Data on ssri medications.

Medical Q&A [Moderated]
1

Hello docs!

i have a few questions on your thoughts about ssri medications.
For some background (i know this is not medical advice), i have taken a couple different medications over the past 3 years. Sertraline at like 50mg, and the past year venlafaxine XR at 37.5mg only.

i believe some of the data on these medications do not show that much efficacy above placebo, but however the specific one i am taking, i have found a study here Efficacy of Venlafaxine Extended-Release Capsules in Nondepressed Outpatients With Generalized Anxiety Disorder
however these reductions in HAM-A score are not major compared to placebo right?

its been awhile since i havent been on a medication and im on such a low dose i am just wondering if these things are even working/worth taking. (I am not looking for advice on altering my medication)

i have a few concerns and i would love to hear your professional opinion on the matter.

  • are these medications well studied? I have seen some scary claims people have made such as them causing lots of brain chemical changes that are very difficult to return to baseline.

  • do you think these medications work well enough for doctors (atleast the ones ive met) to just prescribe always to anyone who mentions anxiety issues?

  • do you think that a dose of 37.5mg of venlafaxine XR likely is improving any outcomes?

  • would you have any concerns of long term effects of these medications, and how difficult it is to return to normal after stopping use? It seems doctors wean people off of them within a month or so usually, but there is entire organizations such as survivingantidepressants.org or whatever that make a massive case for reducing by 10% every like 4 weeks even into microdoses less than 1mg before people stop taking them. Not really sure what to believe.

thanks a lot!

  • Sam
2

Sam,

Thanks for the post. Some of the questions here are more appropriate for your health care provider or a formal consultation. That said, I can answer some of them generally.

  1. The RCT you shared shows a significant benefit w/ venlafaxine compared to placebo on the outcomes measured. I’m not equipped to debate the utility of HAM-A with respect to clinical practice. A systematic review found that 5 patients with anxiety would need to be treated with antidepressants rather than placebo for 1 patient to see clinical improvement. (Antidepressants for generalized anxiety disorder - PubMed)
  2. With respect to whether or not venlafaxine, a SNRI, or other medications like SSRI’s are well studied for treating anxiety, the answer is a resounding yes. A change in “brain chemistry” that drives changes in clinically relevant outcomes - positive or negative- has not been shown in research.
  3. I cannot speak to your specific experience with this medication, but yes, that dose has been shown to be effective compared to placebo. (Venlafaxine extended release (ER) in the treatment of generalised anxiety disorder: twenty-four-week placebo-controlled dose-ranging study - PubMed)
  4. I do not have concerns with long term effects of SNRI’s or SSRI’s, no. Some of these medications need a taper if you’re switching to something else or no longer in need of treatment, which should be guided by the prescribing physician.
  5. Behavioral therapy is also useful for anxiety and 10/10 would recommend as adjunctive treatment for most folks. -Jordan
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