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????It’s a good question—the limited data we have (a few 1-3 year follow up studies in PD) indicate that anxiolytic tolerance does not form and that side effect burden is much less than with SSRIs. This is not the strongest evidence base but it does tell us something.
Surely you jest. SSRIs are not associated with falls, dementia, or all-cause mortality.
Association Between Benzodiazepine Use With or Without Opioid Use and All-Cause Mortality in the US
This cohort study uses data from the National Health and Nutrition Examination Surveys to evaluate whether benzodiazepine use, with or without opioid use, is associated with increased all-cause mortality relative to the use of low-risk antidepressants.
jamanetwork.com
The impact of SSRIs on mortality and cardiovascular events in patients with coronary artery disease and depression: systematic review and meta-analysis - Clinical Research in Cardiology
Background Depression is common in patients after acute coronary syndromes (ACS) and with stable coronary artery disease (CAD) and has been associated with increased mortality and morbidity. However, it is unclear whether selective serotonin receptor inhibitors (SSRIs) reduce mortality or...
link.springer.com
I don't think I have ever encountered a long-term benzo patient who had previously done therapy, SRIs, BuSpar, and Remeron. Usually they were started on the benzo first or second line, with or without SSRI, and simply continued to take it for decades. Most of them have never had effective exposure therapy for anxiety.Even if tolerance does occur, an important question is: is this complete tolerance? (Pt is back at baseline prior to starting the benzo) or partial tolerance? And how much? 30-40% tolerance means 60-70% sustained relief in a treatment-resistant anxiety patient who has done the therapy, SRIs, buspar, Remeron, atypical antipsychotics heaven forbid, what have you.
Some people do seem to develop tolerance to SSRIs, though it doesn't seem to be as common/universal as with benzos. Have you not seen this? It can take anywhere from a year or two to decades, where the patient starts to feel like their medication isn't working anymore. I'm not sure about mechanism but it doesn't seem to be class-based because switching to a different SSRI usually fixes the problem.Finally, if anxiolytic tolerance does occur with benzos, I don’t see why this cannot also apply to SSRIs. Unless we collectively feel like the benzo-induced “euphoria” to which tolerance develops is the anxiolysis itself.