Medicines to relieve anxiety and depression

There is currently no panacea that can "cure" all anxiety and depression. Related drugs that have been clinically proven to be effective are mainly divided into prescription antidepressants and anti-anxiety preparations that must be used strictly in compliance with doctor's instructions, as well as over-the-counter products that can only play an auxiliary regulatory role. All drugs must be evaluated by a professional psychiatrist first, and self-diagnosis and self-purchasing of drugs are absolutely prohibited.

Last month, I accompanied a friend who was diagnosed with moderate depression and generalized anxiety to a follow-up consultation. The pill box in her hand was sertraline, which belongs to the most commonly used clinical SSRI (selective serotonin reuptake inhibitor). She felt nauseous every day for the first week after taking it. She couldn't even swallow the iced American she often drank at work. She thought she had stepped into a trap of fake medicine. It wasn't until the doctor told her that this kind of medicine generally takes 1-2 weeks to take effect gradually, and that the early gastrointestinal discomfort and mild drowsiness are normal tolerance reactions, she was relieved. She has been taking it for more than three months now, and she told me that the most obvious change is that when she wakes up in the morning, she no longer stares at the ceiling and cries unconsciously for half an hour, and can get up normally and cook herself a soft-boiled egg.

Of course, not everyone needs to take medication right away. The academic community has always had different opinions on the timing of medication: in the mainstream psychiatric diagnosis and treatment guidelines, for moderate and above depression and anxiety attacks, drug treatment with a sufficient amount and a sufficient course of treatment is the first choice, because it can quickly adjust the level of neurotransmitters in the brain, first pull the person out of the emotional quagmire of "the whole person is falling", and avoid extreme risks such as self-injury.； However, there are also many evidence-based psychological studies showing that for mild anxiety and depression, the intervention effect of cognitive behavioral therapy (CBT) is actually equivalent to that of SSRI drugs, and the long-term recurrence rate is lower. It can be improved without medication first, and can be improved through psychological intervention + lifestyle adjustment.

Many people may have taken drugs such as alprazolam and lorazepam when they have an acute anxiety attack or suffer from insomnia all night long. They are anti-anxiety drugs of the benzodiazepine class. They can calm people down after taking them for more than ten minutes, and the effects are very fast. But a warning: if you take this kind of medicine continuously for more than 4 weeks, you may develop dependence. Therefore, clinicians usually only prescribe 1-2 weeks' dosage, and repeatedly tell you "take it only when you really can't bear it." Do not take it as daily medicine every day. I have been exposed to a case before. I secretly saved a dozen boxes of Lorazepam and took it whenever I felt uncomfortable. In the end, taking one pill no longer worked. I had to take three or four pills before I could fall asleep. It took me almost half a year to slowly reduce the dosage. It was really not worth the gain.

There are also many people who are afraid of the side effects of prescription drugs and want to find "all-natural" alternatives. St. John's wort extract, oryzanol, vitamin B complex, which have become very popular recently, and even various anti-anxiety gummies and mood tablets from Internet celebrities, many people have followed the trend and bought them. To be honest, oryzanol and B-complex can indeed mildly regulate autonomic nervous system disorders. If you just work a lot of overtime recently and occasionally have palpitations and can't sleep well, taking some can indeed help, but it is basically useless for diagnosed anxiety and depression. As for St. John's wort, low-dose over-the-counter preparations are indeed available in Europe and the United States to improve mild depression, but its problem is that it has serious interactions with many commonly used drugs. Previously, a netizen took St. John's wort at home for more than half a month while taking short-acting contraceptive pills. As a result, she got unexpectedly pregnant. After going to the hospital for a checkup, she learned that St. John's wort will accelerate the metabolism of contraceptive pills and directly reduce the contraceptive effect. If you are taking anticoagulants, anti-epileptic drugs, etc., the risk is much higher. Don't touch "natural mood pills" of unknown origin.

When many people hear that they need to take psychotropic drugs, their first reaction is, “Will it make me stupid? Will it be addictive? ”There’s really no need to demonize this type of medicine. I have seen too many people refuse to take medicine because they are afraid of side effects, and eventually become severely depressed and cannot get out of bed, which in turn delays the best opportunity for intervention. The so-called "can't think straight and want to sleep" reaction is mostly a tolerance reaction in the early stage of medication. It usually disappears in 2-4 weeks and will not really make you stupid. Except for the benzodiazepines mentioned just now, the commonly used antidepressants are not addictive. When stopping the medicine, as long as you slowly reduce the dosage according to the doctor's advice, you will not experience serious discomfort. Those who say "you feel uncomfortable when you stop taking the medicine" mostly stop it on their own without authorization. They have a normal withdrawal reaction and are not addicted.

To be honest, medicine is just a tool to help you bring your mood back to a normal level. It is not a magic pill that will make everything go smoothly once you take it. I once had a client who took the medicine for half a year and her mood became much more stable, but she still felt chest tightness and trembling hands when she got to work. Later, she quit her job as a PUA every day. Within two months, her dosage was reduced by half. It worked better than any other adjustment plan. If you expect that taking medicine alone can solve all the messes in your family, workplace, and interpersonal relationships, then it’s really better to save some money.

There is another very important point to mention: everyone's reaction to drugs is very different. Others take sertraline and it works, but you may have unbearable side effects. Some people take SNRI venlafaxine, which is particularly effective, and some people take it and get migraines that make them unable to go to work. Therefore, do not buy medicines randomly by looking at the "medication homework" on the Internet. You must go to a regular psychiatry department. The doctor will choose the most suitable plan for you based on your physical condition, symptom characteristics, and whether you have other underlying diseases. This is the most responsible approach for you.