Addition of benzodiazepines to selective serotonin reuptake inhibitors to optimize treatment of depression: a hospital based study

Abstract

Background: Selective serotonin reuptake inhibitors ameliorate depression and anxiety slowly and in fact increase anxiety or insomnia initially. Addition of clonazepam to escitalopram improves response: thereby improving symptoms associated with depression, reducing side-effects and alleviating core depressive symptoms. The aim of study was to assess the benefits of adding benzodiazepines in management of depression.Methods: It was an open label prospective study of 8 weeks of escitalopram group versus escitalopram with benzodiazepine group in moderate to severe depression. 51 subjects who gave written informed consent and were fulfilling the inclusion and exclusion criteria were included in the study and grouped into escitalopram alone or escitalopram with benzodiazepines.Results: In the present study nearly 60% of the patients were prescribed clonazepam. Though combined group with benzodiazepines had faster onset of action in controlling depressive symptoms than escitalopram group alone at 4 weeks of treatment, there was no significant difference in the pattern of reduction of MADRS score in both the groups at 8 weeks of follow up.Conclusions: Augmenting benzodiazepines to antidepressants are more effective in management of depression associated anxiety and sleep disturbances initially till SSRIs start action.

Expert’s preference on escitalopram and clonazepam for treating depression and anxiety in Indian diabetic and hypertensive patients

“…SSRIs are considered as first-line treatment for various anxiety and depressive disorders. It is important to note that SSRIs may initially worsen anxiety or insomnia before gradually alleviating depression and anxiety [23] . Escitalopram is the most preferred SSRI due to its high efficacy, safety, tolerability, and lower risk of mood fluctuations [24] .…”

Expert Opinion on the Prescription Practice of Selective Serotonin Reuptake Inhibitors for Major Depressive Disorder in Indian Settings

“…For numerous anxiety and depressive disorders, SSRIs are considered the first line of treatment. It is important to note that SSRIs may initially exacerbate insomnia or anxiety before gradually ameliorating both conditions [14]. This finding underscores their efficacy, safety, tolerability, and lower risk of mood swings noted in SSRI treatment [15].…”