Managing Anxiety and Medication Withdrawal: A Patient's Journey

Drug withdrawal

Hello Doctor: I have been taking "Duloxetine 30 mg" for about 4 to 5 months due to long-term anxiety issues.
This may stem from the six months I spent caring for my father, who had cancer, until his passing about six or seven years ago.
I am unsure why I still experience anxiety after such a long time.
Whenever there is a physical issue, I become extremely anxious (most of the time), and I have even had moments where I felt I was losing control and might die (though these instances are very rare, only one or two times).
During these episodes, which last about half an hour, I cannot calm down no matter what I do.
When I get anxious, I experience diarrhea, and the diarrhea increases my anxiety, leading me to visit various hospitals frequently.
I am now very concerned about my bowel movements and weigh myself daily, fearing any weight loss or health issues.
Even though I know this is not normal, I try to reassure myself that it's just my overthinking.
This has resulted in frequent gastrointestinal cramps, gas, and occasional diarrhea (I have undergone cancer antigen tests, stool tests, and ultrasounds, all of which were normal).
My mother strongly disapproves of my seeing a psychiatrist, which sometimes leads to conflicts.
Recently, I have considered stopping the medication, but even taking half a pill still results in diarrhea.
Although it may only last a day or two, over the past 5 to 6 days, I have gone from half a pill to completely stopping the medication, and I suspect that gas has increased—it's loud but not foul-smelling.
Certain areas of my skin feel electric when touched (this has lasted for two to three days), and I have experienced some warmth and sweating without a fever, along with a headache (I'm unsure if this is due to eye strain or the medication).
My diarrhea has become more unformed.
This has caused me significant anxiety, worrying whether it is a serious condition or just withdrawal symptoms.
I have consulted a gastroenterologist about the unformed stools and dark spots, and they temporarily said there was no issue.
I would like to ask the doctor:
1.
Should I continue to stop the medication, or should I take it for a while longer before reducing the dosage?
2.
If I need to reduce the dosage, how should I do it? One pill every two days, one pill every three days, or can I go directly to half a pill?
3.
Could the unformed stools and electric sensations be potential side effects of abruptly stopping the medication? How should I address this?
4.
If this is the case, should I consider trying a different medication, or should I seek help from another psychiatrist?
5.
In the past month or two, I have found myself unusually emotional, often tearing up at videos or songs, which surprises me.
Is this a problem, or am I overthinking it?
Thank you, doctor, for taking the time to read my concerns amidst your busy schedule.
I have asked my psychiatrist, but the responses have been rather vague and rushed.
I worry about bothering others with too many questions, but most people around me do not understand my situation, which has caused me significant distress.
I felt compelled to seek help online.
Thank you.

Kang Xiaodi, 20~29 year old female. Ask Date: 2024/05/01

Dr. Wu Enliang reply Psychiatry

1.
Should I continue taking the medication or reduce the dosage after some time? A: Given your current level of anxiety, it's best not to stop the medication for now.

2.
If I want to reduce the dosage, how should I do it? One pill every two days, one every three days, or can I just take half a pill? A: For now, do not stop the medication.
If you decide to taper off, it should be done gradually and ideally under the guidance of a healthcare professional.

3.
I have experienced loose stools and a tingling sensation.
Could these be potential side effects of abruptly stopping the medication? How should I address this? A: These symptoms are likely related to anxiety rather than medication withdrawal.

4.
If that's the case, should I consider switching medications or seek help from another mental health professional? A: Whether to switch medications is a discussion to have with your doctor.
You might also consider consulting another mental health professional who has more availability and fewer patients.

5.
Recently, I've found myself unusually emotional, crying more easily when watching videos or listening to songs, which surprises me.
Is there something wrong, or am I overthinking this? A: It's normal for people to be emotional; this is not a problem.
Dr.
Wu Enliang

Reply Date: 2024/05/01

More Info

Managing anxiety and medication withdrawal can be a complex and challenging journey, particularly for individuals who have experienced significant stressors in their lives, such as caring for a terminally ill loved one. Your situation reflects a common struggle faced by many who deal with anxiety disorders, especially when compounded by the emotional toll of caregiving and loss.

Firstly, it’s important to acknowledge that anxiety can persist long after the initial stressor has passed. The body and mind can remain in a heightened state of alertness, leading to ongoing anxiety symptoms. This can manifest physically, as you’ve described with gastrointestinal issues, and emotionally, with feelings of panic or fear of losing control.
Regarding your current medication, "杜憂停" (likely Duloxetine or a similar medication), it’s crucial to approach any changes in your medication regimen cautiously. Here are some considerations based on your questions:
1. Should you continue to stop the medication? It’s generally advisable to consult with your prescribing physician before making any decisions about stopping or continuing medication. Abruptly stopping certain medications can lead to withdrawal symptoms, which may include gastrointestinal distress, mood swings, and physical sensations like the "electric shock" feeling you described.
2. How to taper off the medication? If you and your doctor decide that tapering off is appropriate, it’s typically recommended to do so gradually. A common approach is to reduce the dose by a small amount (for example, by 25% or 50%) and maintain that dose for a week or two before reducing it further. This allows your body to adjust to the changes. However, the exact tapering schedule should be personalized based on your specific situation and under medical guidance.

3. Are the symptoms you’re experiencing withdrawal effects? The symptoms of diarrhea, tingling sensations, and sweating could indeed be related to withdrawal from the medication, especially if you have recently stopped or reduced your dosage. It’s essential to monitor these symptoms and discuss them with your healthcare provider. They may suggest supportive measures or adjustments to your tapering plan.

4. Should you consider switching medications or seeking additional help? If your current medication is not providing the relief you need or if you are experiencing intolerable side effects, it may be worth discussing alternative medications with your doctor. Additionally, seeking support from a mental health professional, such as a psychologist or therapist, can be beneficial. Therapy can provide coping strategies and emotional support, which can be particularly helpful during medication transitions.

5. Why are you feeling more emotional lately? Increased emotional sensitivity, such as crying more easily, can be a side effect of medication changes or withdrawal. It may also reflect underlying anxiety or depression. This heightened emotional response can be a normal part of processing grief and stress, especially after significant life events. It’s important to allow yourself to feel these emotions and to seek support when needed.

In summary, managing anxiety and medication withdrawal requires a careful and thoughtful approach. Open communication with your healthcare provider is essential to ensure that you are making informed decisions about your treatment. Additionally, consider seeking therapy to help navigate the emotional challenges you are facing. Remember, you are not alone in this journey, and there are resources available to support you.

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