Long-Term Use of Autonomic Nervous System Medications: Concerns and Alternatives

Long-term use of autonomic nervous system (anxiolytic) medications?

Hello Dr.
Wang,
I have been taking medication for autonomic nervous system disorder for one year and three months.
The medications I am taking are Kinax (alprazolam) and venlafaxine (Easyfor) 37.5 mg.
Over the past six months, I have reduced my Kinax dosage to half a pill a day.
Recently, my doctor switched me to Sulnine (Serena) as a substitute for Kinax.
Occasionally, if I stop taking the medication for a few days, I experience dizziness and body heat symptoms, so my doctor advised me to continue taking it.
I feel quite discouraged as I have been on medication for over a year but still rely on it.
I am aware that long-term use of this medication can lead to dependence, so I am unsure how long I will need to take it.
I am considering switching to another clinic or hospital for treatment, but I am currently studying abroad and will not be able to return to Taiwan for another six months.
Additionally, last month I experienced gastrointestinal discomfort and underwent an endoscopy, which revealed a duodenal ulcer.
Therefore, I would like to ask the doctor if I should change my medication after taking autonomic nervous system drugs for such a long time.
Should I continue taking Sulnine and Easyfor at one pill each per day for the next six months? Does long-term use of Kinax and Easyfor also affect the gastrointestinal ulcer?
Thank you for your patient response.

pingu, 20~29 year old female. Ask Date: 2012/03/04

Dr. Wang Chongren reply Psychiatry

Dear Dr.
Wang Chong-Jen, Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare:
Hello,
Regarding the two medications you mentioned in your letter, Kinax is an anxiolytic, while Easyfor is an antidepressant.
Discontinuing these medications suddenly after long-term use may lead to physical discomfort, including dizziness, although fever is less common.
Sulnine is also an anxiolytic but has a longer duration of action, making it less likely to cause withdrawal symptoms upon cessation.
While all three medications have anxiolytic effects, they only address the symptoms.
It is essential to discuss the underlying causes of your anxiety with a physician, such as external pressures (like work or academic competition) or internal pressures (such as personality traits, stress tolerance, and lifestyle habits), and actively seek ways to cope and make changes.
If improvement is not achieved, seeking assistance from professionals or trusted friends is necessary to avoid long-term dependence on medication.
If the current hospital cannot assist you in addressing the root issues, it is acceptable to seek care at another facility.
Some hospitals offer biofeedback therapy or teach stress management and relaxation techniques.
If you have time to explore your psychological state further, consider psychotherapy.
Additionally, adjusting your daily routine, paying attention to exercise, leisure, and sleep, and enhancing learning and work efficiency are all non-pharmacological treatment methods.
Of course, until these methods take effect, if you cannot alleviate your stress, you may need to continue taking your current medications.
Generally, the two medications you mentioned do not affect gastric or duodenal ulcers; however, your anxiety may contribute to the development of duodenal ulcers.
Wishing you good health and peace of mind!
Sincerely,
Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2012/03/04

More Info

Long-term use of medications for autonomic nervous system disorders, such as alprazolam (Kinax), venlafaxine (Easyfor), and sertraline (Sulnine), raises several concerns regarding dependency, side effects, and overall health. It is crucial to understand the implications of prolonged medication use and explore alternatives that may help manage symptoms without relying solely on pharmacological interventions.

Firstly, medications like alprazolam, which is a benzodiazepine, can lead to physical dependence, especially when taken over extended periods. This means that if you suddenly stop taking the medication, you may experience withdrawal symptoms, such as dizziness and increased anxiety, which you have already encountered. This is a common issue with benzodiazepines, as they are designed for short-term use due to their potential for addiction and tolerance. Tolerance occurs when the body becomes accustomed to the drug, requiring higher doses to achieve the same effect, which can lead to a cycle of increasing dosage and dependency.

On the other hand, venlafaxine, an antidepressant that affects serotonin and norepinephrine levels, can also lead to withdrawal symptoms if discontinued abruptly. While it is generally considered safer than benzodiazepines in terms of addiction potential, it is still essential to taper off under medical supervision to minimize any adverse effects.

Regarding your concerns about the potential impact of these medications on your gastrointestinal health, it is important to note that while benzodiazepines and venlafaxine are not directly linked to the development of duodenal ulcers, they can exacerbate anxiety and stress, which are known contributors to gastrointestinal issues. Stress and anxiety can lead to increased stomach acid production and changes in gut motility, potentially worsening existing conditions like ulcers.

Given your situation, where you are experiencing persistent symptoms despite medication, it may be beneficial to consider a multi-faceted approach to treatment. Here are some alternatives and strategies that could complement your current regimen:
1. Psychotherapy: Engaging in cognitive-behavioral therapy (CBT) or other forms of talk therapy can help address the underlying causes of anxiety and autonomic dysfunction. Therapy can provide coping strategies and tools to manage stress without solely relying on medication.

2. Lifestyle Modifications: Incorporating regular physical activity, a balanced diet, and adequate sleep can significantly improve overall well-being. Exercise, in particular, has been shown to reduce anxiety and improve mood.

3. Mindfulness and Relaxation Techniques: Practices such as yoga, meditation, and deep-breathing exercises can help reduce stress and promote relaxation, potentially alleviating some symptoms of autonomic dysfunction.

4. Alternative Therapies: Some individuals find relief through acupuncture, massage therapy, or other holistic approaches. While research is ongoing, these therapies may provide additional support in managing symptoms.

5. Medication Review: Since you are considering switching clinics or healthcare providers, it may be worthwhile to discuss your current medications with a new healthcare professional. They can evaluate your treatment plan and suggest alternatives or adjustments that may be more effective for your specific situation.

In conclusion, while long-term use of medications for autonomic nervous system disorders can be necessary for some individuals, it is essential to regularly assess their effectiveness and explore alternative treatment options. Collaborating with healthcare professionals to develop a comprehensive treatment plan that includes both pharmacological and non-pharmacological approaches can lead to better management of symptoms and improved quality of life. Always consult with your healthcare provider before making any changes to your medication regimen or treatment plan.

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