Drugs to relieve somatization of depression

First, let’s clarify the core conclusion: There are currently no specific clinical drugs for “somatization of depression”. The mainstream standard treatment is centered on first-line antidepressants such as SSRI and SNRI. Analgesic and sedative auxiliary drugs or traditional Chinese medicine prescriptions can be used as needed according to individual symptoms. All medication must be carried out under the guidance of professional psychiatrists/psychologists. There is no universal “optimal prescription” and it is prohibited to purchase medicines by yourself.

I met a 26-year-old Internet operator girl a while ago. She had been suffering from shoulder and back pain for almost a year. She tried massage, bone setting, and plastering. She had no problem at all when taking cervical spine X-rays. When the pain was so severe that she couldn't even lift her arms, she finally had her sperm removed. The psychiatrist diagnosed her with somatization of depression. The doctor prescribed sertraline. She felt a little nauseous after taking it for the first week. She almost stopped taking the medicine without permission, but she gritted her teeth and carried on until the fourth week. The stiffness in her shoulders and back was 80% gone. Last week, she went to climb Mount Taishan with her friends.

Many people will wonder, if they are in pain, why should they take antidepressants? In fact, the somatization of depression is not actually an organic problem in the body. It is caused by long-term emotional suppression that causes neurotransmitters such as 5-hydroxytryptamine and norepinephrine in the brain to be disrupted, which also messes up the signal conduction of the autonomic nerves. The nerves misjudge emotional "stomach pain" as "real pain" in the body. Therefore, no matter how much ibuprofen you take or how many plasters you apply, it will be useless. You have to reverse the neurotransmitter disorder at the root. Commonly used sertraline and escitalopram belong to the SSRI category and have relatively mild side effects. They are suitable for patients who are taking the drug for the first time. If the symptoms of physical pain are particularly obvious, the doctor will most likely prescribe SNRI drugs such as venlafaxine and duloxetine, which will be more targeted for physical pain.

Of course, there have always been controversies. Many people get confused when they hear that they need to take antidepressants. They are afraid of addiction, fear of side effects, and fear of becoming stupid after taking them. It is true that some patients will experience nausea, insomnia, and slight hand tremors in the early stages of taking the medicine. Most people will be relieved on their own in 1-2 weeks. If they really can't tolerate it, just ask a doctor to adjust the medicine. There will be basically no long-term damage. I have talked to many psychiatrists, and their biggest headache is when patients say "it's useless" after just three or four days of taking the medicine. It is really unfair to stop taking the medicine without permission - this type of antidepressant generally takes 2-4 weeks to fully take effect. Symptoms may even be slightly aggravated in the first two weeks, which is normal. You need to give the medicine some time. If the onset of physical symptoms is particularly acute, such as chest tightness that makes you unable to breathe, or a headache that makes you unable to get out of bed, the doctor will also prescribe some benzodiazepines such as alprazolam for a short period of time to suppress the acute symptoms. As long as you follow the doctor's advice and do not take it for a long time, you will not become addicted at all, and you don't have to feel bad about it.

Not everyone accepts the Western medicine plan. Many elders prefer to seek treatment from traditional Chinese medicine. There is no term for "somatization of depression" in Chinese medicine. It is generally classified into the categories of "stagnation syndrome" and "bi syndrome", which are mostly caused by liver qi stagnation and blocked meridians. Using prescriptions such as Xiaoyao Pills and Bupleurum Shugan Powder to soothe the liver and regulate qi, combined with acupuncture and moxibustion, many patients with mild somatization have been clinically cured. Many clinical psychologists believe that mild somatization can be relieved without medication. Running two or three times a week, doing mindful breathing for 10 minutes a day, or doing short-term cognitive behavioral therapy can also alleviate the condition. After all, medication is only three parts toxic, so don’t use it if you can. I have a friend who is a designer. He always had headaches when working on projects some time ago. After checking around, there was nothing wrong. He ran 3 kilometers around the community after get off work every day. After running for two weeks, his headaches disappeared, and even the irritability of staying up late disappeared a lot.

But this has to be said from both sides. If the non-pharmacological solutions you have tried for more than a month are of no use at all, and the pain is so severe that you can't even sleep or go to work, don't take it hard. You still have to take medicine. Not long ago, I met an aunt in her fifties who had chest tightness for more than half a year. Three cardiac angiograms were performed without any problems. She always felt that she had a terminal illness that could not be detected. Finally, the psychiatry department prescribed duloxetine. After taking it for a month, her chest was no longer tight. Now she goes out to dance square dances with her old sisters every day.

And to be honest, don’t think of medicine as a panacea. I once had a client who worked as a planner. After taking medicine for half a year, his back pain was 80% better. However, when he had to work overtime on projects, it relapsed. Later, he received cognitive behavioral therapy for three months. He learned to stop what he was doing to take a breath when he was stressed, without having to carry it, and he never had pain again. Medicine only helps you bring your condition to a passing level. You still have to do the rest of the homework of adjusting your life rhythm and relieving your emotions. Otherwise, even if the symptoms disappear this time, it will still be easy to rebound next time when stress comes up.

To put it bluntly, there is never the best medicine to relieve the somatization of depression, only the one that suits you best. Don't blindly search Baidu to compare symptoms and buy medicine yourself, and don't refuse to see a doctor because you are afraid of side effects. Find a reliable doctor and slowly adjust it. You can always find a plan that suits you. There is really no need to panic.