Benzodiazepines drug treatment for anxiety

Anxiety is a feeling of apprehension, uncertainty, and fear that seems to arise from an unknown source or is out of proportion to any apparent cause. It is also a common symptom in several different types of disorders, such as phobias, panic disorder, obsessive-compulsive disorder, and post-traumatic stress disorder.

Severe anxiety is associated with signs of sympathetic nervous system activity, such as increased heart rate, sweating, tremor, “butterflies” in the stomach, and sometimes restlessness.

The sensation of anxiety is common in humans, and episodes of mild anxiety are common life experiences, and don’t usually require treatment. However, chronic or severe anxiety is usually treated with antianxiety drugs. These are sometimes referred to as anxiolytic drugs or minor tranquilizers.

Some type of non-drug therapy, often psychotherapy or behavioral therapy, is often used also. Most, or perhaps all, of the antianxiety drugs also cause sedation, and these are used as hypnotic (sleep-inducing) agents. Some are also commonly used as skeletal muscle relaxants and anticonvulsants.

Benzodiazepines, such as diazepam (Valium), are the most commonly used antianxiety drugs in the United States. The first drug in this group, chlordiazepoxide (Librium) was introduced in 1960. Before that time, there were not many effective drugs from which to choose.

For many people, this drug, Librium, was named very appropriately. Libre, in French, means free; Liber, in Latin, means freedom.

Additional drugs in the group rapidly followed, and the benzodiazepines, along with those drugs we call the antipsychotics (or major tranquilizers) opened up a new era in the treatment of mental disorders.

Although they do have potentially serious side effects, and they are often misused and abused, the use of these drugs allows many people suffering from serious mental disorders to lead near-normal lives.

In addition to their role in treating anxiety disorders, benzodiazepines have also largely replaced barbiturates (such as phenobarbital, Luminal) for their hypnotic (sleep-inducing) effects. Approximately 20 benzodiazepines are currently available in the United States.

Benzodiazepines act by increasing the inhibitory actions of GABA (gamma-aminobutyric acid) in the brain. There are specific receptors in our brains for the benzodiazepines, and these are very close to the GABA receptors.

When the drug binds to its receptor, it enhances the action of the naturally-occurring GABA in the brain. A valuable result of clarifying the pharmacologic action of benzodiazepines is the availability marketing of a specific benzodiazepine antagonist, flumazenil (Romazicon).

This is used to reverse the sedative effects of benzodiazepines when they are used as sedatives or anesthetics for minor surgery.

Adverse side effects of benzodiazepines include drowsiness and confusion, and caution should be exercised when operating an automobile or other machinery. These effects are worsened by drinking alcohol or when taking other “downer” drugs.

Lack of coordination (ataxia) develops in sensitive individuals, or at high doses. Occasionally, a person might become very aggressive when using these drugs.

Dependence and abuse are other adverse effects of benzodiazepines. Long-term use can result in a withdrawal syndrome, so the drugs are often prescribed for a few weeks only.

However, there are ways to minimize the withdrawal syndrome, usually by very gradually decreasing the dose, so long-term use of the drugs is appropriate when needed.

The good news is that the benzodiazepines are fairly safe drugs, and the dose it takes to cause death with these is over 1000 times greater than the usual therapeutic dose. These are much safer than other drugs, such as phenobarbital (Luminal), previously used to induce sleep or relieve anxiety.

Non Benzodiazepine drugs used to treat anxiety include buspirone (Buspar), its effects seem to be mediated by serotonin-1A receptors, although it’s possible that other receptors could also be involved.

This, and similar drugs in this group (called azapirones), cause less sedation than the benzodiazepines, and do not have muscle relaxant or anticonvulsant effects. Side effects are minimal, and dependence seems less likely than with the benzodiazepines.

Hydroxyzine (Atarax, Vistaril), which is an antihistamine, is also occasionally used for anxiety and sedation, especially before dental procedures.