Medication Overdose or Ineffectiveness: Your Psychiatric Concerns

Q: Medication Overdose or Ineffectiveness: Your Psychiatric Concerns

Hello, Da Zhuang： Generally speaking, Metoprolol can help alleviate symptoms of anxiety and panic. <br>Since you did not experience any significant discomfort while taking half a tablet, the panic-like symptoms that appeared after increasing the dosage to one tablet may not be du

Is it due to drug overdose or drug ineffectiveness?

Hello Doctor,
I would like to ask about my condition.
In April of this year, I suddenly started experiencing nasal congestion, which caused difficulty in breathing and gradually led to anxiety affecting my sleep.
Since August, I have been unable to sleep well.
My psychiatrist prescribed "0.5 mg of Melatonin before bed and 1 mg of Quetiapine before bed." My sleep improved a bit, so I adjusted to "0.5 mg of Melatonin before bed and 0.5 mg of Quetiapine before bed." However, in early October, I began to experience body tremors and an indescribable discomfort.
My psychiatrist then switched my medication to "0.5 mg of Sertraline in the morning, 0.5 mg of Quetiapine before bed, and 1 mg of Sertraline as needed." Later, I experienced strong side effects from Sertraline, including overall weakness, difficulty exerting myself in the restroom, constant fatigue, and blurred vision.
Therefore, I switched back to "0.5 mg of Melatonin before bed and 0.5 mg of Quetiapine before bed." I discussed this with my psychiatrist, who expressed concern that the serotonin effect of Melatonin might be insufficient.
After our discussion, starting on November 21, I changed to "1 mg of Melatonin and 0.5 mg of Quetiapine before bed."
On November 23, I suddenly experienced shortness of breath and hyperventilation, requiring an emergency visit.
From November 24 to 25, I felt fine, but on November 26, I experienced shortness of breath again when I got busy at work.
Since then, I have felt a sense of breathlessness almost every evening.
On November 30, around noon, my body started to feel numb and tremble again.
I quickly took 0.5 mg of Quetiapine and took a nap, after which I felt better.
Today, December 1, after noon, my body started to feel numb and tremble again.

I would like to ask if the increase to 1 mg of Melatonin is causing these strong effects, as I did not feel this way before taking half a pill.
Or could it be that switching medications and then returning to Melatonin has rendered it ineffective for me? I am scheduled for turbinate surgery on December 12, and I am concerned that my current condition may affect the surgery.
However, I need to address the nasal congestion, as it is the source of my anxiety.

Da Zhuang, 40~49 year old female. Ask Date: 2023/12/01

Dr. Lin Mianzhang reply Psychiatry

Hello, Da Zhuang: Generally speaking, Metoprolol can help alleviate symptoms of anxiety and panic.
Since you did not experience any significant discomfort while taking half a tablet, the panic-like symptoms that appeared after increasing the dosage to one tablet may not be due to the increased dose of Metoprolol, but rather a change in your underlying symptoms.
Additionally, stopping Metoprolol temporarily and then resuming it will not cause its effects to disappear.
Therefore, I recommend that you continue taking one tablet of Metoprolol and patiently wait for its therapeutic effects to manifest, as the benefits of an increased dosage may take several weeks to become more apparent.
However, if you are concerned that taking one tablet may cause discomfort, you can reduce it back to half a tablet and observe whether the symptoms improve.
If you feel very anxious, it would be advisable to schedule an earlier follow-up appointment to discuss your concerns with your physician.
Wishing you a speedy recovery.

Reply Date: 2023/12/01

More Info

It sounds like you are experiencing a complex interplay of anxiety, medication side effects, and physical symptoms that are significantly impacting your quality of life. Your situation is not uncommon among individuals dealing with psychiatric conditions, especially when medications are involved. Let’s break down your concerns and provide some insights.

Firstly, it’s important to understand that medications, particularly those affecting serotonin levels like the one you mentioned (likely a selective serotonin reuptake inhibitor or SSRI), can have varying effects on different individuals. The fact that you initially felt some improvement with your sleep medication but then experienced adverse effects when the dosage was increased suggests that your body may be sensitive to changes in medication.
The symptoms you describe—such as feeling faint, experiencing body tremors, and having difficulty with basic physical tasks—are concerning. These could be side effects of the medications you are taking, particularly if you have recently changed dosages or types of medications. For example, medications like Sertraline (景安寧) can sometimes cause side effects such as fatigue, dizziness, or even increased anxiety in some individuals, especially when starting or adjusting the dose.

The feeling of breathlessness and panic you experienced could be linked to anxiety itself, which can manifest physically in various ways, including hyperventilation. When you feel anxious, your breathing may become rapid and shallow, leading to feelings of lightheadedness or even panic attacks. This cycle can be exacerbated by medication changes, as your body adjusts to new levels of neurotransmitters.

Regarding your question about whether the increase in the dosage of your medication (美妥平) is too strong or if the medication has become ineffective due to the changes, it’s essential to consider both possibilities. When you switch medications frequently or adjust dosages, your body may react unpredictably. It’s also possible that the initial effectiveness of the medication diminishes over time, a phenomenon known as tachyphylaxis, where the body becomes less responsive to a drug after repeated use.

Given your upcoming surgery for nasal obstruction, it’s crucial to address these concerns with your psychiatrist or healthcare provider. They can help you evaluate whether your current medication regimen is appropriate and whether adjustments are necessary before your surgery. It’s also vital to discuss any potential interactions between your medications and the anesthesia or other medications you may receive during the procedure.

Here are some steps you might consider taking:
1. Communicate Openly with Your Doctor: Share all your symptoms, including the physical sensations and emotional distress you are experiencing. This information is crucial for your healthcare provider to make informed decisions about your treatment.

2. Medication Review: Ask your doctor to review your current medications and their dosages. They may suggest tapering off certain medications or switching to alternatives that have a more favorable side effect profile for you.

3. Consider Therapy: In addition to medication, cognitive-behavioral therapy (CBT) or other forms of psychotherapy can be beneficial in managing anxiety and panic symptoms. Therapy can provide you with coping strategies and tools to manage your anxiety more effectively.

4. Monitor Your Symptoms: Keep a journal of your symptoms, medication changes, and any triggers you notice. This can help both you and your doctor identify patterns and make more informed decisions about your treatment.

5. Prepare for Surgery: Discuss your concerns about the surgery with your healthcare provider. They can help ensure that your anxiety and medication management are optimized before the procedure.

In conclusion, navigating medication for psychiatric conditions can be challenging, especially when compounded by physical symptoms and anxiety. It’s essential to work closely with your healthcare provider to find a treatment plan that works for you, ensuring that both your mental and physical health are prioritized. Remember, you are not alone in this journey, and there are resources and support available to help you through it.

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