what advantage do ssris have over benzodiazepines in the treatment of anxiety

Selective serotonin reuptake inhibitors (SSRIs

), which were designed to treat depression, are also effective for many anxiety disorders. They have revolutionized the treatment of anxiety, replacing chronic use of benzodiazepines (BZs). SSRIs are effective for OCD, PDs, phobias, PTSD, and GAD (see Table I).

Full Answer

How effective are SSRI antidepressants for anxiety?

They have revolutionized the treatment of anxiety, replacing chronic use of benzodiazepines (BZs). SSRIs are effective for OCD, PDs, phobias, PTSD, and GAD (see Table I). Other antidepressants, including tianeptine, have proven effective in adjustment disorders in which both anxiety and depression are involved.

Are benzodiazepines better than antidepressants for treating anxiety disorders?

It has been reported that people with anxiety disorders tend to tolerate benzodiazepines better than antidepressants ( Cowley 1997 ).

Do benzodiazepines and SSRI’s help social phobia?

Vasile, RG, Bruce, SE, Goisman, RM et al ( 2005) Results of a naturalistic longitudinal study of benzodiazepine and SSRI use in the treatment of generalized anxiety disorder and social phobia. Depression and Anxiety 22: 59 – 67. CrossRef Google Scholar PubMed

Should I take an SSRI and a benzodiazepine together?

Depending on your symptoms, your doctor may recommend starting both an SSRI and a benzodiazepine, and then tapering off the benzodiazepine after 2-4 weeks. This may help you tolerate the initial unpleasant side-effects of SSRIs, while limiting the risks of longer-term benzodiazepine use.

Is SSRI or benzo better for anxiety?

“There is no evidence to suggest that antidepressant drugs are more effective than benzodiazepines in anxiety disorders,” he said. “Certainly, benzodiazepines have fewer side effects.” In their review, the authors cited results for various anxiety disorders.

What is the difference between benzodiazepines and SSRI?

Benzodiazepine, which can reduce coordination and energy, also can cause nausea, headaches and nervousness. SSRIs can also cause nausea, dizziness, insomnia, weight fluctuation, dry mouth, reduced libido and insomnia.

What is the major advantage of SSRIs?

SSRIs have the advantage of ease of dosing and low toxicity in overdose. SSRIs are greatly preferred over the other classes of antidepressants for the treatment of children and adolescents, and they are also the first-line medications for late-onset depression.

Why are SSRIs effective anxiety?

Selective serotonin reuptake inhibitors (SSRIs) are usually the first choice of medication for treating social anxiety disorder (SAD). SSRIs affect your brain chemistry by slowing re-absorption of the neurotransmitter serotonin, a chemical that we think helps to regulate mood and anxiety.

What is the difference between antidepressants and anti anxiety meds?

There are differences between the medications for anxiety and depression. Antidepressant medicine, such as nortriptyline, is primarily for depression. Anxi-anxiety medications include benzodiazepines, which is mostly used for treating anxiety.

Why do SSRIs increase anxiety at first?

Abnormally low levels of serotonin have been linked to depression. SSRIs are thought to improve mood by boosting serotonin activity in the brain. But serotonin is not always a bed of roses. In the early days of treatment, it can increase levels of fear and anxiety and even suicidal thinking in some younger people.

What are the pros and cons of SSRI?

Serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs)Pros: They are effective for a lot of people and they have a solid safety profile.Cons: They can take four to six weeks to build up in your system.

What is the major advantage of selective serotonin reuptake inhibitors SSRIs over other the types of antidepressant therapy?

Selective serotonin reuptake inhibitors (SSRIs) SSRIs increase levels of serotonin in the brain by preventing the reuptake of serotonin by nerve cells. They are often selected as a first-line drug treatment for depression due to effectiveness and a lower risk of side effects compared to older antidepressants.

Are SSRIs better for anxiety than depression?

Researchers have discovered that a commonly used antidepressant also leads to an early reduction in anxiety symptoms.

How do benzodiazepines work for anxiety?

What does Anti-anxiety Medications (Benzodiazepines) do? Benzodiazepines enhance the activity of the neurotransmitter GABA—a chemical in the brain that helps you to feel calm. Their effect also produces drowsiness, making it easier to fall asleep and sleep through the night.

What SSRI is best for anxiety?

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat social anxiety disorder. The only SSRIs that are currently FDA-approved for this condition are sertraline (Zoloft) and immediate- and extended-release paroxetine (Paxil, Paxil CR).

What is the mechanism of action of SSRIs?

Mechanism of Action As the name suggests, SSRIs exert action by inhibiting the reuptake of serotonin, thereby increasing serotonin activity. Unlike other classes of antidepressants, SSRIs have little effect on other neurotransmitters, such as dopamine or norepinephrine.

What are the main effects of benzodiazepines?

Benzodiazepines (sometimes called “benzos” or “minor tranquilizers”) include medications such as Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam). These medications strengthen the effect of the neurotransmitter GABA, which is the primary inhibitory (“turn off”) signaler in the brain. GABA plays a role in sleep, feeling calm, muscle relaxation, and reduction in brain activity. If you are considering starting a benzodiazepine, here are some important things to consider: 1 Benzodiazepines reduce the intensity of physiological symptoms of GAD, such as muscle tension, headaches, panic attacks, sweating, insomnia, and restlessness. 2 Benzodiazepines may also reduce the cognitive symptoms of anxiety, such as worry and rumination. 3 Benzodiazepines are fast-acting, but do not stay in the system very long. Thus, people often experience immediate anxiety relief, which lasts for a few hours. This temporary relief of anxiety may help you complete important life tasks that you have been avoiding (e.g. giving a presentation, interviewing for a job, or travelling to see family). 4 Overall, people report relatively few bothersome side effects when taking benzodiazepines; some possible side-effects include drowsiness, confusion, dizziness, depression, impaired coordination, and vision problems. 5 Benzodiazepines are not considered safe for continuous use, as this can increase risk for physical dependence (addiction). Furthermore, mixing benzos with alcohol can be very dangerous. They are also not recommended for people with severe suicidal or addictive tendencies, or a family history of addiction.

What is the best medication for anxiety?

Selective Serotonin Reuptake Inhibitors (SSRIs) include medications such as Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), and Lexapro (escitalopram). These medications work on serotonin, an important neurotransmitter that plays a role in feelings of well-being and happiness, as well as thinking, memory, sleep, digestion, and circulation. SSRIs are currently considered the first-line medication for many forms of anxiety. If you are considering starting an SSRI, here are some important things to consider:

How long does it take for SSRIs to work?

SSRIs need to be built up in your system slowly. Your doctor will recommend a gradual increase in dosage over the course of 4-8 weeks. It may therefore take a while before you experience full, consistent effects on anxiety reduction.

How many people have anxiety disorders?

Feeling anxious, worried, and tense? You are not alone! Anxiety disorders are the most common mental illness in the US, and General Anxiety Disorder (GAD) affects 6.8 million adults (or 3.1% of the population) every year ( https://adaa.org/understanding-anxiety/facts-statistics ). When feeling overwhelmed with worries and tension, the first step many people take is to ask their doctors about medication. If you struggle with GAD, and are thinking about starting medication, here is some information about two of the most commonly prescribed types of medication: SSRIs and benzodiazepines.

What are the symptoms of a benzodiazepine?

If you are considering starting a benzodiazepine, here are some important things to consider: Benzodiazepines reduce the intensity of physiological symptoms of GAD, such as muscle tension, headaches, panic attacks, sweating, insomnia, and restlessness.

What are the medications that help the brain turn off the signal?

Benzodiazepines (sometimes called “benzos” or “minor tranquilizers”) include medications such as Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam). These medications strengthen the effect of the neurotransmitter GABA, which is the primary inhibitory (“turn off”) signaler in the brain. GABA plays a role in sleep, feeling calm, muscle ...

What is the best treatment for GAD?

The most effective psychological treatment for GAD is cognitive behavioral therapy (CBT). Mindfulness-based therapies, such as yoga, can also be beneficial.

What is the best medication for anxiety?

Selective serotonin reuptake inhibitors ( SSRIs), which were designed to treat depression, are also effective for many anxiety disorders. They have revolutionized the treatment of anxiety, replacing chronic use of benzodiazepines (BZs). SSRIs are effective for OCD, PDs, phobias, PTSD, and GAD (see Table I). Other antidepressants, including tianeptine, have proven effective in adjustment disorders in which both anxiety and depression are involved. Doses of SSRIs for anxiety disorders could be higher than those used for depression, but must be started at lower doses to minimize the shortterm agitation sometimes experienced with these medications. The patient should be counseled that side effects often diminish with time and also that empirical switching to another SSRI may be necessary.

What is the first pharmacological treatment for GAD beyond BZs?

Ilic first pharmacological treatment for GAD beyond BZs was the azapirone buspirone, a partial 5-hydroxytryptamine (serotonin, 5-HT)-lA (5-HT1A) agonist, which decreases the function of postsynaptic 5-HT2receptors. It has been demonstrated to show efficacy in GAD10,20-22and has been associated with maintenance of efficacy over a period of several months.15,16

What are the drawbacks of BZs?

The well-established anxiolytic effects of BZs are modified by several drawbacks, primarily of physical dependence, withdrawal symptoms, and sedation. The development of partial agonists at the y-aminobutyric acid (GAB A)/ BZ receptor complex offers some potential advantages over the traditional BZs. These BZ-like compounds should be effective anxiolytics, but less likely to produce sedation, tolerance, withdrawal, abuse liability, memory impairment, and ethanol potentiation. These newly developed compounds are either BZ derivatives or of a different, chemical structure, that is, imidazopyridine and P-carbolines. The most comprehensively studied has been the P-carboline abecarnil. In an initial double-blind trial, Ballenger et al41demonstrated clinical efficacy at doses in the range of 3 to 9 mg/day, without withdrawal symptoms after short-term treatment. Further placebocontrolled studies42,43have shown modest treatment effects; however, at higher doses, there is some evidence of withdrawal symptoms.

How long does it take for a BZ to work?

Results generally show that approximately 70% of patients will respond to adequate BZ treatment (up to 40 mg/day of diazepam or equivalent for at least 3-4 weeks), but less than two thirds will achieve remission of symptoms. In long-term use, tolerance to side effects does occur, but tolerance to the anxiolytic effect of the BZs does not appear.19With regard to dependence and withdrawal, compounds with a slower onset, of action, for example, oxazepam, have little reinforcing potential, while those with a long half -life, for example, diazepam and chlordiazepoxide, have a lower propensity to produce withdrawal symptoms, even if stopped abruptly. Anyway, discontinuation of acute treatment should be slow because of the potential for rebound anxiety and/or clinical relapse, and an adequate pretreatment assessment should be an important step to evaluate whether a subject would be suitable for BZ therapy, including previous history of withdrawal, liability of abuse, or likelihood of poor compliance. For this reason, and because of the high prevalence of comorbid depression, attention has focused also on different medications and antidepressants as potential treatment for GAD (Table II).

Does buspirone work as well as BZ?

The drug works well when there are conspicuous symptoms of worry, apprehensive tension, and irritability,10and where depressive symptoms are intermixed with anxiety,23while it is less effective than BZs on somatic and autonomically driven symptoms.24,25Patients who have had previous good responses to BZs do not appear to respond as well to buspirone,22probably due to the lack of sedative effect, and inability to alleviate BZ withdrawal symptoms, but starting buspirone 2 to 3 weeks before tapering the BZs has produced better results.26

What is the spectrum of anxiety disorders?

The spectrum of anxiety disorders includes generalized anxiety disorder (GAD), panic disorder (PD) and agoraphobia, obsessive-compulsive disorder (OCD), phobic disorder (including social phobia), and posttraumatic stress disorder (PTSD). With the discovery of new psychotropic medications, specific diagnosis within this spectrum is essential because each of these disorders responds to specific pharmacotherapy. The approach to anxiety should also recognize that anxiety and depression are often comorbid conditions.

Is venlafaxine better than buspirone?

Another double-blind, 8-week study compared venlafaxine (up to 150 mg/day), with buspirone (up to 30 mg/day), and placebo in outpatients with GAD. Both drugs were superior to placebo, but venlafaxine showed an earlier effect and advantage over buspirone in secondary outcome measures, notably the Hamilton Depression Scale anxiety subscore.39

What is an SSRI?

Essentially, SSRIs increase serotonin in the brain. Neural systems affected by increased serotonin regulate mood, sleep, appetite, and digestion. Not surprisingly, the first drugs designed to affect serotonin levels often caused side effects of drowsiness, weight gain, and nausea. Over time, the medications have been refined to better target only specific serotonin receptors (and thus are called selective serotonin reuptake inhibitors). As newer medications are put into the market - first Prozac, then Celexa, now Lexapro - each generation becomes more and more selective in terms of serotonin receptors targeted. Accordingly, the number of side effects has generally been reduced.

What is SSRI medication?

A selective serotonin reuptake inhibitor, or SSRI, is a type of drug that is most commonly used to combat depression and anxiety.

How long does it take for serotonin to increase?

Instead, it usually takes a week or more for a positive change in symptoms to occur.

How to reduce anxiety?

Monitoring and changing anxiety-producing thoughts is one way to make changes that will reduce anxiety. Another way is to learn ways to respond effectively in anxiety-provoking situations, rather than to avoid them. The SSRIs can often help a person accomplish these kinds of changes.

Does neuroplasticity decrease anxiety?

This increased flexibility, or neuroplasticity, does not necessarily mean that anxiety will decrease. What it means is that your brain is more capable of making changes that will lead to a decrease in anxiety. You still need to know what to do to promote anxiety-reducing changes in your brain. Monitoring and changing anxiety-producing thoughts is one way to make changes that will reduce anxiety. Another way is to learn ways to respond effectively in anxiety-provoking situations, rather than to avoid them. The SSRIs can often help a person accomplish these kinds of changes.

Can you take Lexapro with Paxil?

Lexapro (escitalopram) Paxil (paroxetine) Treating anxiety can be done with or without medication. But finding the right medication can be difficult. Each one is different and affects each individual differently. Before you commit to a medication, educate yourself on what exactly is entering your system.

What is the best medication for anxiety?

Doctors often prescribe antidepressants, such as paroxetine (Paxil), fluvoxamine (Luvox), or sertraline (Zoloft), for the treatment of anxiety. Many antidepressants fall into the category of medications called selective serotonin reuptake inhibitors (SSRIs) ...

How many points does paroxetine improve?

We found that during these relatively short trials of 8 to 12 weeks, the average improvement for individuals given paroxetine was 11.1 points, and 8.8 points for individuals given placebo. That is, the drug provided an average benefit over placebo of only 2.3 points on a 56-point scale, and the improvement for individuals given placebo matched 79 percent of the improvement for individuals given the drug. The benefit of the drug was lower in the unpublished trials, indicating that the published studies may have overestimated the drug's effectiveness.

What are the side effects of paroxetine?

2 Other side effects include drowsiness, insomnia, and long-term weight gain.

What is the belief that an individual is receiving treatment?

The belief that an individual is receiving treatment (even if that treatment is as simple as a daily sugar pill) is a major component of symptom relief. The specific chemicals in the drugs may be less responsible for the improvement, and these drugs come with risks.

Do antidepressants help with anxiety?

Many people report experiencing a great deal of benefit from antidepressants for their anxiety. However, because individuals given placebos experience a similar benefit that was almost 80 percent as effective, most of their improvement is not due to the specific ingredients in the drugs. Notably, people who receive placebos fare much better than those given no treatment at all, such as individuals on waiting lists to be enrolled in the clinical trials. 6 These findings indicate that taking action to enroll in a treatment program and participating in some type of intervention may be therapeutic in itself. The belief that an individual is receiving treatment (even if that treatment is as simple as a daily sugar pill) is a major component of symptom relief. The specific chemicals in the drugs may be less responsible for the improvement, and these drugs come with risks.

Is psychotherapy better than antidepressants?

7 Short-term studies have shown comparable effectiveness between antidepressants and psychotherapy. However, longer comparisons show a clear superiority for psychotherapy over antidepressants . 8,9 Psychotherapy, when conducted properly, is aimed at not only providing support and relieving symptoms, but also at helping individuals to develop and practice skills to prevent future occurrences of similar symptoms. This skill development is absent with medication intervention and may be part of the reason for psychotherapy's long-term superiority as a treatment.

Does paroxetine help with anxiety?

Antidepressants' Benefits may not Outweigh Risks. Overall, the benefit provided by paroxetine in the treatment of anxiety is small. As a result, the benefit may not be substantial enough to warrant a recommendation for them to be used as a first-line treatment in clinical practice, given the side effects associated with SSRIs.