The truth is hidden in the eyes: It’s just insomnia, why should I take antidepressants?

“Some patients’ insomnia never gets relief, or the treatment effect is difficult to maintain. Only after careful questioning did we find that they would secretly reduce some of their medications.” On February 20, at the Sleep Medicine Center of Union Wuhan Red Cross Hospital, Dong Feng, deputy chief physician of the hospital’s Department of Neurology, told reporters that a strange consultation phenomenon is common in sleep centers across the country. Some "rebellious" patients will refuse to take drugs with similar effects such as trazodone, venlafaxine, and citalopram.

The reporter compared these drugs and found that they have one thing in common, that is, the words "suicidal tendencies and antidepressants" are emphasized in bold at the top of the instructions. "Patients see the warning words on the instructions and feel that they do not have suicidal tendencies or depression, so they often refuse to take the medicine," said Dong Feng.

Why do doctors prescribe anti-anxiety and anti-depressant drugs to patients with simple insomnia? Dong Feng explained that the incidence of insomnia, depression and anxiety is increasing as people's pace of life accelerates, and the relationship between the three is intricate.

Insomnia is an independent risk factor for depressive disorders. Insomnia and anxiety share common pathophysiological mechanisms and are prone to "comorbidity", so the principle of "treating the same disease" should also be emphasized in treatment. They can occur independently or coexist, and are inseparable at the level of symptomatology and disease. Since insomnia patients with depression and anxiety are very different from those with simple insomnia in terms of clinical manifestations, treatment and prognosis, and have a worse prognosis and more serious harm, doctors will attach great importance to them and use more active treatment methods.

"We will first ask the patient about their sleep status, whether they have difficulty falling asleep, dreaming, shallow sleep, early awakening and other symptoms, and their daily living habits, including smoking, drinking, drinking stimulant beverages, etc." Dong Feng said when talking about how to diagnose such patients, "We will also understand whether they are sleepy during the day, and then ask about some non-specific physical symptoms, such as headaches, dizziness, tinnitus, limb numbness, neck and shoulder discomfort, loss of appetite, weight loss, fatigue, palpitations, etc." While asking questions, we must also carefully observe the patients, understand their state of mind, and try to avoid asking patients directly about their emotional symptoms. For patients who obviously reject emotional illness and have a sense of shame, we will also avoid giving them direct psychological assessment screening. "We will use different antidepressant and anxiety drugs for auxiliary treatment according to the specific symptoms of the patient himself." Dong Feng said.

"Some people's symptoms are complicated, especially elderly patients who have been taking benzodiazepines for a long time to treat insomnia. The medication methods and dosages are not standardized. There is a widespread situation of drug dependence and abuse, and the medication plans at different clinical stages are more complicated." At the end of the interview, Dong Feng called on everyone to ask a doctor as soon as they have doubts about medication, explain their own situation in detail, help improve the treatment plan, do not stop or reduce the medication on their own, and do not blindly misappropriate the treatment plans of other patients.