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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.

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?

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.
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