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For a patient with an anxiety problem with whom you’ve jointly decided to begin a serotonin reuptake inhibitor, like fluoxetine, will their outcome be better if you start lorazepam or some other benzodiazepine at the same time? How much better should the outcome be in order to justify the complexity of starting 2 medications at once, the risk of lorazepam itself, and the risk that your patient might end up on both long term? Is that really better than just starting fluoxetine by itself?
Hi! Jim Phelps here for the Psychopharmacology Institute. Every patient is different, of course. For some, the risk of starting 2 medications at once may really be worth considering. A 2019 Cochrane review of the adult literature on depression with anxiety concluded that starting antidepressants with a benzodiazepine at treatment outset was more effective. It lowered depressive severity more than antidepressants alone in the first 4
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