Posted by sukarno on April 15, 2005, at 4:49:31
In reply to Re: pdoc bullsh!tting me about SSRI helping anxiety?, posted by mworkman on April 14, 2005, at 23:04:30
SSRIs tend to be a crap shoot in the treatment of panic disorder. Not sure about regular anxiety or GAD, but in panic disorder the success rate is 30 to 50 percent according to a psychiatrist I know.
Usually SSRIs make anxiety worse in the beginning of treatment which many patients simply cannot deal with, so a benzodiazepine is often added to get them through this period.
In conclusion, SSRIs are best for anxiety *secondary* to depression. If anxiety is the primary problem and there is no associated depression, or depression is clearly secondary to anxiety, a sedating TCA (tricyclic antidepressant) such as imipramine, nortriptyline or amitriptyline may be useful as would be BuSpar or benzodiazepines.
The psychiatrist I know is also a neurologist and has primarily treated about 4000 panic disorder patients. From what he has seen, SSRIs have caused panic attacks in depressed patients who never experienced panic attacks before, but they don't seem to cause the disorder (panic disorder) itself.
SSRIs also have sexual side effects such as anorgasmia, and lowered or non-existant libido.
Also, the dependence which forms and results in "zaps", visual lag, tolerance ("poop-out"), nausea and vertigo upon discontinuation is something to consider.
SSRIs do work for many folks and I don't mean to knock these drugs in any way, but I feel the tricyclic antidepressants have been given an unfairly bad label since the advent of Prozac in the late 1980s.
Imipramine was once considered the "gold standard" in treating anxiety and depression. It remains an underutilised medication today since the SSRIs came about. However, it seems to have far fewer side effects (less sexual side effects and few to no withdrawal reactions upon discontinuation).
Most docs today are under the influence of drug company propaganda. They don't have time to do their own research, with the exception of a few.
Why go through torture when you can take something like TCAs which will work more quickly and are more sedating? I truly feel sorry for people who have pdocs who are forcing SSRIs down people's throats...especially when those people have had several negative reactions in the past to this class of drugs.
Pdocs need to learn empathy and make better use of existing drugs, instead of trying to push the so-called "latest and greatest" dope on their patients.
Those TV advertisements also need to be curtailed too, don't you think? The advertising is misleading and causes patients to influence their docs into Rxing Paxil, etc.
Psychiatrists today often spend little time with their patients and tend to overdiagnose conditions.
I apologise for this rant as it wasn't directed at any particular person or persons, but rather at the system which is easy to diagnose and easy to prescribe drugs which are new and whose mechanism of action and long-term safety are largely unknown.
poster:sukarno
thread:484205
URL: http://www.dr-bob.org/babble/20050413/msgs/484545.html