Anxiolytic

An anxiolytic is any drug or therapy used in the treatment of anxiety disorders. Different antidepressants, azapirones, benzodiazepines, and non-cardioselective beta-receptor blockers can be prescribed. For somatic symptoms, propranolol and oxprenolol can be used.

Many of the tri/tetracyclic antidepressants currently marketed (e.g. doxepin, trimipramine, amitriptyline, clomipramine) show effective anxiolytic properties independent from their antidepressant activity. Venlafaxine is a relatively new drug with dual action (reuptake inhibitor of serotonin and norepinephrine) and proven efficiacy. Additionally, it may have a shorter latent period than other medications. SSRIs such as Fluoxetine and MAO inhibitors such as moclobemide or phenelzine exert anxiolytic activity, but often only after a latent period of several weeks. The initial SSRI dose should be particular low – for instance, Fluoxetine or Paroxetin 10mg daily – because higher doses may worsen anxiety. The dose may subsequently be increased gradually to 40mg (Fluoxetine) or 50mg (Paroxetin) daily. Most of the SSRI and MAO inhibitors aditionally benefit the disabling symptoms of agoraphobia, often noted to occur together with anxiety disorders. MAO inhibitors and SSRIs must never be given together.

Neuroleptics of the different classes may also be effective as anxiolytics, but this use is usually discouraged because of the high incidence of side effects encountered, especially early and late extrapyramidal ones, which could be irreversible.

Azapirones, such as buspirone, are most commonly prescribed. They are chemically and pharmacologically quite different from most of the other anxiolytics and the adverse effects of dependence, sedation and psychomotor impairment are noticeably less than with benzodiazepines.

Benzodiazepines are prescribed for short-term relief (the FDA recommends a maximum of 8 months for most benzodiazepines) of severe and disabling anxiety. Common medications are diazepam (Valium®) and alprazolam (Xanax®). Benzodiazepines may also be indicated to cover the latent periods associated with SSRIs, MAO inhibitors and azapirones. 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 only a few weeks. There is also the added problem of the accumulation of drug metabolites and adverse effects.

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.

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.

It should be noted that psychotherapy (e.g. cognitive or behavior therapy) is in most cases very useful to assist pharmacotherapy.

Anxiolytikum Ansiolítico Anxiolytique Anksjolityki