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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by rianny on February 16, 2004, at 14:33:23
Why do psychitrists prefer SSRI's or other antidepressants to benzo's? I read that SSRI's tend to treat the original source of anxiety, but it has its own side effects which are much worse than benzo's. Also, once you repond well to an SSRI and take the pill for a while, and when you tapper off, is your brain still out of anxiety? I mean do antidepressants actually cure the anxiety so you don't have to be on medication forever to get rid of anxiety?
If not, why SSRI's? Is it because of the tolerance that benzo's can build or memory loss? I think my memory and cognition were much worse when I was on SSRI's. SSRI also changed my personality in great way.
So, I'm just curious why SSRI's are prefered.
Posted by BackOfClass on February 16, 2004, at 14:53:19
In reply to Why pdocs prefer SSRI's to benzo's?, posted by rianny on February 16, 2004, at 14:33:23
From what I have learned there seems to be a couple reasons. The Benzo's are used off label, while the SSRI's are heavily marketed to treat the disorders. Also, the benzo's are a controled substance - monitored more closely then SSRI. There seems to be this false belief that Benzo's are addicting - may be true, but I prefer the term dependence. This has created a stigma against the medication. The SSRI's are prescribed as a long term treatment, while the Benzo's are thought of a short term - when you get off the Benzo the anxiety comes back. The Benzo's just mask the anxiety, so they say! I think that sums it up.
Posted by ace on February 16, 2004, at 18:51:05
In reply to Why pdocs prefer SSRI's to benzo's?, posted by rianny on February 16, 2004, at 14:33:23
Posted by Viridis on February 16, 2004, at 21:47:34
In reply to Why pdocs prefer SSRI's to benzo's?, posted by rianny on February 16, 2004, at 14:33:23
From what I can tell, it's mostly marketing, combined with widespread, often indiscriminate prescription of benzos like Valium and Xanax until the 90s or so. Benzos gained a reputation for "addiction" (which actually seems to be quite rare, especially for those who really need them). But with all the prescriptions that were handed out, a few people got into trouble. And, most benzos went off-patent, meaning cheap generics and little incentive for drug companies to market them aggressively.
SSRIs etc. were a real breakthrough and work very well for some people. However, each has its own side effects, and many produce "discontinuation syndromes" as bad as or worse than benzos. I can't tolerate SSRIs at all, but do very well with benzos -- it's a highly individual thing.
Benzos have a long track record of safety and effectiveness, and many people have taken them for decades with no problems. But they just aren't big moneymakers, so of course the pharmaceutical companies are going to push their new, expensive products and hey, if they can scare doctors away from benzos at the same time, why not?
I predict that as the new generation of antidepressants and anxiolytics rolls in and SSRIs etc. continue to lose patent status, SSRIs and co. will be blacklisted too. This is a shame, because they really are life-changing meds for some people -- just like benzos (and tricyclics, and MAOIs, which aren't exactly "favored" meds either any more).
Posted by Bill LL on February 17, 2004, at 8:06:05
In reply to Why pdocs prefer SSRI's to benzo's?, posted by rianny on February 16, 2004, at 14:33:23
I can only respond in refernece to my own experience. I have always had severe anxiety depression.
Years ago, before I took antidepressants, I tried Valium for about a year. It helped a little bit but not that much. It also made me very tired all the time.
In contrast, SSRI's have been a great help for me.
Posted by AntiTrust on February 17, 2004, at 18:08:11
In reply to Re: Why pdocs prefer SSRI's to benzo's?, posted by Bill LL on February 17, 2004, at 8:06:05
benzo's are ADDICTIVE is my only answer because that is all i am told at the place I have to go to see a pdoc. they will not rx them and I really do much better w/ my panics/anxiety and such on benies then anything else!
Posted by c ubbybear on February 18, 2004, at 2:56:19
In reply to Because of $$$ and LIES from drug companies!!! (nm) » rianny, posted by ace on February 16, 2004, at 18:51:05
Posted by PsychoSage on February 18, 2004, at 4:27:56
In reply to Re: Why pdocs prefer SSRI's to benzo's?, posted by Viridis on February 16, 2004, at 21:47:34
my zoloft was increased for anxiety, and that didn't help at all. I took a benzo at night for a many months following my only real panic attack. They work very well, but they make you stupider.
Posted by cubbybear on February 19, 2004, at 7:46:52
In reply to Re: Why pdocs prefer SSRI's to benzo's?, posted by PsychoSage on February 18, 2004, at 4:27:56
> my zoloft was increased for anxiety, and that didn't help at all. I took a benzo at night for a many months following my only real panic attack. They work very well, but they make you stupider.
Er. . .could you elaborate on that last word? If you really meant level of intelligence than there are a load of people out there whose IQ is dropping day by day.
honestly, as a benzo user, I'm not offended, but really, what did you mean?
cubbybear
Posted by micro on February 19, 2004, at 13:53:11
In reply to Re: Why pdocs prefer SSRI's to benzo's?, posted by Bill LL on February 17, 2004, at 8:06:05
> I can only respond in refernece to my own experience. I have always had severe anxiety depression.
>
> Years ago, before I took antidepressants, I tried Valium for about a year. It helped a little bit but not that much. It also made me very tired all the time.
>
> In contrast, SSRI's have been a great help for me.Hello, There is no doubt that anxiety is reduced by benzo's. However, depression commonly presents as anxiety and is overlooked. Benzo's do little to relieve depression.
Why some reluctancy to rx/ dependency.
This should be discussed before you begin therapy with Benzo's. Ultimately, the decision is yours once the benefits verses the risks have been evaluated.
Good Luck. Micro
Posted by AntiTrust on February 19, 2004, at 14:05:35
In reply to Re: Why pdocs prefer SSRI's to benzo's? » PsychoSage, posted by cubbybear on February 19, 2004, at 7:46:52
I would define 'stupider' as this.....
bubble headed, cloudy thinking, tired, sleepy, 'unable to think' as before taking benies......
hows that?? <GRIN>been there done that!!
Posted by AntiTrust on February 19, 2004, at 14:15:36
In reply to Re: Why pdocs prefer SSRI's to benzo's? » rianny, posted by BackOfClass on February 16, 2004, at 14:53:19
Benies are addictive and they do cause a dependence. the addictive/dependence goes hand in hand in my book.
some docs/pdocs just will NOT go there, period!I am more than sure that the same doctors, are affraid of 'the addictive/dependence deal' and are affraid of the law suits that it might bring them.... so they treat the patient like a guinee pig on other less effective drugs-less expensive for insurance companies etc.
Posted by PsychoSage on February 19, 2004, at 22:35:44
In reply to Re: Why pdocs prefer SSRI's to benzo's? stupider, posted by AntiTrust on February 19, 2004, at 14:05:35
> I would define 'stupider' as this.....
>
> bubble headed, cloudy thinking, tired, sleepy, 'unable to think' as before taking benies......
>
>
> hows that?? <GRIN>
>
> been there done that!!
thanks for taking that one for me. It's hard to tell how cloudy it makes you if you take it regularly for a while.this is common knowledge anyways. the new sleep and anxiety drugs of the future will be more specific and not affect overlapping systems in the brain so much.
And what about those half-conscious runs to the fridge int he middle of the night. They were almost as bad as zyprexa which is part benzo and even scheduled in Canada.
Posted by Viridis on February 19, 2004, at 23:33:58
In reply to Re: Why pdocs prefer SSRI's to benzo's?, posted by AntiTrust on February 19, 2004, at 14:15:36
What evidence is there that benzos are more "addictive" than other psychiatric meds? I'm not aware of any credible evidence, other than vague rumours. Given the long record of effectiveness of these meds, the "addictive" label seems more a ploy to market new drugs than anything else.
If anyone can provide any evidence that benzos cause more discontinuation problems than SSRIs etc., this would be remarkable. It would totally contradict years of data from the World Health Organization etc. Of course, there are some fringe websites that make these claims, with no substantiation.
Posted by Margit on February 20, 2004, at 2:17:36
In reply to Re: Why pdocs prefer SSRI's to benzo's? » AntiTrust, posted by Viridis on February 19, 2004, at 23:33:58
> What evidence is there that benzos are more "addictive" than other psychiatric meds? <
From my own experience: It was a lot harder and took a lot longer to wean of benzos than SSRIs. It took me 6 months to get off 4mg of Xanax; 3 weeks to get off Paxil 20mg.
Posted by cubbybear on February 20, 2004, at 4:08:09
In reply to Re: Why pdocs prefer SSRI's to benzo's?, posted by Margit on February 20, 2004, at 2:17:36
> > What evidence is there that benzos are more "addictive" than other psychiatric meds? <
>
> From my own experience: It was a lot harder and took a lot longer to wean of benzos than SSRIs. It took me 6 months to get off 4mg of Xanax; 3 weeks to get off Paxil 20mg.Normally it should be true that it takes longer to get off benzos than anti-depressants, but it depends a lot on the individual and the particular drug. Some people can quit benzos pretty easily, and others are (now) finding it almost impossible to get off Effexor.
Posted by PsychoSage on February 20, 2004, at 11:00:12
In reply to Re: Why pdocs prefer SSRI's to benzo's? » Margit, posted by cubbybear on February 20, 2004, at 4:08:09
> > > What evidence is there that benzos are more "addictive" than other psychiatric meds? <
> >
> > From my own experience: It was a lot harder and took a lot longer to wean of benzos than SSRIs. It took me 6 months to get off 4mg of Xanax; 3 weeks to get off Paxil 20mg.
>
> Normally it should be true that it takes longer to get off benzos than anti-depressants, but it depends a lot on the individual and the particular drug. Some people can quit benzos pretty easily, and others are (now) finding it almost impossible to get off Effexor.
>
>Benzos are so immediate and reinforcing. That is how they are more addictive. Anything that rapidly works and that produces desirabe effects has addictive potential. I guess we should use the term dependence even if it is prescribed. Many people have no qualms about taking more than necessary because it's booze in a pill essentially.
Posted by rianny on February 20, 2004, at 19:08:22
In reply to Re: Why pdocs prefer SSRI's to benzo's? ?Margit, posted by PsychoSage on February 20, 2004, at 11:00:12
Maybe pdocs are afraid of patients sueing them.
My pdoc kept telling me "I don't want you to sue me". What kind of doctor is that? He was more worried about getting sued than treating my condition. Some ignorant doctors...This memory just popped up from my head suddenly while reading the above threads, and it makes me pissed.
Posted by Viridis on February 20, 2004, at 22:33:06
In reply to Re: Why pdocs prefer SSRI's to benzo's? » Margit, posted by PsychoSage on February 20, 2004, at 11:00:12
I don't find benzos anything like alcohol. A therapeutic dose works well for anxiety; any more makes me sleepy. Some have more immediate effects than others; Xanax has rapid effects and a short half-life, so not surprisingly, it's associated with the most frequent discontinuation (and abuse) problems. But these are still limited to a small proportion of users. I take it as-needed (like aspirin etc.) and haven't noticed any desire to take it more often (similarly, aspirin is useful but I certainly don't crave it).
Klonopin has a long half-life and for many people (like me) has no noticeable effect other than reduced anxiety. I have no incentive to take any more than what works, and most users seem to respond the same way.
I don't deny that benzos can be problematic for some people, and discontinuation after regular use requires gradual tapering. But discontinuation problems are common (and reported more often) for many widely-prescribed antidepressants than for most benzos.
Paxil and Effexor top the list of most-difficult-to-quit medications in all categories. That doesn't make them bad -- it just means that like benzos and so many other meds, your system gets used to having them and needs time to readjust if they're withdrawn.
Labelling benzos as "booze in a pill" is highly inaccurate and insulting to people with serious anxiety disorders. I've experienced much worse cognitive dulling, disorientation, and other side effects from various SSRIs etc. than from benzos, even after long-term use. The bottom line is that different meds are appropriate for different people, and many drugs that are very effective induce medical dependency -- which is not the same thing as "addiction"..
Posted by jdgjdg on February 20, 2004, at 23:19:12
In reply to Re: Why pdocs prefer SSRI's to benzo's? » Margit, posted by cubbybear on February 20, 2004, at 4:08:09
I've never taken a benzo, but the drug companies definitely do not advertise severe discontinuance with the SSRI's. The pdoc's seem to underplay it as well. It took me 3 months to get off of 400mg Zoloft.
This is the end of the thread.
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