Anxiolytic

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An anxiolytic (or antianxiety agent^[1]) is a drug prescribed for the treatment of symptoms of anxiety. Some anxiolytics have been shown to be useful in the treatment of anxiety disorders, as have antidepressants such as the class of selective serotonin reuptake inhibitors (SSRIs).

Though not anxiolytics, beta-receptor blockers such as propranolol and oxprenolol can be used to combat the somatic symptoms of anxiety.

Anxiolytics are also known as "minor tranquilizers",^[2] though this usage is less common in modern texts.

[edit] Types of anxiolytics

Anxiolytics are generally divided into two groups, benzodiazepines and non-benzodiazepines.

[edit] Benzodiazepines

• Main article: Benzodiazepine

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. There is also the added problem of the accumulation of drug metabolites and adverse effects.^[3] Benzodiazepines include:

• Alprazolam (Xanax)
• Chlordiazepoxide (Librium)
• Clonazepam (Klonopin)
• Clorazepate (Tranxene)
• Diazepam (Valium)
• Lorazepam (Ativan)

Benzodiazepines exert their anxiolytic properties at moderate dosage. At higher dosage hypnotic properties occur.^[4]

[edit] Serotonin 1A agonists

Buspirone (BuSpar) is a serotonin 1A agonist. It lacks the sedation and the dependence associated with benzodiazepines and causes much less cognitive impairment. It may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as the medication does not provide the sedation that these patients may expect or equate with anxiety relief.

[edit] Barbiturates

Barbiturates and meprobamate (Miltown) 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 anymore.

[edit] Hydroxyzine

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.^[5] It has been shown to be as effective as benzodiazepines in the treatment of generalized anxiety disorder while producing fewer side effects.^[6]

[edit] Herbal treatments

Certain herbs, such as St. John's wort, valerian, kava (Kava Kava), chamomile, Kratom, Blue Lotus extracts, Sceletium tortuosum (kanna), Common Skullcap and bacopa monniera are reputed to have anxiolytic properties. With the exception of kava kava, only limited evidence exists for their efficacy.^[7][8]

A team from Brazil found cannabidiol (a constituent of marijuana; also called CBD) to be an effective anti-psychotic and anxiolytic ^[9]. "CBD induced a clear anxiolytic effect and a pattern of cerebral activity compatible with anxiolytic activity. Therefore, similar to the data obtained in animal models, results from studies on healthy volunteers have strongly suggested an anxiolytic-like effect of CBD."

Pineapple sage, or salvia elegans, is used as a treatment for anxiety in traditional Mexican medicine, and a preliminary study on mice has yielded some support for both anxiolytic and antidepressant properties.^[10]

[edit] Over-the-counter

Chlorpheniramine and Diphenhydramine (Benadryl) are reported to have mild anxiolytic properties (off-label use). These drugs are approved by the FDA for allergies, rhinitis, and urticaria.

[edit] Alternatives to medication

Psychotherapy (e.g. cognitive or behavior therapy) is often useful as an adjunct to medication or as an alternative to medication. Research has demonstrated better long-term results for anxiety when treated with psychotherapy as opposed to pharmacotherapy alone.^{[citation needed]}

Meditation is also known for its tendency to reduce anxiety.

[edit] References

[edit] See also

• ATC code N05#N05B Anxiolytics