The Paradox of Serotonergic Over-Prescription: A Comparative Analysis of Long-Term Antidepressant Dependency vs. Benzodiazepine Maintenance in Non-Depressive Anxiety Phenotypes

The contemporary psychopharmacological paradigm exhibits a profound epistemic and systemic bias favoring selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line modalities for isolated anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), irrespective of an absent depressive baseline. This thesis challenges this clinical consensus through a iatrogenic and neurophilosophical critique, demonstrating that the off-label imposition of serotonergic agents on non-depressed brains introduces pathological biological friction, acute neurological activation, and an iatrogenic discontinuation syndrome that medically and volatilely exceeds the withdrawal parameters of traditional GABAergic agents. Utilizing an N-of-1 single-subject case design methodology, this paper constructs a conceptual model around distinct neurological phenotypes, exploring how structural alterations (such as post-traumatic brain injury mechanical shifts) isolate hyper-arousal into a purely somatic, hyper-adrenergic loop. We apply a rigorous neuropharmacological analysis to the mechanism of differential tolerance, establishing that while central receptor systems downregulate sedative actions rapidly, anxiolytic efficacy remains stable and preserved long-term without requiring dose escalation. Conversely, chronic antidepressant use introduces a profound chemical overlay linked to permanent limbic flattening, executive cognitive decline, and a protracted withdrawal syndrome that severely threatens cognitive safety and intellectual autonomy. Ultimately, this work provides a framework for the de-stigmatization of long-term benzodiazepine maintenance, arguing that for non-depressive autonomic phenotypes, targeted GABAergic stabilization possesses superior neurobiological integrity, bioethical alignment, and clinical utility over the algorithmic uniformity of modern antidepressant over-prescription.