Managing Medication Adjustments in Psychiatry: What to Expect

Medication consultation

I was previously taking two tablets of Escitalopram 75 mg and one tablet of Sulpiride 50 mg.
I felt some improvement in my symptoms, but I was very fatigued and somewhat drowsy throughout the day.
After my follow-up appointment, the doctor reduced my Escitalopram to one tablet.
After taking it for two weeks, I felt it was still about the same, so during my next visit, the doctor advised me to take it every other day.
This time, I don't feel as sleepy, but I'm not sure if it's due to the medication reduction or something else, as I feel uncomfortable throughout the day, more anxious, and my mood is unstable.
Additionally, I have excessive sweating in my hands and feet.
I would like to ask the doctor: Typically, do the side effects of discontinuing medication also subside, while the therapeutic effects remain? How long does it usually take for the side effects during the tapering process to alleviate? Is taking the medication every other day too unstable? Can these types of medications help control sweating in the hands and feet? Thank you for your response, doctor.

j, 20~29 year old female. Ask Date: 2024/01/19

Dr. Qiu Junda reply Psychiatry

Hello.
1.
After reducing the medication dosage, the amount will naturally decrease.
However, the impact on efficacy needs to be evaluated.
Typically, a balance must be struck between the medication dosage and side effects, so it is essential to discuss this with the attending physician.
Side effects during the process of reducing medication usually resolve within one to two weeks.
2.
Regarding the administration of the medication, as it has already been assessed by the physician, taking the medication every two days will not lead to instability.
Additionally, sweating in the hands and feet is also one of the symptoms, which will improve with treatment.

Reply Date: 2024/01/19

More Info

Managing medication adjustments in psychiatry can be a complex and nuanced process, particularly for individuals dealing with depression or anxiety disorders. Your experience with the adjustments to your medication regimen, including the transition from taking two pills of Venlafaxine (悦康) to one, and then to taking it every other day, highlights some common challenges faced by patients in similar situations.

Firstly, it's important to understand that when medications are adjusted—whether through dosage changes or frequency of administration—individual responses can vary significantly. The symptoms you are experiencing, such as increased anxiety, emotional instability, and excessive sweating, can indeed be related to the medication adjustments. When a medication is reduced or tapered, some individuals may experience withdrawal-like symptoms or a resurgence of their underlying condition, which can include heightened anxiety or mood instability.

Regarding your specific questions:
1. Will the side effects of stopping medication eventually disappear, while the therapeutic effects remain?
When a medication is discontinued or reduced, side effects associated with the medication may diminish over time. However, the therapeutic effects may not be as straightforward. If the medication was effectively managing your symptoms, reducing the dosage or frequency could lead to a return of those symptoms. It’s essential to communicate with your psychiatrist about any resurgence of symptoms, as they may need to adjust your treatment plan accordingly.

2. How long does it typically take for withdrawal symptoms to resolve?
The duration of withdrawal symptoms can vary widely among individuals and depends on several factors, including the specific medication, the duration of use, and individual physiology. Generally, withdrawal symptoms may begin to improve within a few days to weeks after a dosage reduction, but some individuals may experience lingering effects for a longer period. It’s crucial to maintain open communication with your healthcare provider during this time to monitor your symptoms and make any necessary adjustments.

3. Is taking medication every other day stable enough?
Taking medication every other day can be stable for some individuals, but it may not provide consistent therapeutic levels of the medication in your system. This can lead to fluctuations in symptom control and may contribute to feelings of instability. Your psychiatrist will consider your specific situation and may recommend a more regular dosing schedule if they believe it will provide better symptom management.

4. Can these medications help control excessive sweating?
Some psychiatric medications can have side effects that include sweating, while others may help manage symptoms related to anxiety that can exacerbate sweating. For example, medications like propranolol (Inderal) are sometimes used off-label to help manage physical symptoms of anxiety, including sweating. If excessive sweating is a significant concern for you, it’s important to discuss this with your psychiatrist, who may consider additional treatments or adjustments to your current regimen.

In summary, managing medication adjustments in psychiatry requires careful monitoring and communication with your healthcare provider. It’s essential to report any new or worsening symptoms, as well as any concerns about the effectiveness of your treatment. Your psychiatrist is there to help guide you through this process, ensuring that you find a balance that minimizes side effects while effectively managing your mental health symptoms. Remember, it’s a collaborative effort, and your input is invaluable in tailoring your treatment plan to best meet your needs.

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