Antianxiety Drugs

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These drugs are central nervous system depressants. Many of these anti-anxiety drugs or anxiolytics are, in higher doses, also used as sedative-hypnotics, or calming and sleep-inducing drugs. They seem to act by enhancing the effect of GABA in the brain. The earliest of these depressant drugs included chloroform, chloral hydrate, and paraldehyde, and they were used for anesthesia and for sedation.

Barbiturates were introduced in Germany in 1862 and were widely used for treatment of anxiety and sleep problems until the 1960's. Barbiturates are still available today, including pentobarbital, secobarbital, amobarbital, and phenobarbital. Their major adverse effect is respiratory depression, particularly when used in combination with alcohol, another central nervous system depressant. With the advent of the safer benzodiazepines, use of the barbiturates has declined steadily.

Benzodiazepines are used for two major problems: anxiety and insomnia. Anxiety disorders appropriate for this kind of treatment include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, phobic disorder, and dissociative disorder. The benzodiazepines commonly used for anxiety include alprazolam, chlordiazepoxide, clonazepam, cloraze-pate, diazepam, lorazepam, and oxazepam. For most of these disorders, however, behavioral, cognitive, group, and social therapy, or one of these therapies plus medication, are more effective than medication alone. Ben-zodiazepines used for insomnia include estazolam, flurazepam, midazolam, quazepam, temazepam, and triazolam. Benzodiazepines may also be used to prevent the development of delirium tremens during alcohol withdrawal. Patients become tolerant to the effects of these drugs, meaning they have the potential for physical dependency and addiction. In addition, benzo-diazepines interact with many other drugs, including alcohol. Their use should be limited to brief periods of time, particularly in the treatment of insomnia. Long-term treatment for anxiety should be monitored carefully by the health care provider. Elderly people are more likely than younger people to suffer adverse effects (such as confusion or falls) from benzodiaz-epine use.

Another drug developed for treatment of anxiety is buspirone. Propra-nolol and atenolol, usually used to treat high blood pressure, are useful in treating stage fright or performance anxiety, and clonidine, another blood pressure medication, is successfully used in treatment of anxiety. Nonbenzo-diazepine sleep agents include zolpidem and zaleplon.

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