niming, 20~29 year old female. Ask Date: 2023/10/14

Dr. Wu Enliang reply Psychiatry

Benzodiazepines (BZD) are sedatives that are generally recommended for short-term use or as needed.
They are not considered first-line medications (other antidepressants should typically be used as first-line treatments).
If medication is necessary, it is advisable to discuss it with the treating physician who is familiar with the current condition.
Dr.
Wu En-Liang.

Reply Date: 2023/10/14

More Info

Managing side effects of anxiolytics, particularly for patients with anxiety disorders, is a crucial aspect of treatment that requires careful consideration and communication with healthcare providers. In your case, it seems that your family member has been experiencing significant side effects from the medication, specifically Lorazepam (also known as Ativan), which is commonly prescribed for anxiety and panic disorders.
Firstly, it’s important to understand that Lorazepam is a benzodiazepine, which can be effective for short-term relief of anxiety symptoms. However, it can also lead to side effects such as dizziness, sedation, decreased appetite, and emotional instability, especially when taken regularly or in higher doses. The fact that your family member is sensitive to medications complicates the situation, as even lower doses can lead to pronounced effects.

Given the symptoms your family member is experiencing—dizziness, weakness, reduced appetite, emotional instability, and feelings of anxiety or panic—it’s essential to approach this situation with caution. Here are some strategies to consider:
1. Consult the Prescribing Physician: The first step should always be to communicate openly with the prescribing psychiatrist. Discuss the side effects experienced and express concerns about the current regimen. It may be beneficial to schedule an appointment specifically to address these issues.

2. Medication Adjustment: Based on the feedback from the physician, it may be advisable to revert to the previous regimen of taking Lorazepam only as needed, rather than on a scheduled basis. This can help minimize the risk of dependency and reduce the likelihood of experiencing withdrawal symptoms when the medication is stopped.

3. Consider Alternative Medications: If Lorazepam continues to cause intolerable side effects, the physician may consider switching to a different class of medications. For instance, selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are often used for anxiety and may have a different side effect profile.
4. Monitor for Withdrawal Symptoms: If your family member has stopped taking Lorazepam and is experiencing withdrawal symptoms, it’s crucial to inform the doctor. They may recommend a gradual tapering of the medication rather than abrupt cessation, which can help mitigate withdrawal effects.

5. Lifestyle Modifications: Encourage your family member to engage in non-pharmacological interventions for anxiety management, such as cognitive-behavioral therapy (CBT), mindfulness practices, or relaxation techniques. These can be effective in managing anxiety symptoms and may reduce reliance on medication.

6. Support System: Ensure that your family member has a strong support system in place. Emotional support from family and friends can be invaluable during this time, especially when dealing with anxiety and medication side effects.

7. Regular Follow-ups: Schedule regular follow-ups with the healthcare provider to monitor the effectiveness of any changes made to the treatment plan and to address any new or ongoing concerns.

In summary, managing the side effects of anxiolytics like Lorazepam requires a collaborative approach between the patient, their family, and healthcare providers. Open communication about side effects, potential medication adjustments, and exploring alternative treatments can lead to a more effective and tolerable management plan for anxiety. Always prioritize safety and well-being, and do not hesitate to seek immediate medical attention if there are any thoughts of self-harm or severe emotional distress.

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