Posted by Toby on August 12, 1998, at 9:43:16
In reply to Re: which antidepressant is best for GAD?, posted by Levi on August 11, 1998, at 3:20:47
Buspar is good for generalized anxiety disorder. It does nothing for panic disorder and it works less well in patients that have previously been exposed for long periods of time to benzodiazepines. If a person has been of benzos for a pretty good while, Buspar CAN work.
Next point: yes, benzos can be addicting, but not usually in patients with a true anxiety disorder -- they are generally AFRAID of taking medications and getting addicted and so they usually won't become a drug fiend. The problem with benzos is that people can still get flare ups of anxiety and then are tempted to take extra doses to control the flare ups and can eventually need higher doses all the time to continue to be effective -- essentially a "poop out" of the medication. Having a withdrawal syndrome when a person tries to stop them abruptly does not mean the person is "addicted" (that's a term that really means the person is using the drug inappropriately), but the body does become "dependent" on benzos after awhile and doesn't function well if you stop the medication too quickly (like a diabetic stopping their insulin). Same principle applies to the SSRI's that give a withdrawal syndrome -- the patient is not addicted, the body has just become used to having a certain amount of serotonin in the blood.
Which medication is best? That's up to you and your doctor to figure out. If you have never been on a benzodiazepine before, go with Buspar. Increase the dose slowly (up to 60 mg) and give it up to 6-8 weeks to have full effect. If you have been on benzos before and had abuse problems (I'm speaking to other folks who may be reading this, too), stay away from these as long as possible. If everything else fails, then try a long acting one (that may prevent abuse) like Klonopin or Tranxene. Even if abuse isn't a problem, a long acting one is better since you don't have to take it as often during the day and you don't have those annoying "inter-dose withdrawal symptoms" that can lead you to think the anxiety is returning and trick you into taking more than you really need.
Before the benzos, though, I would try an antidepressant. SSRI's are the safest and have the least side effects (yes they have side effects but not like the old tricyclics) so I'd try Serzone or Remeron first (have calming, somewhat sedating effects -- can be taken all at bedtime to help with sleep and not let you be too drowsy during the day) and then try Prozac or Paxil. If you don't tolerate the SSRI's, then try Trazodone, Imipramine or Pamelor. The wait time is also a couple of months because the dose should be increased slowly to minimize side effects.
The other good medication is Propranolol, a beta blocker used for blood pressure. This is good if you have a lot of physical symptoms like rapid heart rate, tremors, more upset in social situations.
Remember to go slowly with all these medications. If you have side effects, don't go up any further on the dose until the side effects subside. Don't switch around too quickly with the medications because most side effects will go away and you need a good trial of at least 2 months on each medication before deciding it doesn't work -- otherwise you may miss a good medication if you give up too soon. Also, refrain from use of alcohol which doesn't work over the lon haul, can interfere with the medications and will end up giving you withdrawal symptoms that seem like the anxiety is worse and can disrupt your sleep patterns which makes the anxiety worse, too.
poster:Toby
thread:147
URL: http://www.dr-bob.org/babble/19980801/msgs/285.html