Antidepressants and psychotherapies are the mainstay for treating depression, but another option is the benzodiazepine drug alprazolam, which is recommended for treating depression when anxiety is also involved.
Some doctors prescribe a short course of benzodiazepines to help depressed and anxious patients, but this is not supported by NICE guidance. High-potency tranquillisers like alprazolam are thought to have side-effects including dependence, rebound anxiety, memory impairment, accident-proneness and discontinuation syndrome.
A new systematic review from the Cochrane Depression, Anxiety and Neurosis Group suggests that alprazolam may be as effective as antidepressants in treating depression, but the authors urge caution because of the quality of the studies included in their review.
They conducted the usual systematic Cochrane search looking for randomised controlled trials (RCTs) of alprazolam versus placebo or conventional antidepressants for depression in adults, excluding studies with inpatients only. Their search included all RCTs published up until February 2012 and they did not apply any language restrictions.
They found 21 RCTs including a total of 2,693 patients. Typical study duration was 4-6 weeks and 6 of the included studies had a high risk of bias.
Two authors from their team carried out independent data extraction and assessed the quality of the included research, to ensure that their interpretation of the evidence was accurate.
They measured two main outcomes:
- The mean difference (MD) in reduction of depression on a continuous measure of depression symptoms
- The risk ratio (RR) of the clinical response based on a dichotomous measure, with 95% confidence intervals (CI)
Here’s what they found:
- Alprazolam reduced depression symptoms better than placebo
- (MD -5.34, 95% CI -7.48 to -3.20; I2 = 68%)
- (Risk difference RD 0.32, 95% CI 0.22 to 0.42; I2 = 0%)
- Alprazolam reduced depression symptoms as well as tricyclic antidepressants
- (MD 0.25, 95% CI -0.93 to 1.43; I2 = 55%)
- (RR 0.86, 95% CI 0.75 to 0.99; I2 = 37%)
- (RD -0.11, 95% CI -0.24 to 0.01; I2 = 58%)
- (Number needed to treat to benefit NNTB 9, 95% CI 4 to 100)
But the included studies had a number of weaknesses:
- They were heterogeneous
- Overall study quality was poor
- They only addressed short-term effects
- They probably suffer from sponsorship bias and publication bias
The reviewers concluded:
The best evidence currently available suggests that alprazolam may be moderately more effective than a placebo, and as effective as conventional antidepressants, in the treatment of major depression.
However, the multiple shortcomings of the currently available evidence limit confidence in these findings.
Link
van Marwijk H, Allick G, Wegman F, Bax A, Riphagen II. Alprazolam for depression. Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD007139. DOI: 10.1002/14651858.CD007139.pub2.
I have a pressing mental health concern for a loved one involving depression with a suicidal obsession. Having majored in psychology I somehow thought of benzodiazepenes from a pharmacology class I took in college.
1) Would you try alprazolam for depression that has chronic suicidal ideation as a frequent symptom?
2) How do people coping with depression describe the treatment effect and experience of benzo’s both positive and negative?
3) What are other depression meds that can be used with benzo’s and that compliment their effect?
4) My experience with depression usually came with heavy somatic symptoms of lethargy. Long heavy sleeps. Do others people report more cognitive forms of depression?
5) Any helpful information is for the lovely lady in my Facebook cover photo. She’s experienced first hand death related trauma as a young lady from the suicide of her mother in law and is coming upon a two year mark of her father’s death which she also witnessed. As her husband I will be hunting down any effective and safe treatments for her relief.
Hey, I know this was asked 7 years ago, but seeing as it was not answered in that time period, I really want to address your concerns.
1) In regards to any depressive disorder with chronic suicidal ideation present, I would personally be hesitant to consider Alprazolam as any kind of first-line treatment. The reason being, benzodiazepines are well known to lower one’s inhibitions. That would worry me that one could possibly be more likely to have a suicide attempt, or even worse, leading to one completing suicide.
2) I’m going to skip your second question, simply because everyone’s experiences will vary. I’d encourage asking for personal experiences in a forum to better answer this question. However, the answers to your other questions will likely also lend insight to this, also!
3) As for other antidepressant medications that would compliment the effects of Alprazolam, honestly each and every antidepressant would be go well together. However, MAOIs should probably generally be avoided as much as possible in treatment because of their known interactions with many other substances and medications. I would also most likely avoid Tricyclic antidepressants (TCAs include commonly used medications such as Amitriptyline), do to the fact that TCAs alone are known to generally cause marked sedation. This could be very problematic, as Alprazolam (and all benzodiazepines) are commonly referred to as minor tranquilizers by themselves. The synergistic effects could be profound to those without a marked tolerance. SSRIs and SNRIs (classes include drugs such as Zoloft and Effexor XR, respectively) would be a much better choice. However, while these meds are the go-to antidepressant classes currently, it is worth noting they have a significant withdrawal profile if not property tapered, and aren’t nearly as effective as studies had originally claimed. Essentially, unless one is naturally lacking in serotonin, they are much less likely to be effective. Personally, using an atypical antidepressant such as Welbutrin/Bupropion would be one of the first I’d try (after trialing an SSRI/SNRI), as it causes little sedation, and has good success rates. However, as it can be stimulating as a synthetic cathinone, it may exacerbate underlying anxiety. This could, however, be placated by adjusting the doses of one or both medications. I would avoid newer medications like ketamine or the newer Eskstamine due to the abuse potential of both ketamine and benzodiazepines.
4) Depression symptoms can vary, even within the same depressive disorder diagnoses. However, lathargy and excessive tiredness and sleeping are very common symptoms. If these were the main presenting factors, Alprazolam would likely only compound your complaints. Alprazolam/Xanax/Niravam ideally should be used only when depression is associated with anxiety symptoms, as that is what they address most. Everyone’s depression can vary, though.
I hope I was able to answer your questions, and that your loved one is doing better now!
– Bert
I just wanted to add, whenever considering ANY medical treatment, especially pharmaceutical, the risks should always be outweighed by the benefits. If the risk cost ratio is too high, then that treatment should be avoided.
-Bert
Hi Bert I suffer with severe anxiety and depression ,I already tried 15 medication including MAOis but I didn’t have any lucky with that other .. my psychiatrist put me on Clonazepam for the anxiety but it making my depression worse and helping very little with anxiety ..I’m on .5 mg once a day sometimes I take two ..I’m thinking about asking her to go on alprazolam becouse i cannot handle this horrible anxiety with the depression any longer.. I’m not taking any antidepressants at the mo .but I’m convinced that the Clonazepam is making me more depressed!? need some advice please help ..