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Anxiolytic

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An anxiolytic 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.

Types of anxiolytics

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

Benzodiazepines

Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Common medications are lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), and diazepam (Valium). 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 past two weeks. There is also the added problem of the accumulation of drug metabolites and adverse effects.[1]

Benzodiazepines exert their anxiolytic properties at moderate dosagge. At higher dosage hypnotic properties occur.[2]

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.

Barbiturates

Barbiturates and meprobamate exert an anxiolytic effect linked to the sedation they cause. The risk of abuse and addiction is high. Many experts consider these drugs as obsolete for treating anxiety, although they may be valuable for the short term treatment of severe insomnia, only after benzodiazepines or non-benzodiazepines have failed. They are rarely prescribed anymore.

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.[3] It has been shown to be as effective as benzodiazepines in the treatment of generalised anxiety disorder whilst producing less side effects.[4]

Herbal treatments

Certain herbs, such as valerian, kava (Kava Kava), chamomile, Kratom, Blue Lotus extracts, Sceletium tortuosum (kanna) and bacopa monniera are reputed to have anxiolytic properties. With the exception of kava kava, only limited evidence exists for their efficacy.[5][6]

A team from Brazil found cannabidiol (a constituent of marijuana; also called CBD) to be an effective anti-psychotic and anxiolytic [7]. "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.[8]

Over-The-Counter

Chlorpheniramine is the only over the counter medication reported to have some very mild anxiolytic properties (off-label use). The drug is approved by the FDA for allergies, rhinitis, and urticaria.

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.[citation needed]

Notes

  1. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ Montenegro M, Veiga H, Deslandes A; et al. (2005). "[Neuromodulatory effects of caffeine and bromazepam on visual event-related potential (P300): a comparative study.]". Arq Neuropsiquiatr. 63 (2B): 410–5. doi:/S0004-282X2005000300009. PMID 16059590. {{cite journal}}: Check |doi= value (help); Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  3. ^ medicine net. "hydroxyzine (Vistaril, Atarax)". medicinenet.com. {{cite web}}: Unknown parameter |accessdaymonth= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  4. ^ Llorca PM, Spadone C, Sol O; et al. (2002). "Efficacy and safety of hydroxyzine in the treatment of generalized anxiety disorder: a 3-month double-blind study" (PDF). J Clin Psychiatry. 63 (11): 1020–7. PMID 12444816. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  5. ^ Herbal remedies for anxiety - a systematic review ...[Phytomedicine. 2006] - PubMed Result
  6. ^ Valerian for sleep: a systematic review and meta-a...[Am J Med. 2006] - PubMed Result
  7. ^ Zuardi, A.W (2006). "Cannabidiol as an antipsychotic drug" (PDF). Brazilian Journal of Medical and Biological Research. 39: 421–429. ISSN 0100-879X ISSN 0100-879X. {{cite journal}}: Check |issn= value (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  8. ^ [1] Maribel Herrera-Ruiza, Yolanda García-Beltrána, Sergio Morab, Gabriela Díaz-Vélizb, Glauce S.B. Vianac, Jaime Tortorielloa, Guillermo Ramíreza, "Antidepressant and anxiolytic effects of hydroalcoholic extract from Salvia elegans", Journal of Ethnopharmacology, Vol. 107, No. 1, pp. 53-58 (Aug. 2006)

References

  • Albers, Lawrence (2001–2002). Handbook of Psychiatric Drugs. Laguna Hills, California: Current Clinical Strageties. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

See also

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