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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Bill on July 17, 1998, at 13:51:24
I have read some antidepressants are better than others for GAD? Is Remeron one of these?
Posted by ray on July 18, 1998, at 1:54:14
In reply to which antidepressant is best for GAD?, posted by Bill on July 17, 1998, at 13:51:24
> I have read some antidepressants are better than others for GAD? Is Remeron one of these?
You might try Buspar...non addictive, not antidepressant....just anti-anxiety...Seems to work well for my anxiety
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.
Matt
Posted by Levi on August 11, 1998, at 3:20:47
In reply to which antidepressant is best for GAD?, posted by Bill on July 17, 1998, at 13:51:24
> I have read some antidepressants are better than others for GAD? Is Remeron one of these?
Everyone's going to respond in a different way. If I HAD to pick a med it would be Luvox. If, that is, you go on an ssri. perhaps a light does say 50-100mg Luvox added to Klonopin, say - .5mg twice a day. Luvox is a good bet. Wellbutrin, in my estimation will stimulate you in an agitating fashion - effexor, nah... Jump on the seritonin, and Luvox (300mg) is a powerhouse - just be patient for about 3-4 mos. No kidding...
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.
Posted by John on August 31, 1998, at 8:09:43
In reply to which antidepressant is best for GAD?, posted by Bill on July 17, 1998, at 13:51:24
> I have read some antidepressants are better than others for GAD? Is Remeron one of these?
Remeron (mirtazapine) appears to have an anxiolytic effect, similar to benzodiazepines. Further, it is a new class of anti-depressants, offering both a serotonergic and noradrenergic effect. It also antogonizes the 5HT1 receptor (which is the receptor targeted by buspirone). It is also one of the few anti-depressants without a sexual side effect. However, some patients seem to have problems with weight gain, as well as somnolence (sleepiness). Some of this can be managed by taking the medication at night (it's once a day dosing).Bottom line: might be worth a try, as Buspirone seems to have a somewhat equivacal effect, and Remeron may eliminate the need for Benzodiazepine.
This is the end of the thread.
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