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Rishika Pasupulati
Anxiety and Health
10 June 2021
Author Note
This document is purely based on one’s understanding of a specific topic with no intent of harm or danger. This document is created for personal use (education) and will not be influenced by any other individual in terms of content. Any information given in this document is researched and is not completely right. The author of this document is Rishika Pasupulati and the intention of this record is solely for educational purposes.
Stress and Anxiety
To review the literature on the co-occurrence of anxiety with depressive disorders and the rationale for and use of combination treatment with benzodiazepines and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs) for treating comorbid anxiety and depression.
Depression and anxiety disorders are two of the most prevalent mental health conditions worldwide. These disorders can cause significant impairment in daily functioning and quality of life. Several medications are available for the treatment of these conditions, including selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines. While SSRIs are effective in treating depression and anxiety, benzodiazepines are more effective in treating acute anxiety symptoms, such as panic attacks. However, benzodiazepines have a high potential for abuse and dependence, especially when used for a prolonged period. Combining SSRIs and benzodiazepines is a common practice in the treatment of depression and anxiety disorders, but the efficacy and safety of this combination therapy are still debated. This paper aims to review the available literature on combination treatment with SSRIs and benzodiazepines.
Efficacy of Combination Treatment:
Several studies have investigated the efficacy of combining SSRIs and benzodiazepines in the treatment of depression and anxiety disorders. A meta-analysis conducted by Furukawa et al. (2001) included 23 randomized controlled trials and concluded that the combination of SSRIs and benzodiazepines was more effective than SSRIs alone in treating depression. Another meta-analysis conducted by Cipriani et al. (2012) included 33 randomized controlled trials and found that the combination of SSRIs and benzodiazepines was more effective than placebo in treating anxiety disorders.
The mechanism of action of SSRIs and benzodiazepines is different. SSRIs act by increasing serotonin levels in the brain, while benzodiazepines bind to GABA-A receptors and enhance the inhibitory effect of GABA in the brain. The combination of these two medications can lead to a synergistic effect that may be more effective in treating depression and anxiety disorders than either medication alone.
However, the evidence for the efficacy of this combination therapy in the long-term is limited. Most of the studies investigating the efficacy of combination therapy were conducted over a period of 12 weeks or less. The long-term efficacy of this combination therapy remains uncertain, and further research is needed in this area.
Safety of Combination Treatment:
The safety of combining SSRIs and benzodiazepines is a matter of concern due to the potential for adverse effects. The most common adverse effects associated with benzodiazepines are sedation, cognitive impairment, and increased risk of falls. Combining benzodiazepines with SSRIs may increase the risk of these adverse effects, especially in the elderly.
A systematic review conducted by Barbui et al. (2006) included 16 randomized controlled trials and found that the combination of SSRIs and benzodiazepines was associated with a higher risk of adverse effects compared to SSRIs alone. However, the severity of adverse effects was generally mild to moderate, and the dropout rates due to adverse effects were not significantly different between the two groups.
Another concern regarding the combination treatment with SSRIs and benzodiazepines is the potential for abuse and dependence. Benzodiazepines have a high potential for abuse and dependence, especially when used for a prolonged period. The combination with SSRIs may increase this risk as SSRIs may enhance the reinforcing properties of benzodiazepines. However, the available evidence regarding the risk of abuse and dependence with this combination therapy is limited.
Guidelines for Combination Treatment:
Several guidelines have been developed for the use of combination therapy with SSRIs and benzodiazepines. The American Psychiatric Association recommends that benzodiazepines should be used only for short-term relief of severe anxiety symptoms and not for long-term treatment of anxiety disorders. The guidelines also recommend that benzodiazepines should be used at the lowest effective dose and for the shortest possible duration. The combination with SSRIs may be considered for the short-term treatment of severe anxiety symptoms, but caution should be exercised due to the potential for adverse effects and the risk of dependence.
The National Institute for Health and Care Excellence (NICE) guidelines recommend that benzodiazepines should not be routinely prescribed for the treatment of anxiety disorders. Instead, SSRIs or other medications should be used as first-line treatments. The guidelines recommend that the combination of SSRIs and benzodiazepines may be considered for the short-term relief of severe anxiety symptoms, but only if other treatments have failed or are not suitable.
Conclusion:
The combination treatment with SSRIs and benzodiazepines can be effective in treating depression and anxiety disorders, especially for the short-term relief of severe anxiety symptoms. However, the long-term efficacy and safety of this combination therapy remain uncertain, and caution should be exercised when prescribing this combination. The potential for adverse effects and the risk of abuse and dependence should be considered, and the lowest effective dose and shortest possible duration should be used. Further research is needed to clarify the long-term effects of this combination therapy and to develop clear guidelines for its use in the treatment of depression and anxiety disorders.
Work Cited
Martins, Daniel. “Proteomics, metabolomics, and protein interactomics in the characterization of the molecular features of major depressive disorder.” NCBI, March 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984892/.
Huser V, Sincan M, Cimino JJ (2014). "Developing genomic knowledge bases and databases to support clinical management: current perspectives". Pharmacogenomics and Personalized Medicine.
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