Posted by Matt on April 1, 1999, at 1:08:13
In reply to Re: BuSpar and other things for anxiety, posted by Terry on March 31, 1999, at 16:12:50
> I though SSRIs were appropriate for panic?
They are, generally.
And what about Klonopin?
Used by many, many people for pd.
both are approved for that indication, as I understand. I would not use benzodiazepines as a first-choice for long-term treatment of panic disorder because of tolerance/dependency issues. Terry
This is a complicated issue. Some people wonder what the problem is with being dependent on a drug so long as you're not abusing the drug, you need to take the drug to control the pd, and it looks to be safe for long-term use (as are benzos, most would say). In this last regard, we know much more about the consequences of benzo use over the long term than we have SSRI use over the long term, simply in virtue of the fact that benzos have been around for a long time.
It certainly is the case that when the term "dependency" is used, red flags go up, but I think that there are real questions here as to how much weight the prospect of drug dependency should be given in drug selection.
Matt
> > > In an earlier post, you indicated that Buspar is not effective against all types of anxiety. What types of anxiety is it good for and not good for? What type of anti-depressant would you recommend for GAD?
> >
> > It's not effective for panic disorder. For GAD it can be great, and I've heard of a number of wonderful successes. It's gotten a bad reputation mostly because doctors have been prescribing it for panic, perhaps also because some people are dissatisfied with it because it doesn't work as fast as some other anti-anxiety drugs do. I don't know how it works for other anxiety disorders (OCD, PTSD, social phobia).
> >
> > One thing is I think that sometimes (with BuSpar in particular, that is) you need to be willing to push the dose up pretty high (especially if you have depression too).
> >
> > I don't think I could make a general recommendation for what to try for GAD without knowing more (hell, what am I doing making recommendations anyway? :-). BuSpar is good. SSRIs and MAOIs can be good for a lot of people as well although I don't think they've been studied specifically for GAD without depression. Tricyclics might work as well. I'd probably avoid Wellbutrin, although again, it's hard to know for sure. Sometimes what looks like GAD turns out to be depression on closer inspection, that's something to consider especially if it is very severe. There is a tendency to make the assumption that a "sedating" antidepressant will help with anxiety, but this does not always turn out to be true.
> >
> > Antidepressants tend to make people more anxious at first (even BuSpar does this sometimes). Certainly people with panic attacks, and probably people with anxiety disorders who don't have panic attacks, ought to have the option of taking a benzodiazepine (like Ativan, Valium, etc.) when they need it, at least when they are first starting out on antidepressants. Some people need to take an antidepressant (I count BuSpar as an antidepressant) and a benzodiazepine every day, but I think that in the long term this is probably not necessary too often.
> >
> > There are other meds you can try as well (some anticonvulsants, cardiac drugs, etc. work for some people), but these are the most common ones.
> >
> > The best luck that I *personally* have had for anxiety (I have taken an awful lot of meds, I'm afraid) was with Prozac, nortriptyline (a mildly sedating tricyclic), Nardil (MAO inhibitor), Fioricet (a muscle relaxant that contains a barbiturate - used mainly for migraine), and high-dose Librium.
> >
> > Good luck - write more if you'd like.
> >
> > -e
poster:Matt
thread:3795
URL: http://www.dr-bob.org/babble/19990501/msgs/4251.html