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Re: I wish there was a pill for stress

Posted by sukarno on December 14, 2010, at 14:28:42

In reply to Re: I wish there was a pill for stress » Deneb, posted by Melanie-00 on December 6, 2010, at 21:19:52

I've been prescribed benzodiazepines for the past 20 years and they still work as well for my anxiety and panic attacks today as they did in 1990.

Perhaps I am not one of those who develops much of a tolerance because I still experience daytime drowsiness and sedation on a daily basis despite 20 years of taking them regularly as prophylaxis.

If there was a nonsedating BZD on the market which was equally effective, I would jump at the chance to try it.

I won't take SSRIs because they prolong the QT interval, which can cause cardiac arrhythmias in some folks, including TDP (Torsades de pointes). Then there are the sexual side effects which can be permanent, tachyphylaxis (tolerance/"poop-out") and the risk of upper gastrointestinal hemorrhage along with the well recognized withdrawal symptoms which include seizures (albeit rarely, but seen in neonates whose mothers took SSRIs throughout pregnancy).

Fluoxetine and sertraline, for example, increase the production of gastric acid in addition to inhibiting platelet aggregation. This can result in gastritis and exacerbation of existing gastric ulcers (or possibly even cause them).
Some evidence suggests use of an H2-receptor antagonist or proton pump inhibitor along with an SSRI might reduce the risk of upper GI bleeding.

That said, I am only opposed to SSRI antidepressants in the treatment of anxiety (without comorbid depression) because benzodiazepines are largely non-toxic, tried and true and very easy on the human body (to put it in layman's terms). Approximately two percent of people will misuse BZDs according to the studies I've read (which means that 98 percent won't and 98% compliance is pretty good as you won't find those rates with opiates or C-II/C-III CNS stimulants).

For treatment of depression though, I feel SSRIs may be appropriate and using them may outweigh the risks.

Many psychiatrists prefer to combine a benzodiazepine with an SSRI and prescribe both for the long term.

That's just my $0.02.
;-)

regards,
sukarno


Rx: alprazolam 1mg QID, famotidine 20mg BID, cetirizine 5mg BID, GNC Ultra Mega Gold vitamin supplement BID

Dx: panic disorder with agoraphobia, chronic depression, probable PTSD


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