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Re: which antidepressant is best for GAD?

Posted by Matt on July 19, 1998, at 12:52:46

In reply to which antidepressant is best for GAD?, posted by Bill on July 17, 1998, at 13:51:24

Remeron is supposed to be good for GAD. I haven't taken it myself. But it causes weight gain in many people. Plus, it's such a new drug, that other drugs might be better to try first. I was on Prozac for GAD for three years and it worked well until it pooped out.

Here's a separate question. If you just have GAD (and not comorbid depression) why not go with a drug that is designed to target anxiety? Someone mentioned BuSpar already. It's true that it's not habit forming, unlike the benzodiazepines. But it tends not to work as well as do the benzos. It certainly does work for some people, and it may be a good idea to go with it first. But, as one person put it, "The only thing that BuSpar has done for my patients is made them dizzy." Another problem with BuSpar is that it takes 3-4 weeks to start working. If your anxiety isn't bad enough to where that's a problem, fine.

(Here is where the medical heresy begins.)

As I mentioned, far more effective than BuSpar (for most patients) are the benzodiazepines (Xanax, Klonopin, Ativan, Valium, Serax, Tranxene, Librium, etc.). Whenever anyone mentions the word "benzodiazepine" eyebrows raise. "They're *addictive*!," people will cry. But let's look at the facts here. They're very effective. (This isn't to say that they're all the same. Some are more sedating, some have longer half lives, and some work better on most people's anxiety than do others (e.g. Xanax vs. say, Librium). They're also very safe. They can cause some initial sedation until the body gets used to them, and they can cause some short term memory problems (which usually are not a big deal for the patient, especially compared the anxiety that the drugs are removing). And, there is the fact that if they're taken for more than a few weeks, you must taper them off to stop using them. Otherwise, you can experience some really nasty side effects. But if you do taper them, most people find that it's not much of a problem to get off them.

Now, here's my gripe. SSRIs (and other antidepressants like Effexor, Serzone, and Wellbutrin) are handed out like candy (in the US at least). They're medical godsends. They're often first-line drugs for the treatment of GAD because they're not "addictive." But, this seems to be little more than semantic soft-shoeing, so far as I can tell. Most of these drugs *also* need to be tapered when you go off them, otherwise you'll experience nasty side effects. (Ask anyone who tried to get off Paxil or Effexor without tapering!!) Furthermore, they have far more side effects than do the benzos. Benzos won't poop out and leave you in a bind (as Prozac did with me), and the SSRIs often certainly do poop out. There also is the issue of long-term treatment, if this is applicable in your case. We *know* that the benzos are safe for long-term treatment. They've been out almost 40 years. But, we just don't know with the new antidepressants. They've not been out long enough.

So, again I ask. If GAD is your issue, why not go with something like BuSpar (though, again, it doesn't have the best rep for effectiveness) or a benzodiazepine?

All this being said, I'm not a doctor. I'm simply a GAD sufferer who is puzzled at the level of benzophobia in the US. The facts just don't justify such a reaction (at least if SSRIs are being given for GAD instead of benzos), so far as I can tell.





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