Though not anxiolytics, beta-receptor blockers such as propranolol and oxprenolol can be used to combat the somatic symptoms of anxiety.
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Types of anxiolytics
Anxiolytics are generally divided into two groups of medication, benzodiazepines and non-benzodiazepines. There are also herbal treatments used, though research into their efficacy and safety is limited.
Benzodiazepines
- Main article: Benzodiazepine
Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Common medications are lorazepam (Ativan®), 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 severe anxiety and psychosis. There is a risk of withdrawal symptoms and rebound syndrome after continuous usage past two weeks. There is also the added problem of the accumulation of drug metabolites and adverse effects.
Non-benzodiazepines
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 euphoria and sedation that these patients may expect or equate with anxiety relief.
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.
Herbal treatments
Certain herbs, such as St. John's wort and kava (kava kava), have been used as anxiolytics, but limited reliable evidence is available for their efficacy. In Europe, the root of the valerian is also popular as an anxiolytic.
Alternatives to medication
Psychotherapy (e.g. cognitive or behavior therapy) is often useful as an adjunct to pharmacotherapy or as an alternative to medication.
References
- Albers, Lawrence, Rhoda Hahn, Christopher Reist (2001-2002). Handbook of Psychiatric Drugs. Laguna Hills, California: Current Clinical Strageties.