Originally Posted by
Dazzlar13
It is very concerning that they seem to be pushing SSRI/SNRIs only.
Because most GPs and psychiatrists qualified after these became available in the later 1980s and they have little experience of anything else. They've been told SSRIs and SNRIs are newer, better, safer ADs with less side-effects than TCAs and MAOIs. They are certainly newer, but *arguably TCAs and MAOIs are generally more effective and some SSRIs and SNRIs are no safer than the older meds. But they do generally have fewer ongoing side-effects, however, the common ongoing TCA side-effects such as dry-mouth and constipation are manageable and they generally produce less severe initial side-effects and withdrawal issues when quitting.
* the effectiveness of meds is calculated by the number of patients that need to be treated to get one good outcome - Numbers to Treat (NTT). The better a drug's efficacy the lower the number.
De Lima MS, 2003 found the NTT for MAOIs = 2.9, TCAs = 4.3, SSRIs = 5.1.
Arroll B, 2005 came up with a similar result: TCAs = 4, SSRIs = 6.
They mentioned mirtazapine, which I have tried but came off as it stopped working for my anxiety, although it completely knocked me out at night, which is great as I've suffered on and off with insomnia my whole life.
Mirtazapine isn't really an antidepressant, but a potent antihistamine. It seems to treat anxiety mostly by sedation.