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Avatar universal

Benzos vs SSRIs

I was reading the CAMH website (Canadian Addiction and Mental Health)  and it appears that there is still so much controversy regarding first choice medication for anxiety disorders.  I know it is/was old school thinking that benzo were the medication of choice back in the day and in the past few years SSRIs seemed to have taken the forefront because of there supposed lack of addiction.  This absolutely confuses me because lately I thought that there has been a change in idea, again back to the benzo primarily clonazepam for those of us who only have anxiety and not depression.  This confuses me because if there is this confusion out in the medical community, what happens in the long run if your doctor leaves his practice and the new doctor decides that a benzo that you may have been taking successfully for many years, is not the route to continue on strictly because it is not a method of medicating that he or she agrees with.  This is a worry for me because I have recently started clonazepam and it does seem to be working...but I don't want to have the concern lurking in the back of my head that someday I will be refused this medication and have to go through the process that I have already gone through in the past to try and find some antidepressant to take the place of an anti-anxiety medication when I don't have depression but have GAD.  Does anyone of you have any information for me that may clear up this discrepancy in information that I have receive.  Could I possibly be mistake with the CAMH approach to GAD or is this a situation where Canada is lagging behind what is done in the U.S.A.  or is it the same there too.  I am confused and would love some clarification.    
19 Responses
Avatar universal
From what I know SSRIs can be effective for GAD, but not for panic disorder. Benzos are also helpful for GAD, particularly clonazepam. A lot of the other benzos (like ativan) are only supposed to be taken when symptoms present themselves (anxiety/panic attack), so those ones are meant for panic disorder and not GAD.

I think most doctors will prescribe SSRIs either way. In my experience I told my doctor my symptoms and he just told me it was all anxiety related and to take SSRIs, he never made a differentiation between panic disorder and GAD. It is often the problem that a general practitioner won't get into psychiatric disorders, they'll just generalize things like panic attacks and anxiety and give SSRIs for all of them.

Also, benzos do have worse withdrawal symptoms and a higher risk of losing efficacy over time, depending on the drug, dosage and how long they're taken for. You have to be more careful with them and taper properly when you stop taking them. SSRIs have a "discontinuation syndrome" (nice way of saying withdrawals), but they aren't as severe.

Of course, I'm no doctor and I'm basing all of what I say from articles I read on the internet and these boards.
366811 tn?1217426272
If ever there were a "Ryan" type question, your is it! I hope his radar picks it up and he provides his usual thorough response.

But far be it from me to respond to a post without SOMETHING of my own to add to the confusion, so here we go:

I can't speak to the meds, except to say that in my own case the SSRI (Zoloft) was deployed AFTER I had weaned off K'pin and was panic-free. My impression was (mind you, just my impression) that whereas the K'pin sort of helped make the panic go away, I still was not feeling entirely myself. Its like getting over the flu or a cold -yes, you are not "sick," but you are not at the top of your game, either. The Z is what helped with becoming my "old self" once again.

But you mentioned something else which I've always wondered about -the business of how a doctor's "take" on the current state of medicine impacts his recommendation for your treatment, perhaps to the extent of saying your old program really doesn't fit with the new research. But then again, later on we find out the old program really WAS the right thing. Sort of like eggs. First they are good for you. Then, bad. But wait! No, they really are good after all. And that's before we even talk abiout frying them in bacon fat which we positively KNOW is just right! And so I someimes have this "guinea pig feeling" (from the pig's point of view) and wonder if they are really nutz, and I'm talking about the psychiatric cases who attend to our care!

And another thing: am I to believe that every doctor everywhere becomes instantly and simultaneously updated on the latest best thing to do? I don't think so.

And so, whenever I run into this shift in treatment "modalities" (whatever THAT means) I challenge the doctor to explain to me in rational, logical terms (as opposed to medical terms) just WHY he/she thinks the sudden turn in the road is such a good idea. In the end, I try to assess what the worst that can happen is if I follow the new map. If the worse case is "nothing happens," then, OK, I'll give it a shot.

Funny and true story about me: I am beset with allergies: sneezing, coughing, hacking, sniffling, nose-blowing, etc. But the worst is the buring, itching eyes which I of course rub out of skull and then must pick them up, put them in a sandwhich bag and take them back in to the doctor to be replaced. I made that part up. But anyway, the PA who was seeing me began prescribing one thing after the other. You know those TV ads for Clairtin and other allergy meds? I took 'em all, plus OTC stuff for cough, and 2 kinds of eye drops plus "tears." All at the same time and that was WITH medical approval. Nothing. Finally, one night in a fit of itchy-eye syndrome, I soaked a clean wash rag in cool water, and applied it to my eyes as a compress. In a few minutes -problem solved! And I'm talking HOURS of relief here! So now, I just keep a wash rag handy and apply as needed. No more pills or eye drops of ANY kind. And I can tell you that with every new recommendation for an allergy medication, we had the conversation about why it would work. Go figure. A wash rag. Quaint.

The only thing I can offer in terms of the paradox ("pair of docs?" How cool is that?) is that:

1. As a society, we are accustomed to having -and being told we can have exactly what we want when we want it. No compromises. And so, we bring this kind of expectation to medical matters. But alas, the medical "arts" are just THAT in many cases: art, as opposed to (or as well as) science.

2. We are complex beings, and figuring out what is right for US as individuals means EVERYTHING counts, which is why it is a good thing to supply or to discover tons of data about ourselves. What works for Sam may not work for Sally. And I am not sure how even a doctor would be able to instantly make the assessment. It takes time and history to build the chain of evidence that supports one kind of treatment over another.

I am amazed -and sometimes appalled- at the kinds of questions and statements that appear here on the anxiety forum. I don't mean that the material itself is outrageous in any way. I mean that it sometimes appears to me that people are asking clueless hockey pucks like ME for medication and treatment information that clearly should be coming from their doc and I am appalled that the doctor evidently is NOT providing this. Maybe its the kind of thing that you think of after a visit and wish you had asked at the time, but I have a dark suspicion that the medical people are not always as forthcoming with medical information as they might be.

So it all boils down to insistence on explanations that make sense to us, and if these are NOT forthcoming from our doctors voluntarily, then we should challenge them to provide it. In the end, I really don't care WHAT the latest research says -all I want is something that works, and if you are going to tell me to take a different fork in the rod, then you need to tell me WHY.

Yes?
Avatar universal
Thanks for your response.  I did have this conversation with my doctor when he prescribed clonazepam to me and his response was that we have tried many SSRIs for you and Tetratricyclic plus beta blockers and non of them were successful, some slightly more than others, mind you, so clonazepam was the obvious other choice.  Poor Ryan has been very helpful with this decision made about the clonazepam and he called it right from my first posting about treatment.  Surprisingly, my doctor concured.  When I asked my doctor why this is not the first choice for treatment when dealing with a patient who only has GAD/panic and NOT depression, he got a little defensive and said that if they do come out with some other treatment that he thinks would be better in the long run for me, he would definitely want me to make the change.  This felt somewhat contradictory to me in that he initially said that this (clonazepam) was the approved and first choice treatment in my situation seeing as the SSRIs and beta blockers et al were not successful.  This does not instill confidence that if some other new drug were to come along and work for the average person that he would  insist that I try it even if clonazepam were working well for me. My feeling is, if it ain't broke, don't fix it.  This is one of the two fears I have with being on the benzo.  So far it seems to be working fairly well but I don't want the rug ripped out from under me one day just because some doctor who has never had to experience what we have and so only knows for book knowledge and other patient experiences (like we aren't all different, of course)  what it is like to live our lives, make a decision that could put me back in my treatment.  It was hard enough to go off the other meds I have tried in the past, I don't want to have to go through that again when it is unneeded.  Plus I don't want to have to put my family through it either.  I know I am putting the cart before the horse here, but with all the controversy about benzos. out there even though I think it is more for the shorter acting ones like ativan and especially xanax, I really think there is more of a stigma about benzos than there is for any of the other drugs.  I had horrible experiences with paxil, celexa, atenolol and endured them just because I thought that in the long run, I was told, that they would make me feel better; well they didn't.  The only think that kept me going during the times I was on those drugs was lorazepam and I only took it sparingly because of the addictive properties.  So, needless to say, I basically suffered through my treatments.  The only medication that came close to helping me was Remeron and I took that for years and that only helped to give me a baseline of comfort from anxiety.  Lorazepam was the only meds I took that make me "normal" whatever that is.  Because of the short acting properties with that, clonazepam seems to be the answer and even with it, I haven't given it a major test to see if it will do the job of lorazepam but I'm working on that.  My concern is that if something new comes along even though my meds are working for me, that I should have the option of staying with what I feel works for me.  I just don't understand why the first choice of medication for someone with GAD and panic would be an antidepressant as opposed to an anti-anxiety pill.  I know I'm not the smartest person, but to me, that still doesn't compute when you have a benzo like clonazepam that you don't keep increasing if it is prescribed correctly.  Doctors are always offering to increase or decrease SSRIs when people go through rough patches...I just don't get the reasoning. Please enlighten me.  

Maybe I should change my name from Barfer to Annoying or Confused or maybe even Ranter!  
366811 tn?1217426272
You're looking to ME for enlightenment? Surely you jest. The problem here, in my opinion, has as much to do with doctors who get defensive as it does with whatever the hell the deal is (today, heh, heh) with the meds. If that doctor is not a shrink, then GET a shrink who's specialty is anxiety. And if that doctor IS a shrink, then get a different shrink.

I'm not making this up.

The point is this: before you even BEGIN to sort out the logic behind recommendations of this or that, you MUST be dealing with someone who's on the same page as you are -there really, really, has to be a "connection." Given the nature of our affliction, dealing with a medical professional who doesn't seem to "get it," simply adds to the anxiety problem itself. It's like: "I'm taking this med because my doctor is driving me crazy." Damn right.

It probably doesn't matter when it comes to just stitching you up because you scraped your knee or something; but we're talking about BRAIN and MIND here, my friend. The first mission is therefore not an evaluation of YOU, but rather, of the psychiatric case who's going to try to HELP you. And YOU are the gatekeeper on that score.

There is nothing wrong with your thinking or your logic. Not to me, anyway. But your intelligence is being deployed against a confusing mass of data and opinion. Maybe I'M wacky (there is evidence) but I say: get with someone who listens, understands and makes sense. THEN start teasing apart all the decision-making material.

Yes? No?

Yes-no?
Avatar universal
Maybe I shouldn't have addressed this just to you, JSGeare, I apologize!  Enlightenment would be appreciated from all sources! lol  

Doctors, although I shouldn't paint them all with the same brush and there definitely are really great ones out there, but trying to find the right one can be daunting... they absolutely drive me crazy and we all know that I'm already half-way there anyway.  Changing doctors in Canada, I don't think is quite as easy as it is down there.  Even if I could, starting over with a new doctor is like trying to paper train a new puppy.  Sometimes you have to expect **** in places you really don't expect and no matter what you do, the odor can still linger.  
480448 tn?1426952138
You bring up an interesting topic for sure....

I'll try to shed a little bit of light on the topic if possible.

First, there are (as most of you already know) SEVERAL different kinds of SSRI's...and while they all basically end up doing the same thing...they all achieve that result (allowing more serotonin to be available for our brains) different ways, chemically.

Therefore, CERTAIN SSRI's are more optimal for different diagnoses.  They are used to treat plain old depression, to Panic Disorder, GAD, etc etc....with a great deal of success (for MOST people).  Sometimes, it takes a bit of experimentation both with dosages and actual meds to find the combination "just right" for each individual person.

Benzos were never meant to be for long-term use.  They are usually prescribed concurrently with an SSRI (or other forms of anti-depressants) for temporary relief from extreme anxiety.  They are not good "candidates" for long term use anyway, because of the tolerance one builds to them after time.

The best "advice" I have for ANYONE either seeking treatment for anxiety/depression for the first time...or if you are an old "pro" going in for "maintenence", so to speak...that the VERY best person to prescribe these meds is a psychiatrist.  That is what they do...their specialty.  NOT that a PCP cannot prescribe them properly...but a psychiatrist will be the most knowledgeable....in DIAGNOSIS (which is so important to be properly diagnosed)...to the available and appropriate RX's out there.

If you have cancer...you go to an oncologist....if you have a horrible fracture, you go to see an orthopedic surgeon, right?  Same thing goes for our minds.....we owe it to ourselves to make sure we are being treated properly.  Starting OUT at a PCP?  Sure.  For some people...they never need to go beyond that....but for others with long-term anxiety issues....or anxiety that isn't being well-treated, a psychiatrist is the best option.

Oh, and JS...the eyeballs in a baggie made me laugh so hard I about fell out of my chair!!!!  Hysterical!

Hope that little diddy helped a bit, anyways.
366811 tn?1217426272
I'll admit that I have heard from more than one source that the medical system in Canada leaves much to be desired, so I get it about the difficulty in being paired up with the right person. And I appreciate nurse girl for having enlightened us on the SSRI deal. All I remember is that when I took it, everyone ELSE got better.

And I also remember Ryan saying something about how the SSRI's are "selective" only to a point -that point being the kind of a phsyical theatre of operation in our heads and mechanism of action (delay of seratonin reuptake). However, beyond that, they are not so precise that each one targets a particular something exclusively. And this is why individual "make up" has much to do with how any particular SSRI is going to work.

But the over-arching issue here, I think, has as much to do with a confidence level in the practitioner as it does with the meds themselves, so I hope you can at least get in the care of a shrink whose specialty is aligned with your particular need. For what it's worth, if shared frustration is of any benefit, then you have MINE because I am frustrated and not a little angry that you are having this difficulty. I am SURE you will resolve it, and if you need someone to kick a few doors down for you, let me know. Meanwhile, please let us know what you are able to do to come to grips with this situation as it is a key component of our collective wisdom.

We're with you on this.

Avatar universal
I thank you for your response and expertise.  I knew I'd be opening up a huge can of worms with this discussion.  I would love to see a discussion about this topic between you and Ryan.  Now that would make for a very interesting Sunday.  

Back in the 50s SSRIs were not available for people with GAD so benzos, in particular Valium was prescribe for those people with anxiety issues.  Then if needed a tricyclic might have been added for depression.

You mentioned that I should go to a specialist, particularly a psychiatrist because they know what should be prescribed for GAD.  Interestingly, I initially went to my GP for treatment and he was the one that tried a variety of SSRIs, beta blockers, as well as tricyclics and eventually tetracyclics along with the lorazepam on an as needed basis.  Then I decided it was time to seek out the advice and treatment from a psychiatrist who also worked with me in CBT.  Once I was well into my therapy, and with just a slight dosage change in the medication that at that time was giving me the best result, I asked him what would have been his first choice in medication if I had gone to him first.  His response was exactly what my GP had said and done.  In my case, it wouldn't have changed a thing and it is unlikely that he would have even considered the Remeron which I was on when I started with the psychiatrist, at all....Note:  that was the medication that helped me the most at that time in my life.  At this point, I have to tell you, I would have done and taken anything to make me feel halfway whole.  I went into every new drug experience with a very positive attitude because I really wanted to get well.  I had gone from someone who felt I could conquer the world and anything life could through at me to someone who couldn't leave her house.  I did all the work, kept a log, charted my panic attacks with relation to what I did that day and if I had a period, or what I ate, drank and how I slept.  My shrink was so impressed with the effort I put into it.  I had flow charts for every month I worked with him.  I was not someone who was going to sit and wallow in my disorder.  After one year and a half of therapy and being on the same medication for approx. 5 years with the occasional ativan, I made a decision to go off the Remeron and see how I could do without it.  I've discovered that I need something on an ongoing basis but what I also discovered is that I am a much happier person off an antidepressant.  I have GAD NOT depression and taking a benzo just evens out my anxiety and doesn't mess with my mind otherwise...I feel "normal".  So, is it better to feel "normal" or have all the sideffects that I had to deal with on all the other antidepressant medications.  I am the last person who ever wants to feel like I am addicted to anything and it is my impression that clonazepam taken twice daily is a good option for someone with GAD and is highly unlikely to need increasing.  Benzos tend to be lumped into one category and I think that is the reason why there is such a huge discrepancy as to what is appropriate treatment for those of us who have GAD alone.  I read all the time on this website as well as others, of people trying to get off of benzos because of the fear of becoming addicted.  My thoughts are that some of us are going to have to have some sort of medication for GAD our whole lives...it is not something we are going to grow out of.  I don't think that is the case for everyone but when you have had it as long as I have, you know that you go in peaks and valleys but it eventually rears its ugly head again.  Just like my daughter who has epilepsy, she has had it since she was a year old and now she is 30.  There is no way that she will ever go of medication, it is just a normal part of her life.  So, does that mean that use of a long acting benzo for someone who will need medication for the rest of there life, is any different than the forever use of medication for epilepsy...it's all in the brain.

I know this is very controversial but I feel it is an open and honest discussion that needs to be addressed.  The controversy is in the medical community as well, which doesn't make it any easier for us especially since we do have GAD which in itself makes decisions for taking medication difficult...talk about the "what ifs"!!!  
Avatar universal
I just picked up your message after sending my last missive...maybe I should have read it first then I may have been able to condense my thoughts (not something that is easy for me, you may have noticed).  I really thank you for you support.  Typically, this has become a control issue for me that will always be a part of my life because that just the kind of person I am.  

Maybe I should have called myself Control Freak instead of Barfer...

  
366811 tn?1217426272
I hold out to you that you are not only NOT confused (although the data IS confused) but rather that if you have an exceedingly fine grasp of what's been going on. The CBT is a good thing, and in your case a smidgen of analysis might not be a bad idea, either. You are RIGHT, some folks will be doing the medication tango all their lives, but let it NOT be because the other alternatives have not been brought to bear on the problem. Given what little is truly known about the brain and mind, it is little wonder that the state of diagnosis and treatment is similarly unmature and a work in progress.

I favor the contrivery and discussion among people of intelligence, character and good will such as yourself.

I do not envy the burden you bear, especially because I bore it for so long myself. But I admire you and honor you for really keeping your head in the midst of this very choppy sea. There is no question in mind that you are your own best advocate and I support and encourage you in the effort to get to the bottom of things. Because of you and people like you, many more of us will be free of this affliction and I hope and pray that at last you will be counted among them.

The kick down offer still stands.

-S
Avatar universal
I have also gone down the long road of antidepressants trying to find something to help my GAD and panic.  I was on paxil for years as well as lexapro, prozac, cymbalta and a host of others - have also been in CBT for a long time too.  All for panic or GAD.  Spent so many years trying one after another.  Stayed on the paxil which just seemed to increase my anxiety and caused the development of a major tremor.  30 years ago was tried on valium and it worked for the GAD, but not the panic.  I think some people just need the benzos and the benzos alone.  Since the benzos have gotten a bad rap for their addictive nature, I willingly try anything the psychiatric community cares to try me on.  I always end up here with the short acting xanex.  Until I read that xanex was short acting. I could have sworn that it lasted all day.  Since reading that it only lasts 4 hours (you guessed it), it really only lasts hours.  Talked with my shrink re: klonopin.  He said about 1/2 of his patients are like me and take the xanex and the other the klonopin.  Since valium didn't work for me, he doubts that the klonopin would either.  Just seems that the doctors want to put everyone on the SSRIs because they are not as addicting, but it seems it should matter more what works than what is addicting or not especially when you have had the condition for decades.
480448 tn?1426952138
Hi There,

I agree with you that every case is individual, and what works for one person, may not work for the next, etc etc.  Same with disorders...obviously, something like GAD without major depression....people would wonder why not just benzos?  Why an AD?

The short answer is that the long term affect of the SSRI's (in particular) actually are meant to DECREASE anxiety.  Not that it works for everyone....but it does for a lot of people.  Of course, that would be an optimal goal...to decease overall anxiety or anxious episodes, not just to take a med when the anxiety strikes.

I agree that if a benzo works, and a person is doing well on JUST a benzo, why not JUST the benzo then?  Because it isn't a PRACTICAL long term medication.  Unless we're talking an occasional dose here or there for anxiety, ANY regular regimen of a benzo will lead to tolerance, and the need for a higher dose eventually to reach the desired affect.

It really IS a catch 22.  

This is a great discussion.....and I'm sure you'll find people on all ends on the spectrum.

I am ALWAYS very interested in the whole medication debate.  There are people out there who have had 100% success from panic, GAD, depression, etc....with NO medication intervention at all.  PERSONALLY, *I* have had great success WITH medication.  It isn't for everyone, that's for sure.

Avatar universal
You've hit it right on the head when you said "It should matter more what works than what is addicting or not especially when you have had the condition for decades."  

It is even a controversy in our own community where there are people who will say you have to get off of benzos. just because that is what they have heard through websites or their medical professional.  We all have had experiences good and bad with different drugs for GAD and panic but as important as it is to share information, it is just as important to be aware that not everyone is going to have the same experience on meds.  Benzos have a bad reputation and even for those of us who are on them and are fairing well, it scares us because of the reputation.  Being who we are, we are very open to suggestion and if a doctor or someone you respect says that you have to get off the benzo because they will be a problem in the long run, it is going to wear on your mind.  I know now after trying many different SSRIs etc. that I feel I may have wasted a lot of time and good years trying to find something  that was never going to work  for me.  I know that SSRIs are great for a lot of people, my frustration is that because the medical profession has such power over us when we are at our most vulnerable, we don't question, we just want the disorder to go away and if the medical community is split on what is the appropriate therapy, you are only going to get the medication that that particular doctor thinks is right regardless of whatever else is out there.  If it goes against the grain of the doctor, you can be sure he will not prescribe it for you.  To me, I don't understand why wouldn't they try a proven anti anxiety pill before they would try an antidepressant to relieve what is obviously anxiety and not depression.  To me it makes more sense and if that isn't successful, then go to the SSRI.  I just wish the medical community were all on the same page...it would make someone like me, who obviously over analysis everything, a lot more comfortable.

480448 tn?1426952138
GREAT post!!

I have a great example of a doc "insisting" on d/cing a benzo.

My father, who has ALWAYS been an insomniac...has been taking Xanax *only* AT BEDTIME  for decades.  Sure, his dose gradually increased through the years..but only like twice I think.  A new doc came into his physician's practice and INSISTED he be weaned off the Xanax.

He had tried other sleep aids through the years by choice, b/c he never liked taking anything unnecessarily.  I'm talking a 70 yr old super healthy active man who takes NO prescription meds other than the Xanax!  

He suffered MANY a sleepless nights b/c they stopped the Xanax.  He isn't a big complainer...and I told him that the whole thing was insane!  ONE pill at bedtime for sleep?  And it worked for hiim?  He still was on a fairly low dose considering (1 mg) .  The doc told him when he asked to be put back on it (after months of being off)...."absolutely not, you are addicted".  Pfffftttttt.  I was appalled.

To this day...I still do not think he ever got back on it...and his sleep suffers as a result.  

Why?  Because of the benzo rep, for sure.  And it is stupid.  My father was not addicted...tolerant?  Maybe.  But come on.

Man, how that tee'ed me off....still does.  Can you tell?  LOL.
480448 tn?1426952138
Hysteria?

You must be kidding.

Sheeeesh.

And, it may help to actually read more than ONE of my posts before you make such harsh judgements about me or "nurses" in general.

480448 tn?1426952138
Ryan....my sole purpose for posting recently is to try and help others.  I respect your knowledge, but at the same time, I do not think it's quite fair to paint all nurses as "ill informed", or that you "wouldn't expect any less from a nurse".  But, hey...you are entitled to your opinion.  I do not take THAT personally.  I am proud of my profession and worked pretty darn hard to get where I am.  The learning process is constant...and something I enjoy a lot.

For the most part, in my posts...I ALWAYS indicate that what works for one patients may not work for another...and it is BEST to discuss ANY concerns with a physician.  I didn't do that in the case of this thread, and for that, I apologize to the readers.

Thing is...I do not see much difference in your statements vs mine.  You are expressing that an SSRI can NEVER work for anxiety.  I can tell you, both from very personal experience, as well as professional exposure, that MANY people with anxiety disorders benefit greatly from the use of an SSRI.  Is it for everyone?  Certainly not.  If a medication like Clonazepam works for a patient, then that is super.  And, yes, there ARE differences between benzos.  Sadly, a lot of physicians seem to prescribe more of the short acting, tolerance building benzos, like Ativan, Xanax.  That's what was great about this particular discussion.  I am a very open minded person and would NEVER pretend to know everything.  I enjoy reading about others' experiences and opinions.  I think it would be fair to say that NONE of us have all the answers.  That was the crux of this great discussion.

I will be careful to temper my posts with the proper verbage as to not "scare" the impressionabble people that may be reading and/or posting.  That was certainly never my intention whatsoever.  Sometimes it is nice to have someone who DOES understand how a medication works to explain it in layman's terms.

Constructive criticism is a great thing...but blatant put-downs just aren't quite fair.  And, that is just me being 100% honest.  I was HIGHLY offended by your tone towards me.  I have no issue with you, or anyone for that matter...calling me on anything....but a little respect goes a long way.  

I've never been either too proud or too stubborn to consider another's criticism towards me.  You never even gave me a chance.  I would have loved to enter into an intelligent conversation with you and everyone else about this very topic.  

And, I DO pen my post with all due respect.

Avatar universal
I knew I'd be opening a can of worms when I came up with this discussion.  My hope is that it has made us all think and hopefully the medical community will realize that not all people with GAD/panic are cut from the same cloth.  There are many options out there for us and it is very important to explore them to find the right solution and make our lives palatable.  

We all have to take some responsibility as to how we approach the subject of medication to people in this community as we are very sensitive to the power of suggestion.  There are ways of disagreeing on a subject without being overbearing or, on the flip side,  to scare the liver out of someone to make them feel they have to change medications because of what they have read on this forum.  I wish all our doctors were completely up to date on the ongoing changes with medication but that isn't the case even for those psychiatrists out there who specialize in GAD/panic.  

Ryan, you are going to make an outstanding doctor and I only wish that you lived up here because I would be your first patient.  (That, I know will never happen primarily because of our social medical situation and I know what you think of socialized medication, but that's another conversation.)  

Nursegirl, your intentions were well meant and I appreciate them.  It is the type of information that one would get from their general practitioner.  

The initial purpose for this discussion was to understand why even psychiatrists start with an SSRI for treatment of GAD/panic instead of going to clonazepam or someother similar long term benzo.  There is a stigma attached to benzos even in the medical community and it is my concern with long time use of clonazepam, that at some time or other  I will be turned down for medication just because it is a benzo.  It wouldn't be the first time as I have read on this forum, that other have experienced this.  I don't know what the answer is and was hoping for some enlightenment, hopefully in the form of someone knowing that the medical community has decided as a group that they agree with the benzo treatment of GAD/panic and the stigma will be gone and we can all live happily ever after...just a dream, I know, but one can never give up hope.
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It has been an interesting discussion.  Whether people with GAD/panic need only a benzo, a benzo and an SSRI or just an SSRI I believe is individual.  I also think the different benzos are individual as well.  For example, I do not do well on a long acting benzo like Klonopin or Valium.  I do better on xanex that I have taken for 20 plus years.  I must admit I am very vulnerable to suggestion.  Before I started reading forums such as this, I was content to take my little xanex and then take another one as needed.  I was almost shocked to find out that they only work for 4 hours and were short acting.  I still wish I never read that because they used to work sometimes all day and half the night before I knew they would wear off after 4 hours.  My dosage did not appear to increase, or not so that I had noticed in all those years, although I do admit my maximum dosage was 4 mg/day.  I didn't know I was in tolerance until reading about it and, yup, sure enough I was in tolerance so that the 4 mg/day max didn't work as well.  I panicked being that is the type of person I am and cut myself down to .75 mg/day (slowly) before I realized that it was ludicrous.  Why was I suffering prolonged anxiety, keeping myself locked up and agoraphobic because people said xanex was bad, didn't work well, built up tolerance, etc?  I'm not saying it was you folks that did that, just my reading about society in general's take on xanex.  Hey if I were a diabetic and it was insulin we were talking about and even if I built up a tolerance to the insulin, the doctors would surely increase it and everything woudl be hunky dorey.    My poor doctor had me in his office telling him that I had to get off benzos cause I read benzos were bad, that I had to get off them the way some lady doctor in the UK got people off benzos by substituting valium, and then with me back in his office telling him that the valium didn't work and I was more agoraphobic than ever before before he put me back on the xanex.  Then as I read more, I came to him asking him to put me on Klonopin.  When he said he didn't feel it was the right med for me, this time I listened.  He finally listened to me that all the SSRIs did was increase my overall anxiety even after I had been on them for years.   I just wish my doctor was younger cause I dread ever having to break in a new psychiatrist.  I just wish all psychiatrists and doctors would read this entire discussion when thinking about putting their patients on any medications for anxiety.
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I applaud you for coming forward.  You are and others like you and me, read and listen to this information and scare ourselves that we are not only going to do harm to ourselves if we keep taking this stuff but also, that our families will suffer because we can't or won't be able to function well.  As I said before, I know I opened up a can of worms with this discussion, but it needed to be said.  We should be supportive of whatever decisions people make for their mental health just as we would for any other health issue.  I know lots of people who take xanax on a regular basis and swear that it is the only thing that works for them and as far as you thinking the xanax lasted for an entire day, well, when I took lorazepam, even though I had been told it didn't, it sure seemed to last all day for me too.  The only reason I stopped taking the lorazepam was because I was afraid after reading all the information about it being so highly addictive.  My problem was that I wouldn't take it regularly enough because I was afraid.  Therefore, I kept having anxiety and panic issues on the days without it and was perfectly fine on the days I took it.  So to think that the people on this forum aren't super attuned to suggestion, would be unrealistic.  This has nothing to do with intelligence, it has everything to do with our makeup and I'm not talking lipstick.  It is extremely important to make informed decisions but ultimately, it is our bodies and it should be our decisions as to what works or doesn't work for our own situations.  Gather information and try to make the best decision for YOU.  I really appreciate Ryan's input because it comes from first-hand and a scientific basis.  You can take the information from him and then decide if it actually fits your profile.  That is what is important.  Take the information, talk with your doctor and then try and figure out what is the best decision for YOU, not what is right for the average person but what is right for YOU.  I think Ryan appreciates that.  He makes suggestions and damn it if he isn't right most of the time...but sometimes the information needs to be tweaked for your personal situation.  Bottom line...we are a community and should act that way.  The decisions we make are difficult ones and we should support each-other no matter what.  We all want the same thing, to be able to live as full a life as possible.
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