Anti-anxiety (anxiolytic) drugs mainly reduce the severity of anxiety associated with various disease states. However, due to the other activities that these agents cause, they are widely used in medicine. Anti-anxiety medications are available by prescription, but patients can also benefit from milder substances available on the market that have a calming and anxiety-reducing effect.
Anti-anxiety drugs: types and effects of individual drugs
The most commonly used anxiolytics arebenzodiazepines . The classification of these drugs is based on the duration of their action. There are benzodiazepines with short-acting (e.g. alprazolam - Xanax), medium-acting (like lorazepam - Lorafen) and long-acting (e.g. diazepam - Relanium). Benzodiazepines act by enhancing the influence of the GABA neurotransmitter on its receptors. The stimulation of these structures by GABA causes the flow of chlorine ions to the nerve cell, which results in putting the neuron into the state of the so-called hyperpolarization - this reduces the excitability of nerve cells. Benzodiazepines alleviate both components of anxiety: both mental and physical.
Benzodiazepines, due to their speed of action, are mainly used in the immediate management of anxiety and psychomotor agitation. Diazepam is also given to patients who are in an epileptic state.
A substance with a chemical structure different from benzodiazepines isbuspiron(Spamilane). The mechanism of action of this anxiolytic agent is also different, because it has an affinity for one of the serotonergic receptors (by binding to it, the drug inhibits the activity of the serotonin system), and additionally has a stimulating effect on the noradrenergic and dopaminergic systems. The action of buspirone focuses on reducing the intensity of mental manifestations of anxiety. The agent may be an alternative to benzodiazepines (especially in patients who are at increased risk of addiction to psychotropic drugs), but it should be taken into account that the anxiolytic effect of buspirone takes some time to develop - it is estimated after about 2-4 weeks of using the drug.
Another anxiolytic is hydroxyzine(Atarax), which is also used outside psychiatry (e.g. to relieve itchy skin). Hydroxyzine acts mainly on serotonin receptors, leading to their blockade, it has less effect on dopaminergic and adrenergic receptors. The preparation has a sedative and anxiolytic effect.
Some patients with anxiety symptoms may benefit from the use of a beta-blocker drug -propranolol(Propranolol WZF). The drug does not affect the psychological phenomena associated with anxiety disorders, but it can reduce somatic symptoms associated with anxiety, such as extremely strong hand tremors (seen, for example, in stressful situations in patients with social phobia).
Anti-anxiety drugs: when are they used?
Anxiolytic agents are primarily used to relieve anxiety. Depending on the drug used, a reduction in the intensity of mental or somatic manifestations of anxiety is achieved, it is also possible to alleviate the intensity of both of these types of symptoms.
Problems such as generalized anxiety disorder, social phobia or panic disorder anxiety disorder are examples of the use of anti-anxiety medications.
Other indications for anti-anxiety medications include:
- the need to temporarily control psychomotor agitation (related to a mental illness or occurring as a result of taking psychoactive substances or their sudden withdrawal),
- delirium,
- withdrawal syndrome,
- short-term treatment of sleep disorders,
- premedication before surgery,
- reduction of somatic manifestations of anxiety (e.g. significant trembling of the hands).
Anti-anxiety agents with anticonvulsant properties are used in the treatment of epilepsy, some preparations from this group are also useful (thanks to their muscle-relaxing effect) in controlling conditions associated with soreness and excessive muscle contractions.
Anti-anxiety drugs: side effects of use
The most important side effect of anxiolytics is sedation (sedation) caused by many of them. This phenomenon does not have to be dangerous in itself, but the danger arises when a patient taking anxiolytic drugs drives a car or another machine - excessive sedation or even sleepiness in such a situation increases the risk of causing an accident. Therefore, before starting treatment with anxiolytics, ask your doctor how the drug affects the ability to maintain attention andconcentration.
In addition to the sedation described above, the side effects of anti-anxiety medications differ depending on the group of the drug used. In the case of benzodiazepines, side effects can be:
- slight drop in blood pressure,
- dizziness,
- nausea,
- weakness,
- ataxia (motor incoherence),
- anterograde amnesia (related to a short period after taking the drug).
The aforementioned ailments are usually mild, but other problems may also arise during benzodiazepine therapy, the occurrence of which suggests the need to seek medical attention. We are talking about the symptoms of poisoning with these drugs, which include:
- impaired movement and gait coordination,
- speech disorder,
- nystagmus,
- significant problems with maintaining attention,
- memory impairment,
- disturbance of consciousness,
- impaired work of the respiratory center.
An overdose of benzodiazepines is a condition that requires hospitalization - in a hospital setting, patients are given intravenous flumazenil, which is a drug that is opposed to benzodiazepines.
An unusual and rare (occurring in less than 1% of patients taking benzodiazepines) side effect is the so-called paradoxical reaction. In this case, the patients experience an increase in anxiety, as well as psychomotor agitation accompanied by aggression or rage. People from extreme age groups (young and elderly patients) as well as patients with impulse control disorders and organic brain defects are at increased risk of paradoxical reactions to benzodiazepines.
It should also be mentioned that in the case of benzodiazepines there is a risk of developing addiction. For this reason, these drugs are implemented for a short time (2 to 4 weeks), in addition, it is most advantageous to prescribe the lowest effective dose of these agents to the patient. Addiction to benzodiazepines can be so strong that its treatment (including gradual reduction of the doses used by the patient) can take even many months.
Buspirone shows significantly fewer side effects. Generally, its tolerance in patients is better than in the case of benzodiazepines, and buspirone is not addictive. Among the side effects of taking this drug are dizziness, a feeling of internal tension and headaches.
A small number of side effects are also caused by hydroxyzine, among them the most common are drowsiness and dry membranesmucous membranes.
ImportantAnti-anxiety drugs: measures for children
In the treatment of anxiety in children, pharmacological agents are generally avoided - as long as it is possible (psychotherapeutic interactions play a key role in this group of patients). If psychotherapy alone does not allow for the desired improvement, then pharmacotherapy is implemented only.
Important!Benzodiazepines in children should only be used when absolutely necessary - for example, in a panic attack that cannot be controlled by any other means. Hydroxyzine is considered a drug safer than benzodiazepines.
Over-the-counter anxiolytics
All the anxiolytics described above are available on prescription. Some people, however, prefer to avoid visiting a doctor and look for over-the-counter anti-anxiety drugs on their own. Medicines with this type of action cannot be bought without visiting a specialist, but there are dietary supplements containing natural remedies that can alleviate mild anxiety and have a calming effect. The most popular substances of this type are:
- lemon balm,
- valerian (valerian),
- hop cone,
- St. John's wort.
As an example of an over-the-counter anxiety reliever, Nervomix contains the substances listed above.
According to some people, the advantage of natural substances is that they can actually have an anxiolytic effect, and their use does not cause addiction. However, it is worth taking into account the fact that the use of natural anxiolytics is unlikely to be sufficient in a situation where the patient has significant, severe anxiety disorders. If in doubt as to whether there is a need to obtain a prescription anxiolytic drug, it is best to consult a doctor - a psychiatrist, or simply a family doctor.