Warning NoteFatal reactions can occur when SSRIs and MAOIs are taken at the same time. There should be at least a 2- to 5-week break if a patient is changing from one type of antidepressant to the other. (There should be a 5-week break after taking Prozac, because of its long duration of action, and before taking an MAOI.) |
Benzodiazepines
Benzodiazepines are effective medications for most anxiety disorders and have been the standard of treatment for years. However, their use has been associated with a high risk for dependency and abuse. (Some reports suggest they are harder to withdraw from than heroin.) Therefore, they have been supplanted in most cases by SSRIs and by newer antidepressants. Benzodiazepines include:
- Alprazolam (Xanax) and clonazepam (Klonopin) are effective for panic disorder, some phobias, and generalized anxiety disorder. Benzodiazepines in combination with selective serotonin reuptake inhibitors may be particularly helpful in the treatment of panic attacks, although there is no standard as yet for the safest and most effective method for administering this combination.
- Other benzodiazepines, including diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium), are used mainly for generalized anxiety.
Side Effects. Benzodiazepines have many side effects. The most common are daytime drowsiness and a hung-over feeling. In rare cases, they can cause agitation. The may worsen respiratory problems. The drugs stimulate eating and can cause weight gain. In one 2002 study, 33% of patients experienced incontinence at least twice a week. Highest risk was in long-acting drugs, such as chlordiazepoxide. Benzodiazepines can interact with certain drugs, including cimetidine (Tagamet), antihistamines, and oral contraceptives. Benzodiazepines are potentially dangerous when used in combination with alcohol. Overdoses can be serious, although they are very rarely fatal.
The elderly are more susceptible to side effects and should usually start at half the dose prescribed for younger people. These drugs increase the risk of falling, which can increase the risk for hip fracture in older people. Also of concern are studies showing a high risk of automobile accidents in people who take benzodiazepines. Benzodiazepines taken during pregnancy are associated with birth defects, and they should not be used by pregnant women or by nursing mothers.
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