SSRIs or Benzos?

[BobIndy]

I am going to be seeing my doc this week for a follow-up and need some advice from some of you all! Basically I suffer from mild to moderate social anxiety, fear of crowds, public speaking. I don't have any depression. I just get the classic signs of anxiety like sweaty palms, racing pulse, sweats, blushing, panic around people I don't know. I am probably going to be starting medication again soon. But as a young man I am scared of the sexual side effects of the ssri's. I have had issues falling asleep in the past, so I'd hate to sacrifice decent sleep to help my anxiety. I am looking for a good medication to not destroy my sex drive or give me insomnia. Are Zoloft, Paxil, & Prozac basically the same, or are any better than the other? What about only using a small dose Ativan or Xanax or Clonopin instead of ssri? Some people have told me good things about Celexa and Lexapro, which can be a bit easier on the side effects? Or does it come down to, if you DO take an ssri, you usually have to supplement it with something else to help sleep/sex drive? Thanks to anyone who can give me some answers here!

[insights]

Are Zoloft, Paxil, & Prozac basically the same, or are any better than the other?

While doing the same basic things, there are differences between them, including some differences in side-effects and their severity. They may also not be equally effective for you. 

What about only using a small dose Ativan or Xanax or Clonopin instead of ssri?

It depends on how often you need to take them. If it is no more than a couple of times a week then benzodiazepines would be a good choice. However, if your anxiety is such that you'd need to take them daily, then they may not be the right meds. The problem isn't the drugs, but doctors' attitudes to them. More and more are refusing to prescribe them because of the perceived dependency issue (antidepressants aren't any better in that regard). Sometimes they then insist their patients quickly discontinue them, to even quit them cold-turkey which can be a very unpleasant experience. Even if your doctor is happy to prescribe them, s/he could fall under the proverbial bus in 6 months time and the replacement might not be as accommodating.

Or does it come down to, if you DO take an ssri, you usually have to supplement it with something else to help sleep/sex drive?

From what you've written, Buspar might work for you. It is usually only effective for generalized anxiety disorder and, to a lesser extent, social anxiety disorder, and even then it only works for some. However, it is relatively side-effect free and is one of the supplement drugs used to counter SSRI sexual dysfunction. IMHO, definitely worth a try before going down the SSRI route.

Ian

[AMRELP2712]

Ian, the last drug you described with less side effects. Would that help regular day-to-day anxiety? I get panic attacks once in awhile but my main problem is functioning normally with the anxiety.. I'm sorry to post on this but I have seen your replies and I also am worried about side effects. Zoloft was horrible for me. and I would like to try something without as many side effects. I also have tummy troubles, ulcers.. and the zoloft really upsets them. I would like to try something else but I don't really know what to lean towards

[insights]

Ian, the last drug you described with less side effects. Would that help regular day-to-day anxiety?

Maybe. Buspar is very much a hit or miss drug. The only way to know is to try it. It almost certainly won't stop panic attacks. At least I've never come across anyone who claimed it helped. 

I also have tummy troubles, ulcers.. and the zoloft really upsets them.

Most ulcers are curable. How are yours being treated?

As for the Zoloft, like most serotonergic antidepressants, it can cause blood 'thinning' which man be a problem with ulcers. Many may also cause GI problems initially.

Antidepressants with very little effect on serotonin are (in the order I suggest you try them) nortriptyline (Aventyl, Pamelor), agomelatine (Valdoxan), venlafaxine (Effexor), trazodone (Desyrel), and mirtazapine (Remeron).

Ian

[lcfrogs]

I have tried Buspar and it did nothing for me. I know other people who have also tried it and it did nothing for them as well. As Ian said, it is definitely hit or miss. But I think it is mostly miss.

[stevo1111]

Having taken BusPar for over 2 months, it does certainly do something. It seems to create a level of disconnect between you and strong emotions, very dislike any other medication I have tried (SSRIs, TCAs, BZDs). It does not seem to stop the thoughts which cause anxiety, nor effect the somatic manifestations, but rather create a bizarre disconnect between you and the emotions. For some, this may work very well. For others, this may do nothing!

For the OP. Buspar is likely worth a try at first, as the side effects that accompany other medications are most likely not outweighed by the benefits you will receive. I too suffer from mild to moderate levels, and the side effects that accompany anti-depressants are just not worth it. When in the mild phase, it seems to be doing something, however when you enter the moderate regime you might as well be eating tic tacs. Perhaps the combination of Buspar as a preemptive and a fast acting BZD as the occasional panic blocker would work?

[AMRELP2712]

Ian,

Thank you for replying, I am treating them with prilosec. And have been for  a few years. I actually stopped taking them for awhile then got back on them with my pregnancy because of super bad heart burn. i still take one 40  ml once a day I was taking 2x. Funny but I did not know they were cureable! That relives some stress for me already lol. And I have enough GI issues not ready for more, but whatever it takes to get better right. How do I suggest these medications to my DR. I will be seeing him on the 19th of Feb to start up new medication..

[insights]

Funny but I did not know they were cureable! That relives some stress for me already lol.

Most ulcers, some 80-85%, are caused by either Helicobacter pylori infecting the stomach, or long term use of NSAIDs, aspirin, etc. If caused by the bacterium then ulcers will usually self heal once the bug is eradicated with antibiotics. Damage from NSAIDs may require surgery.

And I have enough GI issues not ready for more, but whatever it takes to get better right. How do I suggest these medications to my DR.

Just ask, reminding him/her of the problems you had with Zoloft which makes you wary of trying antidepressants that thin the blood and you therefore wish to try an AD that doesn't affect serotonin. Doctors are not, or at least shouldn't act like little tin gods who make all the decisions. They are our employees. Someone we pay directly, or indirectly through our health insurance. So we are entitled to have an input into our treatment as long as it is medically sound. If yours is one of those doctors who makes pronouncements from on high brooking no arguments, then find another.

Ian

[laineyk]

 Can Trazadone be used for anxiety? Most stuff I have read its used for sleep

[insights]

Can Trazadone be used for anxiety?

Sure. It is an antidepressant at higher doses. Because it is quite sedating, especially at low doses, it is mostly prescribed as a sleeping pill these days, but at 150-200mg plus the antidepressant effects kick-in. In several respects it is a very good antidepressant. Apart from sedation it usually produces only moderate initial side-effects, typically blurred vision and dry mouth, maybe some constipation, and few long term ones. Unlike most other antidepressants it usually doesn't kill the libido and may enhance it. However, as with everything about antidepressants, there are no guarantees.

Two cautionary notes. Both male and female priapism is a potential side-effect. It is very rare, but not unheard of. Secondly, the main trazodone metabolite is meta-Chlorophenylpiperazine (mCPP), one of the Ecstasy drugs. There isn't enough to cause halucinations, however, it can cause headaches. There can also be just enough of it in the system to show up in drug screening tests. Something to be aware of if you're subject to employment drug screening. In which case you should declare that you are on trazodone to your employer.

Ian