General questions on benzos with ADs

[akb]

This may be one for PDU our resident med guru

_ Does taking benzos with a new AD interfere with the effects of the AD?

_ If you are taking benzos to alleviate anxietx associated with a new AD, will you still notice when the AD has kicked in?

_ apart from maybe less side efFcts, are SSRI and SNRI more effective than the old tricyclics?

[panic_down_under]

Does taking benzos with a new AD interfere with the effects of the AD?

It seems benzodiazepines may reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis which is how they produce the therapeutic response (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).

In light of these studies benzodiazepines use should probably be limited to a couple of weeks when first taking antidepressants if they trigger a spike in anxiety, for a while after AD dose increases for the same reason and thereafter only for occasional breakthrough anxiety.


If you are taking benzos to alleviate anxietx associated with a new AD, will you still notice when the AD has kicked in?

Yes, but it may be delayed and/or a higher antidepressant dose required to achieve it.


apart from maybe less side efFcts, are SSRI and SNRI more effective than the old tricyclics?

Imho, no. And most of the older psychiatrists I've asked with experience in prescribing all three classes, plus MAOIs, agree with me.

As a generalisation, I believe MAOIs are more effective than TCAs which are generally a little more effective than the SNRI duloxetine (Cymbalta) - venlafaxine (Effexor) and desvenlafaxine (Pristiq) are *really only SSRIs - which in turn is more effective than the SSRIs. However, that may not hold true at the individual level. It all comes down to how well a med meshes with a patient's biology.

* fluoxetine, fluvoxamine, paroxetine & sertraline inhibit noradrenaline/norepinephrine reuptake more than des/venlafaxine, though still only weakly.

[akb]

Hi PDU

Thanks for your reply. Confirmed what I suspected.