Managing Anxiety and the Dilemma of Changing Doctors in Mental Health

Anxiety and the desire to change doctors?

Hello Dr.
Ding! (The content may be a bit long, as I want to provide detailed information for you to better understand my situation.
Thank you for your patience!) Previously, while working and preparing for the national postal service exam, I experienced significant stress and irregular meal times due to shift work, which led to various health issues.
I have not had a strong constitution since childhood, and my gastrointestinal system is particularly weak.
Starting from my second year of work after graduation, my condition worsened to the point where I needed to undergo an endoscopy annually.
Despite treatment, I experienced relapses, including gastric ulcers and gastroesophageal reflux disease (GERD).
I primarily took Western medications and followed my doctor's instructions, but I still experienced stomach pain whenever I was anxious or had sudden bloating.
During my exam preparation, I suffered from gastrointestinal discomfort and insomnia.
I was reluctant to undergo another endoscopy or consult a gastroenterologist, so I visited a psychiatrist near my home for the first time.
After taking medication for 1-2 weeks, I found it easier to sleep.
I later went to a large hospital for an examination, where the doctor diagnosed me with autonomic nervous system dysfunction and prescribed muscle relaxants and gastric medications.
However, I did not notice any significant improvement after taking them.
Last year, I participated in the postal service exam and was first on the waiting list.
Although I had finally passed, the postal service informed me that I would have to wait until the selected candidates were called before they would notify me if there were any vacancies.
This left me in a state of uncertainty.
I initially planned to continue working while waiting for a notification, reassuring myself that at least I had an income.
However, while working, I experienced persistent burping, headaches, and stomach pain, with different areas of my body hurting daily.
Despite feeling exhausted, I struggled to fall asleep in bed and became increasingly sensitive to noise (my home is near a busy road, and my neighbors often run washing machines at night).
The lack of sleep made me more fatigued, leading to chest tightness and a lack of energy when speaking with clients.
I noticed that many colleagues were taking sick leave, each with different conditions.
Eventually, I could no longer cope and struggled with indecision for a long time.
After discussing with my father and friends, and even consulting a fortune teller, I resigned in May of this year.
However, after a day or two, I realized that I was not as happy as I had imagined.
I found myself worrying and regretting my impulsive decision, feeling insecure without an income.
Although my family did not rely on my salary, I felt uneasy starting my day.
Suddenly without a job, I didn't know what to do.
I began walking for exercise with my parents, but after feeling tired and lost in thought, I stopped exercising altogether.
I felt depressed and exhausted, even contemplating suicide.
However, the thought of the pain involved deterred me.
Due to some family issues, I didn't want to share my feelings with them, so I returned to see the psychiatrist I had initially consulted.
He informed me that my condition had worsened and that I would need to take medication for an extended period.
He advised me to focus solely on him and not to consult other specialists.
Following his instructions, I took my medication before bed from mid-May until now.
My physical condition has improved compared to when I was working, but I still often feel fatigued.
If I am not engaged in activities, I tend to want to sleep continuously.
The doctor assured me that this was normal and that I would feel better when occupied.
Currently, my main concerns are that, in addition to fatigue, I have always had cold hands and feet, even in summer, and I still experience bloating.
I am underweight (160 cm tall and weighing 44-45 kg), and several people have commented on my thinness, with my father even calling me a "paper doll." Additionally, after bowel movements, I sometimes experience cramping in my gastrointestinal tract, but I feel better after eating.
I often wonder if I have some illness and if I should undergo a comprehensive examination at a large hospital.
I am also hesitant to continue taking psychiatric medications.
During each visit, the doctor asks about my recent mood and events, provides brief responses, and continues to prescribe the same medications.
Although he assures me that there are no side effects, friends have mentioned that some medications can block brain neurotransmitters.
Currently, I am taking clonazepam 0.5 mg, Calmdown 37.5 XR, and lowen 0.5 mg, along with alprazolam for my stomach.
I increasingly distrust this doctor because he does not offer further solutions, merely attributing my stomach pain and insomnia to anxiety and suggesting travel, exercise, and a regular lifestyle.
It feels like I am just sharing my feelings and then going home with medication.
I believe that the psychological aspect has its limits.
I am considering seeing a traditional Chinese medicine practitioner to adjust my constitution and, if my mood becomes depressed again, consulting another mental health professional.
However, I am afraid that stopping the medication abruptly could lead to negative consequences.
The doctor insists that I need to continue taking the medication until I receive notification from the postal service and get back on track with work.
I feel helpless and uncertain about what to do next.
I kindly ask for your assistance, Dr.
Ding.
Thank you very much!

Sha Er, 20~29 year old female. Ask Date: 2015/08/18

Dr. Ding Shuyan reply Psychiatry

Hello,
In your message, you mentioned whether you should go to a major hospital for further examination.
In the past, your test results indicated that you have autonomic nervous system dysregulation.
Physical discomfort and psychological stress are often two sides of the same coin.
When symptoms of anxiety and depression improve, physical complaints may also lessen.
Of course, just because previous tests showed no issues doesn't mean that similar symptoms in the future should be ignored.
However, if your mental health symptoms remain significant, it is essential to pursue active treatment in that area.
As for your physical symptoms, unless there are new developments, there may not be an urgent need for repeated examinations.
Regarding your physician, he has personally examined you, while I am someone you have never met online; therefore, you should not place more trust in my words than in your doctor's.
Psychiatric treatment often requires time and is not as quick as recovering from a cold.
Sometimes, it takes one to two months to determine the effectiveness of a medication.
Occasionally, a medication may not be ineffective but may not yield satisfactory results, which can be awkward.
Some doctors may prefer to wait and see if the medication continues to show effects, while others may choose to switch medications.
Both approaches can be valid, and I have encountered both situations.
Additionally, a physician's decisions can sometimes be influenced by the patient, but patients typically lack medical training and clinical experience in treatment.
If doctors solely follow patients' requests, it can sometimes lead to slower recovery.
You might consider asking your physician why there hasn't been a medication adjustment and share your thoughts with him.
Personally, I do not dismiss traditional Chinese medicine or folk remedies, but I believe it is unwise to abandon Western medicine in favor of them entirely.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2015/08/18

More Info

Managing anxiety can be a complex and multifaceted process, especially when it involves navigating the healthcare system and making decisions about treatment options. Your situation reflects a common struggle many individuals face when dealing with mental health issues, particularly when symptoms manifest physically, such as gastrointestinal problems, fatigue, and sleep disturbances.
Firstly, it’s important to recognize that anxiety can significantly impact both mental and physical health. The symptoms you describe—such as headaches, stomach pain, and feelings of being overwhelmed—are not uncommon among those experiencing high levels of anxiety. The fact that you have a history of gastrointestinal issues, including ulcers and reflux, may exacerbate your anxiety, creating a vicious cycle where anxiety leads to physical symptoms, which in turn increases anxiety.

Your experience with the mental health system, including the transition from a gastroenterologist to a psychiatrist, is also noteworthy. It’s not unusual for patients to feel frustrated when they perceive that their concerns are not being fully addressed. It’s essential to have a healthcare provider who listens to your concerns and collaborates with you on a treatment plan. If you feel that your current psychiatrist is not meeting your needs, it might be beneficial to seek a second opinion or to consult another mental health professional. This is a common practice and can provide you with new insights or treatment options.

Regarding your medication regimen, it’s crucial to understand that while medications like clonazepam (Clonopam) and alprazolam can be effective for managing anxiety, they can also have side effects, including sedation and dependency if used long-term. It’s essential to have an open dialogue with your psychiatrist about your concerns regarding medication, including any side effects you may be experiencing and your feelings of fatigue. If you feel that the current medication is not helping or is causing unwanted effects, discuss this with your doctor. They may consider adjusting your dosage or switching to a different medication that may be more suitable for your situation.

In addition to medication, therapy can be a valuable component of anxiety management. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety disorders, as it helps individuals identify and challenge negative thought patterns and develop coping strategies. If your psychiatrist is not providing therapy, you might consider seeking a therapist who specializes in CBT or other therapeutic modalities that resonate with you.

You mentioned considering traditional Chinese medicine (TCM) as an alternative approach. While some individuals find TCM helpful, it’s essential to ensure that any alternative treatments do not interfere with your current medications. Always consult with your healthcare provider before making changes to your treatment plan.

Lastly, lifestyle modifications can also play a significant role in managing anxiety. Regular exercise, a balanced diet, adequate sleep, and mindfulness practices such as meditation or yoga can help reduce anxiety symptoms. Engaging in activities that you enjoy and that bring you a sense of fulfillment can also improve your overall well-being.

In summary, managing anxiety is a journey that often requires a combination of medication, therapy, lifestyle changes, and open communication with healthcare providers. If you feel that your current treatment is not effective, don’t hesitate to seek a second opinion or explore additional therapeutic options. Your mental health is paramount, and finding the right support is crucial for your recovery.

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