Anxiolytic medications are used for the treatment of anxiety disorders and their related psychological and physical symptoms.
People with anxiety disorders can exhibit fear responses, such as defensive behaviors, high levels of alertness, and negative emotions.
Anti-anxiety medication is any drug that can be taken or prescribed for the treatment of anxiety disorders, which may be mediated by neurotransmitters like norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA) in the central nervous system.
[3] Anti-anxiety medication can be classified into six types according to their different mechanisms: antidepressants, benzodiazepines, azapirones, antiepileptics, antipsychotics, and beta blockers.
Benzodiazepines are effective in emergent and short-term treatment of anxiety disorders due to their fast onset but carry the risk of dependence.
[5] The first monoamine oxidase inhibitor (MAOI), iproniazid, was discovered accidentally when developing the new antitubercular drug isoniazid.
[citation needed] There are six groups of anti-anxiety medications available that have been proven to be clinically significant in treatment of anxiety disorders.
Different kinds of benzodiazepine will vary in its pharmacological profile, including its strength of effect and time taken for metabolism.
[13] One antiepileptic, pregabalin, has been found to be better at treating GAD than a placebo, and comparable effects to benzodiazepines.
SSRIs are beneficial in both acute response and long-term maintenance treatment for both depression and anxiety disorder.
[16] SSRIs can increase anxiety initially due to negative feedback through the serotonergic autoreceptors; for this reason a concurrent benzodiazepine can be used until the anxiolytic effect of the SSRI occurs.
[18] The SSRIs paroxetine and escitalopram are USFDA approved to treat generalized anxiety disorder.
[13] (active enantiomer of citalopram) The common early side effects of SSRIs include nausea and loose stool, which can be solved by discontinuing the treatment.
The brain is incapable of upregulating the receptors to sufficient levels especially after discontinuation of the drugs with short half life like paroxetine.
Both fluoxetine and its active metabolite have a long half life therefore it causes the least withdrawal symptoms.
[24][25] TCAs may cause drug poisoning in patients with hypotension, cardiovascular diseases and arrhythmias.
[26] Mirtazapine has demonstrated anxiolytic effect comparable to SSRIs while rarely causing or exacerbating anxiety.
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.
Benzodiazepines are also prescribed in tandem with an antidepressant for the latent period of efficacy associated with many ADs for anxiety disorder.
[32] Benzodiazepines include: alprazolam (Xanax), bromazepam, chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), oxazepam, temazepam, and Triazolam.
Benzodiazepines lead to central nervous system depression, resulting in common adverse effects like drowsiness, oversedation, light-headedness.
Beta blockers reduce anxiety by decreasing heart rate and preventing shaking.
[38] Pregabalin (Lyrica) produces anxiolytic effect after one week of use comparable to lorazepam, alprazolam, and venlafaxine with more consistent psychic and somatic anxiety reduction.
Unlike BZDs, it does not disrupt sleep architecture nor does it cause cognitive or psychomotor impairment.
[43] Phenibut is a GABAB receptor agonist,[42] as well as an antagonist at α2δ subunit-containing voltage-dependent calcium channels (VDCCs), similarly to gabapentinoids like gabapentin and pregabalin.
Bromantane acts mainly by facilitating the biosynthesis of dopamine, through indirect genomic upregulation of relevant enzymes (tyrosine hydroxylase (TH) and aromatic L-amino acid decarboxylase (AAAD)).
Menthyl isovalerate is a flavoring food additive marketed as a sedative and anxiolytic drug in Russia under the name Validol.
[58] Etifoxine has similar anxiolytic effects as benzodiazepine drugs, but does not produce the same levels of sedation and ataxia.
[59] Further, etifoxine does not affect memory and vigilance, and does not induce rebound anxiety, drug dependence, or withdrawal symptoms.