Choosing the Right Psychiatrist: Managing Anxiety and Insomnia Medications

Which doctor should I see?

I would like to ask...
Recently, due to severe insomnia and anxiety, my doctor prescribed me Lishutong to take at night.
However, after a few months, I still rely on this medication to fall asleep, and I have increased my dosage from one tablet to one and a half tablets to achieve sleep.
Previously, he suggested that I take an SSRI medication, Lexapro, but I was hesitant because I had used it a few years ago and knew it would take a long time to taper off.
After discussing this in a recent follow-up appointment, I started taking Lexapro, but my insomnia worsened at night.
I then consulted another doctor who prescribed me an additional half tablet of Lishutong.
My question is: 1.
Is there a risk of addiction to Lishutong (and how can I gradually taper off this medication)? 2.
For simple insomnia and anxiety that I cannot seem to resolve, is it necessary to return to using Lexapro? (I originally did not feel down, but since taking this medication, I have felt somewhat low and my sleep quality has not improved.) 3.
Regarding the doctors, could you recommend which doctor I should see for my concerns?

Jun Nan, 40~49 year old female. Ask Date: 2014/03/29

Dr. Ding Shuyan reply Psychiatry

Hello, long-term and excessive use of Lexotan may lead to some degree of tolerance.
However, whether a patient becomes addicted to a medication often depends more on the patient's mindset than on the medication itself.
Some people enjoy taking medication, while others are afraid of it, leading to different outcomes.
Using antidepressants to treat long-term insomnia and anxiety is quite acceptable! The key is to choose medications with fewer side effects that are effective.
I have mentioned this to many users before; if you are seeing a doctor, I do not recommend bringing your physician's prescriptions or treatment suggestions to ask strangers like us online.
If my opinion differs from your physician's, I can't think of any reason why you should trust our online responses more than the doctor who is personally treating you.
If you lack confidence in your treating physician, it is also acceptable to seek another doctor.
When choosing a physician, it is fundamentally about selecting one you have confidence in, as this will yield more benefits.
Of course, a physician's attitude can sometimes affect our feelings.
A doctor who is kind, warm, and responsive to requests is generally a compassionate physician.
However, some doctors may be harder to communicate with and have their own principles, which are sometimes rooted in their desire to do what is best for the patient.
This is similar to the different ways strict fathers and loving mothers express their care for their children! I have several physician friends who are very compassionate and caring, but they may appear serious and speak directly to patients.
Nevertheless, they are highly skilled, and their patients often have good treatment outcomes.
Therefore, judging solely by appearance does not equate to understanding one's inner qualities.
When we shop, the store owner who profits from us is usually smiling and courteous, right? Wishing you all the best, Dr.
Ding Shuo-Yan.

Reply Date: 2014/03/29

More Info

Choosing the right psychiatrist and managing medications for anxiety and insomnia can be a complex and challenging process, especially when previous experiences with medications have not yielded the desired results. Here’s a comprehensive approach to your questions and concerns.

1. Addiction Potential of Lishutong (Estazolam)
Estazolam, marketed under the brand name Lishutong, is a benzodiazepine used primarily for the treatment of insomnia. While it can be effective for short-term use, there is a risk of developing tolerance and dependence, especially with prolonged use. Tolerance means that over time, you may need higher doses to achieve the same sedative effect, which seems to be happening in your case.
To taper off Estazolam safely, it is crucial to consult with your psychiatrist. A gradual reduction in dosage is typically recommended to minimize withdrawal symptoms and rebound insomnia. Your psychiatrist may suggest a tapering schedule, which could involve reducing your dose by a small amount every week or two, depending on your specific situation.

2. The Need for SSRIs like Lexapro (Escitalopram)
SSRIs, such as Lexapro (Escitalopram), are commonly prescribed for anxiety and depression. While they can be effective, they may take several weeks to show benefits, and some patients experience side effects, including increased anxiety or mood changes initially. If you find that your anxiety worsens with Lexapro, it’s essential to communicate this to your psychiatrist.
In some cases, it may be necessary to adjust the dosage or switch to a different medication. It’s also worth noting that combining medications, such as an SSRI with a benzodiazepine, can sometimes help manage anxiety more effectively. However, this should always be done under the supervision of a healthcare professional.

3. Choosing the Right Psychiatrist
Finding the right psychiatrist is crucial for effective treatment. You mentioned that your previous psychiatrist was thorough but had a less than pleasant demeanor, while the new psychiatrist is more approachable but may not provide the same level of attention due to a higher patient load. Here are some considerations:
- Communication Style: It’s essential to feel comfortable discussing your symptoms and treatment options with your psychiatrist. If you feel rushed or unable to ask questions, it might be worth seeking a psychiatrist who can provide more personalized attention.

- Experience with Your Conditions: Look for a psychiatrist who has experience treating anxiety and insomnia specifically. They should be familiar with the latest treatment options and be willing to tailor their approach to your needs.

- Availability: Consider the psychiatrist's availability for follow-up appointments. Regular check-ins can be vital for adjusting treatment plans as needed.

- Referrals and Reviews: Ask for referrals from trusted sources or look for online reviews to gauge other patients' experiences with the psychiatrist.

Additional Considerations
- Therapy: In addition to medication, cognitive-behavioral therapy (CBT) has been shown to be effective for anxiety and insomnia. If you haven’t already, consider seeking therapy alongside your medication regimen.

- Lifestyle Changes: Incorporating lifestyle changes such as regular exercise, a balanced diet, and good sleep hygiene can significantly impact your anxiety and sleep quality.

- Support Groups: Engaging with support groups for individuals dealing with anxiety and insomnia can provide additional coping strategies and a sense of community.

In conclusion, managing anxiety and insomnia requires a multifaceted approach, including careful medication management, effective communication with your healthcare providers, and lifestyle adjustments. Always prioritize open dialogue with your psychiatrist to ensure that your treatment plan aligns with your needs and preferences. If you feel that your current psychiatrist is not meeting your needs, don’t hesitate to seek a second opinion or find a new provider who can offer the support you require.

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