Posted by Alan on October 11, 2002, at 22:40:56
In reply to Re: benz. / vs SSRI's...see bottom » Alan, posted by pharmrep on October 11, 2002, at 20:03:20
> ** well alan...i got you some face time today...i got the chance to ask 4 doctors how they felt about benz, and why benz. are not used as much as ssri's....i got similar and varied answers, but here are the commonalities.
> ---feelings on why benz. are not used as much__
> 1) habit forming
> 2) short acting
> 3) the anxiety may be treated, but it may leave the depression even worse...there are some (not all) ssri's that can treat both depression and anxiety.
>
> PS If an SSRI like Celexa or Lexapro can reduce a persons score on...lets say the madres scale from 26 (major depression)...by 50% to 13..(mild depression), and also the inner tension items (anxiety subscale), I wouldnt call that "little improvement".
================================================Thank you for addressing my question pharmrep.
What I am about to say is not directed specifically to you but is commentary on the content of the answers provided by your sample of 4 selected doctors.
Bzds vs AD's for anxiety disorders:
1)Habit forming?
What specifically is meant? That those with chronic anxiety disorders develop "medical dependence" on a medicine designed to treat a medical condition? (Or do the 4 doctors even make a distinction between addiction and medical dependence?)
Or that there is a typical dependence/withdrawl cycle as now commonly seen in many new AD's, euphemistically referred to as "discontinuation syndrome". Or tolerance similarly referred to as AD "poop-out" (not to mention dosage escalation to treat patients when they do "poop-out")?
As long as doctors are pushing an SSRI at every patient who even looks at them cross-eyed, there's not going to be any opportunity to observe drug-seeking behavior associated with "habit forming" (just another euphemism for medical dependence). In fact, what they see right now is SSRI-avoidant behavior.
But let the doctors start withholding SSRIs and doing all they can to get people off of them (a day that may well come), and then we will see drug-seeking behavior from people who might even prefer to be off but can't even possibly quit over the two week period now recommended as a taper (it took a good long time for there to be an admission that AD's needed to be tapered in the first place, remember?).
2) short acting?
How is keeping up with one or two or three doses of a bzd that much different than taking a once a day AD? Half-life isn't an issue that I know of if bzd's are managed and prescribed properly...at least no less important than keeping up with their dosage regime of an AD.
Or are you talking about short acting in the sense that they are supposedly not meant to be taken for longer than let's say 3 - 4 weeks at a time? That myth was long ago disproven by the "Report on the Rational Use of Benzodiazapines" issued by the World Heath Organisation (independent and hardly a heavily pharmecutically sponsored organisation) that considered 40+ years of studies concluding that short AND long term use of bzds in the treatment of anxiety disorders is not only highly effective but very safe for the general population. The typical panic population does NOT report escalating dosages but rather a level that generally stays the same or DEcreases over time.
3)Huh? I thought the issue was anxiety disorder. Taking away anxiety with a bzd with the result being residual, exacerbated depression shows that the individual doesn't have an anxiety disorder to begin with but has the ubiquitous "mixed anx/depress" dx commonly used when the less skilled clinician (usually the front line physicians like GP's or internists whom these new AD's are the company's largest market by far) can not or are incapable of teasing out which is primary and which is secondary in order to treat effectively...The only known and relatively uncommon side effect of any bzd and depression that I've read about or know of is with klonopin...and decreasing the klon dosage while augmenting with xanax or ativan is the standard antidote and treatment protocol whenever this occurs.
As a matter of fact, there are studies that conclusively prove that xanax has a mild antidepressant effect - probably because it relieves relentless, hopeless depression ABOUT the anxiety...
Which leads to the PS. part.
How are clinicians going to decipher if the relentless anxiety is what is primary - driving the hopelessness of depression, if an AD is going to stimulate and sedate (to use the crudest of layman terms) at the same time? Does this scale take into account whether or not there was any augmentation with a bzd?
As a veteran of 6 AD's that did just that, never treating my anxiety disorder because of the pushing of the AD as the superior and therfore first line of treatment of anxiety disorder, and similar stories from a sizable population on this board and others that have to end up taking a bzd in the end with their AD anyway, and with efficacy rates at very best 40 - 50% by any company's own accounts, perhaps the 4 doctors can answer one key question.
Why aren't bzd's with efficacy rates in the 70 -80 percentile being offered on an equal footing with the new AD's (post 1992) in the treatment of anxiety disorders?
Curious,
Alan
poster:Alan
thread:109458
URL: http://www.dr-bob.org/babble/20021006/msgs/123300.html