Long term Benzos for GAD - medication question

[Pental08]

I've been on SSRI'S for 8 years - different kinds - I've now been on Sertraline for 2 years - and am now on the top dose.

However It doesn't even touch the sides with my anxiety, Propranolol now has no effect on me at all either.

My Private psychiatrists is quite frustrated with this and the NHS system, and has offered to write me a letter to my GP or for my GP to ring him, OR he is keen for me to see a private specialist Dr.

My psychiatrist thinks I should be a regular dose benzodiazepine - but I'm wondering what medication he was thinking of as most seem to be for short term only - and he thinks I should be on a long term med in this drug group!

Does anyone know which med he might be alluding too? he keeps talking about my brain make-up and 'Gabba' and that I need the right quality meds - he keeps alluding to the fact that It might be a kind of drug I can only get privately.

[panic_down_under]

My psychiatrist thinks I should be a regular dose benzodiazepine - but I'm wondering what medication he was thinking of as most seem to be for short term only - and he thinks I should be on a long term med in this drug group!

Does anyone know which med he might be alluding too? he keeps talking about my brain make-up and 'Gabba' and that I need the right quality meds - he keeps alluding to the fact that It might be a kind of drug I can only get privately.

While benzodiazepines (BZDs) are considered to be short-term meds these days, they have been prescribed for long periods in the past. And despite all the hysteria about them, they usually do work well without tolerance being a significant issue for many.

However, are several issues with taking them long-term. Firstly, they can be hard to quit once dependence develops. Depending on the dose and duration of use, it may take up to a year to wean off them, sometimes longer. Secondly, doctors are reluctant to prescribe them and even if you find one that will, s/he could retire/move/fall under the proverbial bus tomorrow and the replacement may not be as accommodating. Worse he/she may insist on weaning you off the BZD within weeks, even cold-turkey, causing much misery.

Consequently, long-term BZD use has risks. However, it may still have a place when nothing else works. But you don't seem to be at that point yet. SSRIs are not the only antidepressants. Arguably, they aren't even the most effective. Doctors just prefer them because they are the safest in overdose, although citalopram and escitalopram may be the exceptions to even that.

You still have SNRIs and TCAs to explore, even the old MAOIs are an option again as modern food processing techniques have greatly eased the food restrictions which limited their use in the past. Many older psychiatrists that practiced through the MAOI, TCA, SSRI and SNRI eras consider the MAOIs the most effective antidepressants and this was also my experience.

[Ethansmom]

He my be referring to Klonopin/Clonzapam, which has a long half life. That's what i'm currently taking. it helps along with my Citalopram. I'm still not better though.

[CHELLEB1017]

I took .50mg Klonopin daily for about 4 months along with 20mg and ended up weaning of the klonopin only because I was taking it to feel numb to prevent anxiety and felt I was abusing it. I now just take the Citalopram and will take a half of klonopin when needed maybe once a month if I am having a very bad day. Usually ppl are prescribed them short term but there are many who take them for years the weaning process will just be alot longer.

[SmilingAlbert]

Pregabalin is seen as having an effect similar to Benzos for GAD, and doctors will prescribe for long periods if need be. There is an issue regarding cost as it is quite new and until recently was on patent in the UK. Now it is off and there are generics emerging which has lowered the cost. However, some areas have restrictions even now, and I think it is not official for GAD even now in Scotland, for example (though it is in rest of UK).

As the name perhaps suggests, it is a GABA analogue. To quote from WIKI:

"The World Federation of Biological Psychiatry recommends pregabalin as one of several first line agents for the treatment of generalized anxiety disorder, but recommends other agents such as SSRIs as first line treatment for obsessive-compulsive disorder and post-traumatic stress disorder.[32] It appears to have anxiolytic effects similar to benzodiazepines with less risk of dependence.[33][34]

The effects of pregabalin appear after 1 week of use and is similar in effectiveness to lorazepam, alprazolam, and venlafaxine, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychosomatic anxiety symptoms.[35] Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it has a beneficial effect on sleep and sleep architecture, characterized by the enhancement of slow-wave sleep.[35] It produces less severe cognitive and psychomotor impairment compared to those drugs; it also has a low potential for abuse and dependence and may be preferred over the benzodiazepines for these reasons.[35][36]"

It might be worth discussing this with your shrink. If he does reccommend it, he can write a letter and you should be able to get a NHS prescription from your GP; a private prescription is unlikely to be affordable, even now. (potentially £100+s a month).

Best wishes,

Albert