An anxiolytic (also antipanic or antianxiety agent) is a medication or other intervention that inhibits anxiety. This effect is in contrast to anxiogenic agents, which increase anxiety. Together these categories of psychoactive compounds or interventions may be referred to as anxiotropic compounds/agents. Some recreational drugs such as alcohol induce anxiolysis. Anxiolytic medications have been used for the treatment of anxiety and its related psychological and physical symptoms. Anxiolytics have been shown to be useful in the treatment of anxiety disorders. Bright light therapy and other interventions have also been found to have an anxiolytic effect.
Anxiolytics are also known as minor tranquilizers. The term is less common in modern texts, and was originally derived from a dichotomy with major tranquilizers, also known as neuroleptics or antipsychotics.
- 1 Types of anxiolytics/anti-anxiety drugs
- 1.1 Medications
- 1.2 Over-the-counter pharmaceutical drugs
- 1.3 Future drugs
- 1.4 Common drugs
- 2 Alternatives to medication
- 3 See also
- 4 References
Types of anxiolytics/anti-anxiety drugs
Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Benzodiazepines may also be indicated to cover the latent periods associated with the medications prescribed to treat an underlying anxiety disorder. They are used to treat a wide variety of conditions and symptoms and are usually a first choice when short-term CNS sedation is needed. Longer-term uses include treatment for severe anxiety. There is a risk of a benzodiazepine withdrawal and rebound syndrome after continuous usage for longer than two weeks, and tolerance and dependence may occur if patients stay under this treatment for longer. There is also the added problem of the accumulation of drug metabolites and adverse effects. Benzodiazepines include:
- Alprazolam (Xanax)
- Bromazepam (Lectopam, Lexotan)
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin, Rivotril)
- Clorazepate (Tranxene)
- Diazepam (Valium)
- Flurazepam (Dalmane)
- Lorazepam (Ativan)
- Oxazepam (Serax, Serapax)
- Temazepam (Restoril)
- Triazolam (Halcion)
- Tofisopam (Emandaxin and Grandaxin) is a drug that is a benzodiazepine derivative. Like other benzodiazepines, it possesses anxiolytic properties, but, unlike other benzodiazepines, it does not have anticonvulsant, sedative, skeletal muscle relaxant, motor skill-impairing, or amnestic properties.
Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor (SSRIs) are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. SSRIs are primarily classified as antidepressants and typically higher dosages are required to be effective against anxiety disorders than to be effective against depression; nevertheless, most SSRIs have anxiolytic properties. They can, however, be anxiogenic early on in the course of treatment due to negative feedback through the serotonergic autoreceptors. For this reason in some individuals a low dose concurrent benzodiazepine therapy might be beneficial during the early stages of serotonergic therapy to counteract the initial anxiogenic effects current serotonergics antidepressants have.
Older tricyclic antidepressants (TCAs) are anxiolytic too; however, their side effects are often more severe in nature. Examples include imipramine, doxepin, amitriptyline, and the unrelated trazodone. Monoamine oxidase inhibitors (MAOIs) are very effective for anxiety, but due to drug dangers, are rarely prescribed. Examples include: phenelzine and tranylcypromine. A reversible MAOI, which has none of the dietary restrictions associated with classic MAOI's, moclobemide is used in Canada and the UK as Manerix and in Australia as Aurorix which have none of the more severe SSRI's and SNRI's caused SSRI discontinuation syndrome, an often overlooked and damaging syndrome which is objectively and subjectively as bad or, for some, even worse than Benzodiazepine withdrawal syndrome.
Mebicar (mebicarum) is an anxiolytic produced in Latvia and used in Eastern Europe. Mebicar has an effect on the structure of limbic-reticular activity, particularly on hypothalamus emotional zone, as well as on all 4 basic neuromediator systems – γ aminobutyric acid (GABA), choline, serotonin and adrenergic activity. Mebicar decreases the brain noradrenaline level, exerts no effect on the dopaminergic systems, and increases the brain serotonin level.
Afobazole is an anxiolytic drug launched in Russia in the early 2000s. Its mechanism of action remains poorly defined, with GABAergic, NGF and BDNF release promoting, MT1 receptor antagonism, MT3 receptor antagonism, and sigma agonism all thought to have some involvement. It has yet to find clinical use outside of Russia.
Selank is an anxiolytic peptide based drug developed by the Institute of Molecular Genetics of the Russian academy of sciences. Selank is a heptapeptide with the sequence Thr-Lys-Pro-Arg-Pro-Gly-Pro. It is a synthetic analog of a human tetrapeptide tuftsin. As such, it mimics many of its effects. It has been shown to modulate the expression of interleukin-6 (IL-6) and affect the balance of T helper cell cytokines. There is evidence that it may also modulate the expression of brain-derived neurotropic factor in rats.
Bromantane is a stimulant drug with anxiolytic properties developed in Russia during the late 1980s, which acts mainly by inhibiting the reuptake of both dopamine and serotonin in the brain, although it also has anticholinergic effects at very high doses. Study results suggest that the combination of psychostimulant and anxiolytic actions in the spectrum of psychotropic activity of bromantane is effective in treating asthenic disorders compared to placebo.
Barbiturates exert an anxiolytic effect linked to the sedation they cause. The risk of abuse and addiction is high. Many experts consider these drugs obsolete for treating anxiety but valuable for the short-term treatment of severe insomnia, though only after benzodiazepines or non-benzodiazepines have failed. They are rarely prescribed any more.
Hydroxyzine (Atarax) is an old antihistamine originally approved for clinical use by the FDA in 1956. It possesses anxiolytic properties in addition to its antihistamine properties and is also licensed for the treatment of anxiety and tension. It is also used for its sedative properties as a premed before anesthesia or to induce sedation after anesthesia. It has been shown to be as effective as benzodiazepines in the treatment of generalized anxiety disorder, while producing fewer side-effects.
Pregabalin's therapeutic effect appears after 1 week of use and is similar in effectiveness to lorazepam, alprazolam, and venlafaxine, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychic and somatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it does not disrupt sleep architecture and produces less severe cognitive and psychomotor impairment; it also has a low potential for abuse and dependence and may be preferred over the benzodiazepines for these reasons.
Sublingual administration of Validol produces a sedative effect, and has moderate reflex and vascular dilative action caused by stimulation of sensory nerve receptors of the oral mucosa followed by the release of endorphins. Validol is typically administered as needed for symptom relief.
Certain natural substances are reputed to have anxiolytic properties, including the following:
- Garcinia indica (Kokum)
- Scutellaria lateriflora
- Coriandrum sativum (Coriander)
- Salvia elegans (Pineapple Sage)
- Cannabidiol (a cannabinoid found in marijuana)
Over-the-counter pharmaceutical drugs
Picamilon is a prodrug formed by combining niacin with GABA that is able to cross the blood–brain barrier and is then hydrolyzed into GABA and niacin. It is theorized that the GABA released in this process activates GABA receptors, with potential to produce an anxiolytic response. Picamilon is sold in the United States as a dietary supplement, while in Russia it is sold as a prescription drug.
Chlorpheniramine (Chlor-Trimeton) and Diphenhydramine (Benadryl) have hypnotic and sedative effects with mild anxiolytic-like properties (off-label use). These drugs are approved by the FDA for allergies, rhinitis, and urticaria.
Melatonin has anxiolytic properties, likely mediated by the benzodiazepine/GABAergic system. It has been used experimentally as an effective premedicant for general anesthesia in surgical procedures.
Due to deficits with existing anxiolytics (either in terms of efficacy or side-effect profile), research into novel anxiolytics is active. Possible candidates for future drugs include:
Prescription-free drugs are often poor anxiolytics and often worsen the symptoms over time. However, they are often used for self-medication because of their wide availability (e.g. alcoholic beverages).
Ethanol is used as an anxiolytic, sometimes by self-medication. fMRI can measure the anxiolytic effects of alcohol in the human brain. The British National Formulary states, "Alcohol is a poor hypnotic because its diuretic action interferes with sleep during the latter part of the night." Alcohol is also known to induce alcohol-related sleep disorders.
The anxiolytic effects of solvents act as positive modulators of GABAA receptors (Bowen and colleagues 2006).
Inhalants are commonly used as anxiolytics by street children in Latin America, Africa, and Asia but also by impoverished indigenous communities.
Alternatives to medication
Psychotherapeutic treatment can be an effective alternative to medication. Exposure therapy is the recommended treatment for phobic anxiety disorders. Cognitive behavioral therapy (CBT) has been found to be effective treatment for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Healthcare providers can also help by educating sufferers about anxiety disorders and referring individuals to self-help resources. CBT has been shown to be effective in the treatment of generalized anxiety disorder, and possibly more effective than pharmacological treatments in the long term. Sometimes medication is combined with psychotherapy, but research has not found a benefit of combined pharmacotherapy and psychotherapy versus monotherapy.
- "antianxiety agent" at Dorland's Medical Dictionary
- Youngstedt, Shawn D; Kripke, Daniel F (2007). "Does bright light have an anxiolytic effect? - an open trial". BMC Psychiatry 7: 62. doi:10.1186/1471-244X-7-62. PMC 2194679. PMID 17971237.
- "anxiolytic (tranquilizer)". Memidex (WordNet) Dictionary/Thesaurus. Retrieved 2010-12-02.
- Gelder, M, Mayou, R. and Geddes, J. 2005. Psychiatry. 3rd ed. New York: Oxford. pp236.
- Lader M, Tylee A, Donoghue J (2009). "Withdrawing benzodiazepines in primary care". CNS Drugs 23 (1): 19–34. doi:10.2165/0023210-200923010-00002. PMID 19062773.
- Montenegro, Mariana; Veiga, Heloisa; Deslandes, Andréa; Cagy, Maurício; McDowell, Kaleb; Pompeu, Fernando; Piedade, Roberto; Ribeiro, Pedro (2005). "Neuromodulatory effects of caffeine and bromazepam on visual event-related potential (P300): A comparative study". Arquivos de Neuro-Psiquiatria 63 (2b): 410–5. doi:10.1590/S0004-282X2005000300009. PMID 16059590.
- Barlow, David H. Durand, V. Mark (2009). "Chapter 7: Mood Disorders and Suicide". Abnormal Psychology: An Integrative Approach (Fifth ed.). Belmont, CA: Wadsworth Cengage Learning. p. 239. ISBN 0-495-09556-7. OCLC 192055408.
- medicine net. "hydroxyzine (Vistaril, Atarax)". medicinenet.com. Archived from the original on 13 May 2008. Retrieved 17 May 2008.
- Llorca PM, Spadone C, Sol O (November 2002). "Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study". J Clin Psychiatry 63 (11): 1020–7. doi:10.4088/JCP.v63n1112. PMID 12444816.
- Bandelow, B.; Wedekind, D.; Leon, T. (Jul 2007). "Pregabalin for the treatment of generalized anxiety disorder: a novel pharmacologic intervention". Expert Rev Neurother 7 (7): 769–81. doi:10.1586/1473722.214.171.1249. PMID 17610384.
- Owen, RT. (Sep 2007). "Pregabalin: its efficacy, safety and tolerability profile in generalized anxiety". Drugs Today (Barc) 43 (9): 601–10. doi:10.1358/dot.2007.43.9.1133188. PMID 17940637.
- The Great Soviet Encyclopedia http://encyclopedia2.thefreedictionary.com/Validol[full citation needed]
- Farmak Product Information - Validol http://farmak.ua/assets_images/drugs/instruction/en/25/Validol_Product_Information.pdf[full citation needed]
- Itop Doctor http://doctor.itop.net/DirectoryItem.aspx?DirId=1&ItemId=268[full citation needed]
- Jefferson, J. W. (1974). Beta-adrenergic receptor blocking drugs in psychiatry. Archives of general psychiatry, 31(5), 681. doi:10.1001/archpsyc.1974.01760170071012 http://archpsyc.jamanetwork.com/article.aspx?articleid=491265
- Noyes Jr, R. (1982). Beta-blocking drugs and anxiety. Psychosomatics, 23(2), 155-170.
- Patel, Manish; Antala, Bhavesh; Barua, Chandana; Lahkar, Mangala (2013). "Anxiolytic activity of aqueous extract of Garcinia indica in mice". International Journal of Green Pharmacy 7 (4): 332–35. doi:10.4103/0973-8258.122089.
- Wolfson, P; Hoffmann, DL (2003). "An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers". Alternative therapies in health and medicine 9 (2): 74–8. PMID 12652886.
- Emamghoreishi M, Khasaki M, Aazam MF (2005). "Coriandrum sativum: evaluation of its anxiolytic effect in the elevated plus-maze". Journal of Ethnopharmacology 96 (3): 365–370. doi:10.1016/j.jep.2004.06.022. PMID 15619553.
- Herrera-Ruiz, Maribel; García-Beltrán, Yolanda; Mora, Sergio; Díaz-Véliz, Gabriela; Viana, Glauce S.B.; Tortoriello, Jaime; Ramírez, Guillermo (2006). "Antidepressant and anxiolytic effects of hydroalcoholic extract from Salvia elegans". Journal of Ethnopharmacology 107 (1): 53–8. doi:10.1016/j.jep.2006.02.003. PMID 16530995.
- Zuardi, A.W.; Crippa, J.A.S.; Hallak, J.E.C.; Moreira, F.A.; Guimarães, F.S. (2006). "Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug". Brazilian Journal of Medical and Biological Research 39 (4): 421–9. doi:10.1590/S0100-879X2006000400001. PMID 16612464.
- Shephard RA (June 1987). "Behavioral effects of GABA agonists in relation to anxiety and benzodiazepine action". Life Sci. 40 (25): 2429–36. doi:10.1016/0024-3205(87)90758-2. PMID 2884549.
- Foster AC, Kemp JA (February 2006). "Glutamate- and GABA-based CNS therapeutics". Curr Opin Pharmacol 6 (1): 7–17. doi:10.1016/j.coph.2005.11.005. PMID 16377242.
- Miyata, Shigeo; Hirano, Shoko; Ohsawa, Masahiro; Kamei, Junzo (2009). "Chlorpheniramine exerts anxiolytic-like effects and activates prefrontal 5-HT systems in mice". Psychopharmacology 213 (2–3): 441–52. doi:10.1007/s00213-009-1695-0. PMID 19823805.
- Pierrefiche, G; Zerbib, R; Laborit, H (1993). "Anxiolytic activity of melatonin in mice: Involvement of benzodiazepine receptors". Research communications in chemical pathology and pharmacology 82 (2): 131–42. PMID 7905658.
- Naguib, Mohamed; Gottumukkala, Vijaya; Goldstein, Peter A. (2007). "Melatonin and anesthesia: A clinical perspective". Journal of Pineal Research 42 (1): 12–21. doi:10.1111/j.1600-079X.2006.00384.x. PMID 17198534.
- Fux M, Levine J, Aviv A, Belmaker RH (1996). "Inositol treatment of obsessive-compulsive disorder". American Journal of Psychiatry 153 (9): 1219–1221. PMID 8780431.
- Palatnik A, Frolov K, Fux M, Benjamin J (2001). "Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder". Journal of Clinical Psychopharmacology 21 (3): 335–339. doi:10.1097/00004714-200106000-00014. PMID 11386498.
- Gilman, J. M.; Ramchandani, V. A.; Davis, M. B.; Bjork, J. M.; Hommer, D. W. (2008). "Why We Like to Drink: A Functional Magnetic Resonance Imaging Study of the Rewarding and Anxiolytic Effects of Alcohol". Journal of Neuroscience 28 (18): 4583–91. doi:10.1523/JNEUROSCI.0086-08.2008. PMC 2730732. PMID 18448634.
- http://pubs.niaaa.nih.gov/publications/aa41.htm[full citation needed]
- Howard, Matthew O.; Bowen, Scott E.; Garland, Eric L.; Perron, Brian E.; Vaughn, Michael G. (2011). "Inhalant use and inhalant use disorders in the United States". Addiction science & clinical practice 6 (1): 18–31. PMC 3188822. PMID 22003419.
- Zwanzger, P.; Deckert, J. (Mar 2007). "[Anxiety disorders. Causes, clinical picture and treatment]". Nervenarzt 78 (3): 349–59; quiz 360. doi:10.1007/s00115-006-2202-z. PMID 17279399.
- Shearer, SL. (Sep 2007). "Recent advances in the understanding and treatment of anxiety disorders". Prim Care 34 (3): 475–504, v–vi. doi:10.1016/j.pop.2007.05.002. PMID 17868756.
- Gould, RA; Otto, M; Pollack, M; Yap, L (1997). "Cognitive behavioral and pharmacological treatment of generalized anxiety disorder: A preliminary meta-analysis". Behavior Therapy 28 (2): 285–305. doi:10.1016/S0005-7894(97)80048-2.
- Pull, CB. (Jan 2007). "Combined pharmacotherapy and cognitive-behavioural therapy for anxiety disorders". Curr Opin Psychiatry 20 (1): 30–5. doi:10.1097/YCO.0b013e3280115e52. PMID 17143079.