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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 jay on February 15, 2002, at 17:54:23
Got this abstract from medline, and it is one of the first to give a outward "thumbs down" to Effexor for "Generalised Anxiety Disorder". The article mentions benzos are *still* first-line treatment, period. As I am coming off of Effexor and using benzos, things sure as hell feel much better! Come to think of it, I have always felt better on benzos than on ANY a.d. Plus, I really can't understand the bizzare and far more dangerous reasoning in using more harmful drugs like antipsychotics over safe and cheap benzos.
Prescrire Int 2001 Oct;10(55):131--4 Related Articles, Books
Venlafaxine and generalised anxiety disorder: new preparation. Minimise recourse to drugs.
(1) Generalised anxiety disorder is defined as excessive anxiety for at least 6 months. (2) Management is based primarily on psychological measures, with the aim of limiting recourse to drugs. The reference drugs are benzodiazepines. The treatment period should be as short as possible, to avoid adverse effects such as sedation and dependence. (3) Venlafaxine is a non tricyclic, non MAOI antidepressant. A sustained-release formulation has just been granted marketing authorisation in France for generalised anxiety disorder. (4) The clinical assessment file on venlafaxine in this indication includes results from two 8-week trials and a placebo-controlled trial with 6 months follow-up. The trials showed a significant improvement with venlafaxine on standard anxiety scales, but the clinical impact (at best moderate) has been poorly assessed. We found no comparison between venlafaxine and benzodiazepines. (5) In one trial venlafaxine was no more effective than buspirone. (6) The most frequent adverse effects of venlafaxine are gastrointestinal disorders, insomnia and dizziness. Venlafaxine carries a risk of drug interactions and withdrawal symptoms. (7) In practice, venlafaxine provides nothing new in the treatment of generalised anxiety disorder. The reference drug treatment remains a benzodiazepine.
Posted by Frankie on February 15, 2002, at 18:36:25
In reply to Effexor *no good* for 'anxiety/GAD'..., posted by jay on February 15, 2002, at 17:54:23
> Got this abstract from medline, and it is one of the first to give a outward "thumbs down" to Effexor for "Generalised Anxiety Disorder". The article mentions benzos are *still* first-line treatment, period. As I am coming off of Effexor and using benzos, things sure as hell feel much better! Come to think of it, I have always felt better on benzos than on ANY a.d. Plus, I really can't understand the bizzare and far more dangerous reasoning in using more harmful drugs like antipsychotics over safe and cheap benzos.
>
> Prescrire Int 2001 Oct;10(55):131--4 Related Articles, Books
>
> Venlafaxine and generalised anxiety disorder: new preparation. Minimise recourse to drugs.
>
> (1) Generalised anxiety disorder is defined as excessive anxiety for at least 6 months. (2) Management is based primarily on psychological measures, with the aim of limiting recourse to drugs. The reference drugs are benzodiazepines. The treatment period should be as short as possible, to avoid adverse effects such as sedation and dependence. (3) Venlafaxine is a non tricyclic, non MAOI antidepressant. A sustained-release formulation has just been granted marketing authorisation in France for generalised anxiety disorder. (4) The clinical assessment file on venlafaxine in this indication includes results from two 8-week trials and a placebo-controlled trial with 6 months follow-up. The trials showed a significant improvement with venlafaxine on standard anxiety scales, but the clinical impact (at best moderate) has been poorly assessed. We found no comparison between venlafaxine and benzodiazepines. (5) In one trial venlafaxine was no more effective than buspirone. (6) The most frequent adverse effects of venlafaxine are gastrointestinal disorders, insomnia and dizziness. Venlafaxine carries a risk of drug interactions and withdrawal symptoms. (7) In practice, venlafaxine provides nothing new in the treatment of generalised anxiety disorder. The reference drug treatment remains a benzodiazepine.
I agree with you that the Benzo's are the safest and cheapest way to control anxiety. The only drawbacks are that they don't last long, and unless you combine them with a good serotonin-based antidepressant, they don't work as effectively. But, then again, I have primary OCD symptoms and the Benzo's don't touch that! Even so, you will get better results with Klonopin, etc... if you find the right antidepressant to combine it with. There will be a lower risk of building a tolerance over time too. Effexor was probably too stimulating with the norepinephrine elevation. Try another antidepressant. That is just my advice.Frankie.
Posted by Frankie on February 15, 2002, at 18:36:36
In reply to Effexor *no good* for 'anxiety/GAD'..., posted by jay on February 15, 2002, at 17:54:23
> Got this abstract from medline, and it is one of the first to give a outward "thumbs down" to Effexor for "Generalised Anxiety Disorder". The article mentions benzos are *still* first-line treatment, period. As I am coming off of Effexor and using benzos, things sure as hell feel much better! Come to think of it, I have always felt better on benzos than on ANY a.d. Plus, I really can't understand the bizzare and far more dangerous reasoning in using more harmful drugs like antipsychotics over safe and cheap benzos.
>
> Prescrire Int 2001 Oct;10(55):131--4 Related Articles, Books
>
> Venlafaxine and generalised anxiety disorder: new preparation. Minimise recourse to drugs.
>
> (1) Generalised anxiety disorder is defined as excessive anxiety for at least 6 months. (2) Management is based primarily on psychological measures, with the aim of limiting recourse to drugs. The reference drugs are benzodiazepines. The treatment period should be as short as possible, to avoid adverse effects such as sedation and dependence. (3) Venlafaxine is a non tricyclic, non MAOI antidepressant. A sustained-release formulation has just been granted marketing authorisation in France for generalised anxiety disorder. (4) The clinical assessment file on venlafaxine in this indication includes results from two 8-week trials and a placebo-controlled trial with 6 months follow-up. The trials showed a significant improvement with venlafaxine on standard anxiety scales, but the clinical impact (at best moderate) has been poorly assessed. We found no comparison between venlafaxine and benzodiazepines. (5) In one trial venlafaxine was no more effective than buspirone. (6) The most frequent adverse effects of venlafaxine are gastrointestinal disorders, insomnia and dizziness. Venlafaxine carries a risk of drug interactions and withdrawal symptoms. (7) In practice, venlafaxine provides nothing new in the treatment of generalised anxiety disorder. The reference drug treatment remains a benzodiazepine.
I agree with you that the Benzo's are the safest and cheapest way to control anxiety. The only drawbacks are that they don't last long, and unless you combine them with a good serotonin-based antidepressant, they don't work as effectively. But, then again, I have primary OCD symptoms and the Benzo's don't touch that! Even so, you will get better results with Klonopin, etc... if you find the right antidepressant to combine it with. There will be a lower risk of building a tolerance over time too. Effexor was probably too stimulating with the norepinephrine elevation. Try another antidepressant. That is just my advice.Frankie.
Posted by Mr. Scott on February 15, 2002, at 19:10:35
In reply to Re: Effexor *no good* for 'anxiety/GAD'..., posted by Frankie on February 15, 2002, at 18:36:25
Jay-
I agree completely with you. I'm trying everything else but benzos right now, but I know if nothing works better, where to come home to.
Scott
Posted by jay on February 16, 2002, at 16:26:19
In reply to Re: Effexor *no good* for 'anxiety/GAD'..., posted by Frankie on February 15, 2002, at 18:36:25
Yes, I can understand esp. in such conditions as OCD, an antidepressant is much needed. On that note, in Europe, many drug makers are coming up with formulations made of both an antidepressant and a new benzo, like Xanax. This hopefully forces docs to have a benzo with an a.d, regardless of what they think.When I went to my first pdoc, it was always a benzo+antidepressant. Now, almost 10 years later, I am coming full circle again, back to a similar combo. Again, on almost all measures, for GAD and anxiety-related conditions, they beat anti-convulsants and antipsychotics right out. Coming to think of it, I think it is scarry doctors are still prescribing this stuff to a large number of people who "don't" need these meds, and would do much better with a benzo. Life is TOO short..cut to the chase and look after the symptoms, and we can get on with our lives.
> > Got this abstract from medline, and it is one of the first to give a outward "thumbs down" to Effexor for "Generalised Anxiety Disorder". The article mentions benzos are *still* first-line treatment, period. As I am coming off of Effexor and using benzos, things sure as hell feel much better! Come to think of it, I have always felt better on benzos than on ANY a.d. Plus, I really can't understand the bizzare and far more dangerous reasoning in using more harmful drugs like antipsychotics over safe and cheap benzos.
> >
> > Prescrire Int 2001 Oct;10(55):131--4 Related Articles, Books
> >
> > Venlafaxine and generalised anxiety disorder: new preparation. Minimise recourse to drugs.
> >
> > (1) Generalised anxiety disorder is defined as excessive anxiety for at least 6 months. (2) Management is based primarily on psychological measures, with the aim of limiting recourse to drugs. The reference drugs are benzodiazepines. The treatment period should be as short as possible, to avoid adverse effects such as sedation and dependence. (3) Venlafaxine is a non tricyclic, non MAOI antidepressant. A sustained-release formulation has just been granted marketing authorisation in France for generalised anxiety disorder. (4) The clinical assessment file on venlafaxine in this indication includes results from two 8-week trials and a placebo-controlled trial with 6 months follow-up. The trials showed a significant improvement with venlafaxine on standard anxiety scales, but the clinical impact (at best moderate) has been poorly assessed. We found no comparison between venlafaxine and benzodiazepines. (5) In one trial venlafaxine was no more effective than buspirone. (6) The most frequent adverse effects of venlafaxine are gastrointestinal disorders, insomnia and dizziness. Venlafaxine carries a risk of drug interactions and withdrawal symptoms. (7) In practice, venlafaxine provides nothing new in the treatment of generalised anxiety disorder. The reference drug treatment remains a benzodiazepine.
>
>
> I agree with you that the Benzo's are the safest and cheapest way to control anxiety. The only drawbacks are that they don't last long, and unless you combine them with a good serotonin-based antidepressant, they don't work as effectively. But, then again, I have primary OCD symptoms and the Benzo's don't touch that! Even so, you will get better results with Klonopin, etc... if you find the right antidepressant to combine it with. There will be a lower risk of building a tolerance over time too. Effexor was probably too stimulating with the norepinephrine elevation. Try another antidepressant. That is just my advice.
>
> Frankie.
Posted by Frankie on February 16, 2002, at 17:40:14
In reply to Re: Effexor *no good* for 'anxiety/GAD'..., posted by jay on February 16, 2002, at 16:26:19
>
> Yes, I can understand esp. in such conditions as OCD, an antidepressant is much needed. On that note, in Europe, many drug makers are coming up with formulations made of both an antidepressant and a new benzo, like Xanax. This hopefully forces docs to have a benzo with an a.d, regardless of what they think.
>
> When I went to my first pdoc, it was always a benzo+antidepressant. Now, almost 10 years later, I am coming full circle again, back to a similar combo. Again, on almost all measures, for GAD and anxiety-related conditions, they beat anti-convulsants and antipsychotics right out. Coming to think of it, I think it is scarry doctors are still prescribing this stuff to a large number of people who "don't" need these meds, and would do much better with a benzo. Life is TOO short..cut to the chase and look after the symptoms, and we can get on with our lives.
>
>
> > > Got this abstract from medline, and it is one of the first to give a outward "thumbs down" to Effexor for "Generalised Anxiety Disorder". The article mentions benzos are *still* first-line treatment, period. As I am coming off of Effexor and using benzos, things sure as hell feel much better! Come to think of it, I have always felt better on benzos than on ANY a.d. Plus, I really can't understand the bizzare and far more dangerous reasoning in using more harmful drugs like antipsychotics over safe and cheap benzos.
> > >
> > > Prescrire Int 2001 Oct;10(55):131--4 Related Articles, Books
> > >
> > > Venlafaxine and generalised anxiety disorder: new preparation. Minimise recourse to drugs.
> > >
> > > (1) Generalised anxiety disorder is defined as excessive anxiety for at least 6 months. (2) Management is based primarily on psychological measures, with the aim of limiting recourse to drugs. The reference drugs are benzodiazepines. The treatment period should be as short as possible, to avoid adverse effects such as sedation and dependence. (3) Venlafaxine is a non tricyclic, non MAOI antidepressant. A sustained-release formulation has just been granted marketing authorisation in France for generalised anxiety disorder. (4) The clinical assessment file on venlafaxine in this indication includes results from two 8-week trials and a placebo-controlled trial with 6 months follow-up. The trials showed a significant improvement with venlafaxine on standard anxiety scales, but the clinical impact (at best moderate) has been poorly assessed. We found no comparison between venlafaxine and benzodiazepines. (5) In one trial venlafaxine was no more effective than buspirone. (6) The most frequent adverse effects of venlafaxine are gastrointestinal disorders, insomnia and dizziness. Venlafaxine carries a risk of drug interactions and withdrawal symptoms. (7) In practice, venlafaxine provides nothing new in the treatment of generalised anxiety disorder. The reference drug treatment remains a benzodiazepine.
> >
> >
> > I agree with you that the Benzo's are the safest and cheapest way to control anxiety. The only drawbacks are that they don't last long, and unless you combine them with a good serotonin-based antidepressant, they don't work as effectively. But, then again, I have primary OCD symptoms and the Benzo's don't touch that! Even so, you will get better results with Klonopin, etc... if you find the right antidepressant to combine it with. There will be a lower risk of building a tolerance over time too. Effexor was probably too stimulating with the norepinephrine elevation. Try another antidepressant. That is just my advice.
> >
> > Frankie.Jay and Mr. Scott,
I agree. The struggles of anxiety disorders are not even comprehensable to a person that has never dealt with one. I have symptoms of about every one of the 5 anxiety disorders there are. GAD, PTSD, OCD, PD, SP (social phobia). My primary ones though are OCD and SP, both doing better by the day, I am happy to say. I can tell you guys from experience that without the antidepressant, forget it! I have gone off St. John's Wort (which I used for about 3 years, with good success, I might add), and Zoloft for about a week, before making the switch to Celexa. In each case, especially the first, I thought I was going to die, for sure. And, in both instances, I bumped up my Xanax to the next dose up, since I didn't have the antidepressant. But ironically, it did nothing but space me out. So, my conclusion: Depression is heavily involved in all anxiety disorders, for the most part. Use the antidepressant as primary, and the benzo as secondary, or back up. But, take them both every day. Never miss, unless you feel you can cut down the benzo to a lower dose. I find that Europe thing very interesting. I would love to see a drug that combines that 2 together! It really should be this way anyway. Take care guys.
Frankie.
This is the end of the thread.
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