An anxiolytic (also antipanic or antianxiety agent^[1]) is a drug A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease used for the treatment of symptoms A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A symptom is subjective, observed by the patient, and not measured of anxiety Anxiety is a psychological and physiological state characterized by cognitive, somatic, emotional, and behavioral components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, apprehension, fear, or worry. Anxiety is a generalized mood condition that can often occur without an identifiable. Anxiolytics have been shown to be useful in the treatment of anxiety disorders Anxiety disorders are blanket terms covering several different forms of abnormal and pathological fear and anxiety which only came under the aegis of psychiatry at the very end of the 19th century. Current psychiatric diagnostic criteria recognize a wide variety of anxiety disorders. Recent surveys have found that as many as 18% of Americans may.

Beta-receptor blockers Beta blockers is a class of drugs used for various indications, but particularly for the management of cardiac arrhythmias, cardioprotection after myocardial infarction (heart attack), and hypertension. Propranolol was the first clinically useful beta adrenergic receptor antagonist. Invented by Sir James W. Black in the late 1950s, it such as propranolol US FDA:link and oxprenolol Oxprenolol is a non-selective beta blocker with some intrinsic sympathomimetic activity. It is used for the treatment of angina pectoris and abnormal heart rhythms. It is also used for treating high blood pressure, although not anxiolytics, can be used to combat the somatic The term somatic refers to cells of the body, rather than gametes (eggs or sperm). In humans, somatic cells contain two copies of each chromosome (diploid), whereas gametes only contain one copy of each chromosome (haploid). Although all somatic cells contain identical DNA, after exposure to specific enzymes, they evolve a variety of tissue- symptoms of anxiety.

Anxiolytics are also known as "minor tranquilizers A tranquilizer, or tranquiliser , is a drug that induces tranquillity in an individual",^[2] though their use and effects are by no means minor; this term is less common in modern texts.

Types of anxiolytics

Benzodiazepines

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 The central nervous system is the part of the nervous system that coordinates the activity of all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish. It contains the majority of the nervous system and consists of the brain and the spinal cord, as well as sedation Sedation is a medical procedure involving the administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Drugs which can be used for sedation include propofol, etomidate, ketamine, fentanyl and midazolam is needed. Longer-term uses include treatment for severe anxiety. There is a risk of a benzodiazepine withdrawal Benzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug or during dosage reductions. Benzodiazepine withdrawal is similar to alcohol withdrawal syndrome and and rebound syndrome Rebound effect is the tendency of a medication, when discontinued, to cause a return of the symptoms being treated to be more severe than before . Medications with a known rebound effect can be withdrawn gradually or in conjunction with another medication which does not exhibit a rebound effect after continuous usage for longer than two weeks. There is also the added problem of the accumulation of drug metabolites Metabolites are the intermediates and products of metabolism. The term metabolite is usually restricted to small molecules. A primary metabolite is directly involved in normal growth, development, and reproduction. Alcohol is an example of a primary metabolite produced in large-scale by industrial microbiology. A secondary metabolite is not and adverse effects.^[3] Benzodiazepines include:

• Alprazolam Alprazolam is a potent short-acting drug of the benzodiazepine class. It is primarily used to treat moderate to severe anxiety disorders (e.g., social anxiety disorder) and panic attacks, and is used as an adjunctive treatment for anxiety associated with moderate depression. It is available in an instant release and an extended-release (Xanax XR) (Xanax)
• Chlordiazepoxide Chlordiazepoxide , is a sedative/hypnotic drug and benzodiazepine derivative. It is marketed under the trade names Klopoxid, Librax (also contains clidinium bromide), Libritabs, Librium, Mesural, Multum, Novapam, Risolid, Silibrin, Sonimen, Tropium, and Zetran (Librium)
• Clonazepam Clonazepam is a benzodiazepine derivative with anticonvulsant, muscle relaxant, and anxiolytic properties. It is marketed by Roche under the trade-names Klonopin in the United States, and Ravotril in Chile. Other names like Rivotril or Rivatril are known throughout the large majority of the rest of the world. Clonazepam is generally considered to (Klonopin)
• Diazepam Diazepam , first marketed as Valium (/ˈvæliəm/) by Hoffmann-La Roche, is a benzodiazepine derivative drug. It is commonly used for treating anxiety, insomnia, seizures including status epilepticus, muscle spasms, restless legs syndrome, alcohol withdrawal, benzodiazepine withdrawal and Ménière's disease. It may also be used before certain (Valium)
• Lorazepam Lorazepam is a high potency benzodiazepine drug which has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant. Lorazepam is used for the short-term treatment of anxiety, insomnia, acute seizures including status epilepticus and sedation of hospitalised patients, as well as sedation (Ativan)

Benzodiazepines exert their anxiolytic properties at moderate dosage. At higher dosage hypnotic Hypnotic drugs are a class of psychoactives whose primary function is to induce sleep and to be used in the treatment of insomnia and in surgical anesthesia. When used in anesthesia to produce and maintain unconsciousness "sleep" is metaphorical and there are no regular sleep stages or cyclical natural states; patients rarely recover properties occur.^[4]

Azapirones

Azapirones are a class of 5-HT_1A receptor The 5-HT1A receptor is a subtype of 5-HT receptor which binds the endogenous neurotransmitter serotonin . It is a G protein-coupled receptor (GPCR) which is coupled to Gi/Go and mediates inhibitory neurotransmission. HTR1A denotes the human gene encoding for the receptor agonists An agonist is a chemical that binds to a receptor of a cell and triggers a response by that cell. Agonists often mimic the action of a naturally occurring substance. Whereas an agonist causes an action, an antagonist blocks the action of the agonist and an inverse agonist causes an action opposite to that of the agonist. They lack the sedation and the dependence Substance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder" associated with benzodiazepines A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and made available in 1960 by Hoffmann–La Roche, which has also marketed diazepam (Valium) since 1963 and cause much less cognitive impairment. They may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as they do not provide the sedation that these patients may expect or equate with anxiety relief. Currently approved azapirones include buspirone Buspirone is a psychoactive drug and pharmaceutical medication of the piperazine and azapirone chemical classes. It is used primarily as an anxiolytic, but also to a lesser extent as an antidepressant. Bristol-Myers Squibb (BMS) gained Food and Drug Administration (FDA) approval for buspirone in 1986, and it went generic in 2001 (Buspar) and tandospirone Tandospirone is a psychoactive drug and pharmaceutical medication of the piperazine and azapirone chemical classes. It is widely used as an anxiolytic and antidepressant agent in China and Japan, where it is marketed by Dainippon Sumitomo Pharma (Sediel). Gepirone Gepirone is a psychoactive drug and research chemical of the piperazine and azapirone chemical classes. It is currently under clinical development in an extended release form as an anxiolytic and antidepressant agent. Pharmacologically, gepirone acts as a selective 5-HT1A receptor partial agonist (Ariza, Variza) is also in clinical development.

Barbiturates

Barbiturates Barbiturates are drugs that act as central nervous system depressants, and, by virtue of this, they produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants. They have addiction potential, both physical and psychological. Barbiturates have now largely 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.

Hydroxyzine

Hydroxyzine Hydroxyzine is a first-generation antihistamine of the diphenylmethane and piperazine classes. It was first synthesized by Union Chimique Belge in 1956 and was marketed by Pfizer in the United States later the same year, and is still in widespread use today (Atarax) is an old antihistamine A histamine antagonist is an agent that inhibits action of histamine via histamine receptors. H1 antihistamines are used as treatment for symptoms of allergies such as runny nose. Allergies are caused by an excessive type 1 hypersensitivity response of the body to allergens, such as pollen released by plants. An allergic reaction, which if severe 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 A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and made available in 1960 by Hoffmann–La Roche, which has also marketed diazepam (Valium) since 1963 in the treatment of generalized anxiety disorder Generalized anxiety disorder is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things that is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are overly while producing fewer side effects.^[6]

Pregabalin

Pregabalin's therapeutic effect appears after 1 week of use and is similar in effectiveness to lorazepam Lorazepam is a high potency benzodiazepine drug which has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant. Lorazepam is used for the short-term treatment of anxiety, insomnia, acute seizures including status epilepticus and sedation of hospitalised patients, as well as sedation, alprazolam Alprazolam is a potent short-acting drug of the benzodiazepine class. It is primarily used to treat moderate to severe anxiety disorders (e.g., social anxiety disorder) and panic attacks, and is used as an adjunctive treatment for anxiety associated with moderate depression. It is available in an instant release and an extended-release (Xanax XR) and venlafaxine Venlafaxine is an arylalkanolamine serotonin-norepinephrine reuptake inhibitor (SNRI). It has a similar chemical structure to the opioid derivative tramadol, and has the tertiary amine functional group necessary for µ-opioid receptor recognition (cf. lefetamine), though it is unknown whether it has an opioid agonist effect. It is surprisingly 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 In physiology, physiological tolerance or drug tolerance is commonly encountered in pharmacology, when a subject's reaction to a drug decreases so that larger doses are required to achieve the same effect. Drug tolerance can involve both psychological drug tolerance and physiological factors. Characteristics of drug tolerance: it is reversible, and additionally unlike benzodiazepines it does not disrupt sleep architecture Sleep is a natural state of bodily rest observed in humans and other animals. It is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than hibernation or coma. It is common to all mammals and birds, and is also seen in many reptiles, amphibians, and fish. In humans, other mammals, and 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.^[7][8]

Herbal treatments

Certain herbs are reputed to have anxiolytic properties, including the following:

• Rhodiola rosea (Arctic Weed/Golden Root)
• Bacopa monnieri Bacopa monnieri is a perennial, creeping herb whose habitat includes wetlands and muddy shores. Brahmi is also the name given to Centella asiatica by some botanists, while others consider that to be a mistake that arose during the 16th century, when brahmi was confused with mandukaparni, a name for C. asiatica (Brahmi)
• Hypericum perforatum St John's wort is the plant species Hypericum perforatum, also known as Tipton's Weed, Chase-devil, or Klamath weed, but, with qualifiers, is used to refer to any species of the genus Hypericum. Therefore, H. perforatum is sometimes called Common St John's wort to differentiate it. The species of Hypericum have been placed by some in the family (St. John's Wort)
• Matricaria recutita Matricaria recutita or German chamomile, also spelled camomile, is an annual plant of the composite family Asteraceae. Synonyms are: Chamomilla chamomilla, Chamomilla recutita , Matricaria chamomilla, and Matricaria suaveolens (German Chamomile)
• Mitragyna speciosa Kratom is a medicinal leaf harvested from a large tree native to Southeast Asia in the Rubiaceae family, first documented by Dutch colonial botanist Korthals. It is botanically related to the Corynanthe, Cinchona and Uncaria genera and shares some similar biochemistry. It is in the same family as coffee and the psychoactive plant Psychotria (Kratom)
• Cannabis sativa Cannabis sativa is an annual plant in the Cannabaceae family. It is a herb that has been used throughout recorded history by humans as a source of fiber, for its seed oil, as food , as a drug (see cannabis (drug)), as medicine (see medical cannabis), and for spiritual purposes (see spiritual use of cannabis). Each part of the plant is harvested (Cannabis)
• Nepeta persica (Catnip)
• Piper methysticum Kava (Piper Latin for "pepper", methysticum Greek for "intoxicating") is an ancient crop of the western Pacific. Other names for kava include ʻawa (Hawaiʻi), 'ava (Samoa), yaqona (Fiji), and sakau (Pohnpei). The word kava is used to refer both to the plant and the beverage produced from its roots. Kava is consumed throughout (Kava)
• Sceletium tortuosum Sceletium tortuosum is a succulent herb commonly found in South Africa, which is also known as Kanna, Channa, Kougoed - which literally means, 'chew(able) things/goodies' or 'something to chew'. The plant has been used by South African pastoralists and hunter-gatherers as a mood-altering substance from prehistoric times. The first known written (Kanna)
• Scutellaria spp. Most are annual or perennial herbaceous plants from 5 cm to 1 m tall, but a few are subshrubs; some are aquatic. They have four-angled stems and opposite leaves. The flowers have upper and lower lips. The genus is most easily recognized by the typical shield on the calyx that has also prompted its common name (Skullcap)
• Valeriana officinalis Valerian is a hardy perennial flowering plant, with heads of sweetly scented pink or white flowers. The flowers are in bloom in the northern hemisphere from June to September. Valerian was used as a perfume in the sixteenth century (Valerian)

Of these, only Kava and Brahmi have shown anxiolytic effects in randomized clinical trials, and only Kava's effect has been independently replicated.^[9]

In mice, trials have shown anxiolytic effects at 50 mg kg−1. However an increase in the dose of N. persica exerted stimulation rather than sedation as is the case for many other herbs.^[10]

A team from Brazil found cannabidiol Cannabidiol is a cannabinoid found in Cannabis. It is a major constituent of the plant, representing up to 40% in its extracts (a constituent of cannabis Cannabis is a genus of flowering plants that includes three putative species, Cannabis sativa, Cannabis indica, and Cannabis ruderalis. These three taxa are indigenous to Central Asia, and South Asia. Cannabis has long been used for fibre (hemp), for medicinal purposes, and as a recreational drug. Industrial hemp products are made from Cannabis; also called CBD) to be an effective anti-psychotic and anxiolytic ^[11]. "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.^[12]

Over-the-counter

Chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl) are reported to have mild anxiolytic properties.[citation needed](off-label use). These drugs are approved by the FDA for allergies, rhinitis, and urticaria.

Alternatives to medication

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

Meditation is also known for its tendency to reduce anxiety.

See also

• ATC code N05#N05B Anxiolytics

References

1. ^ antianxiety agent at Dorland's Medical Dictionary
2. ^ "WordNet Search - 3.0". http://wordnetweb.princeton.edu/perl/webwn?s=anxiolytic. Retrieved 2009-01-01.
3. ^ 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.
4. ^ Montenegro M, Veiga H, Deslandes A (June 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 (inactive 2009-11-14). PMID 16059590. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2005000300009&lng=en&nrm=iso&tlng=en.
5. ^ medicine net. "hydroxyzine (Vistaril, Atarax)". medicinenet.com. http://www.medicinenet.com/hydroxyzine/article.htm. Retrieved 17 May 2008.
6. ^ 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. PMID 12444816. http://www.psychiatrist.com/privatepdf/2002/v63n11/v63n1112.pdf.
7. ^ 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:10.1586/14737175.7.7.769. PMID 17610384.
8. ^ 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.
9. ^ Ernst E (February 2006). "Herbal remedies for anxiety - a systematic review of controlled clinical trials". Phytomedicine 13 (3): 205–8. doi:10.1016/j.phymed.2004.11.006. PMID 16428031.
10. ^ M. Rabbani, S. E. Sajjadi, and A. Mohammadi, Evaluation of the anxiolytic effect of Nepeta persica Boiss. in mice url=[1]
11. ^ Zuardi, A.W; Crippa, JA; Hallak, JE; Moreira, FA; Guimarães, FS (2006). "Cannabidiol as an antipsychotic drug" (PDF). Brazilian Journal of Medical and Biological Research 39 (4): 421–429. doi:/S0100-879X2006000400001 (inactive 2009-11-14). ISSN 0100-879X ISSN 0100-879X. PMID 16612464. http://www.scielo.br/pdf/bjmbr/v39n4/6164.pdf.
12. ^ [2] 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)

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