From the Guidelines
Anxiolytic medications primarily include benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and non-benzodiazepines like buspirone, which are used to manage symptoms of anxiety disorders. For immediate relief of acute anxiety, benzodiazepines like lorazepam, alprazolam, or diazepam work quickly but should be used short-term due to dependency risks 1. For long-term management, SSRIs like sertraline, escitalopram, or fluoxetine are typically first-line treatments, though they take 2-6 weeks to reach full effectiveness 1. Some key points to consider when prescribing anxiolytic medications include:
- The choice of medication should be informed by side-effect profiles, interactions, response, patient age, and preference 1.
- Consider interventions with short-term duration to minimize dependency and side effects 1.
- Monitor regularly for adherence, side effects, and adverse events 1.
- SNRIs like venlafaxine are also effective alternatives for long-term management 1.
- Buspirone offers another non-addictive option with fewer side effects, although it may take 2-4 weeks to become effective 1. These medications work by either enhancing inhibitory neurotransmitters like GABA (benzodiazepines) or by regulating serotonin and norepinephrine levels (SSRIs/SNRIs) to reduce the brain's hyperactive anxiety response. It's essential to be aware of potential side effects like initial increased anxiety, nausea, or sleep disturbances with SSRIs/SNRIs, or sedation and coordination problems with benzodiazepines when starting any anxiety medication. The most recent and highest quality study 1 supports the use of physician-prescribed SSRIs or anxiolytics for the management of anxiety in adult survivors of cancer, which can be generalized to the management of anxiety disorders in the broader population.
From the FDA Drug Label
Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic.
- Anxiolytic medications are typically used to treat conditions such as generalized anxiety disorder or panic disorder, which are characterized by excessive anxiety and worry.
- These medications, like alprazolam, are indicated for the management of anxiety disorders or the short-term relief of symptoms of anxiety 2.
- Anxiolytic treatment is usually reserved for cases where anxiety is severe and interferes with daily life, rather than for everyday stress and tension.
From the Research
Definition and Types of Anxiolytic Medications
- Anxiolytic medications are used to treat anxiety disorders, which can include generalized anxiety disorder, post-traumatic stress disorder (PTSD), and other conditions 3, 4, 5, 6, 7.
- These medications can be classified into several types, including:
- Benzodiazepines (e.g. diazepam, alprazolam) 3, 7
- Selective serotonin reuptake inhibitors (SSRIs, e.g. paroxetine, sertraline) 3, 4, 6
- Serotonin-norepinephrine reuptake inhibitors (SNRIs, e.g. venlafaxine, duloxetine) 3, 5, 6
- Tricyclic antidepressants (e.g. imipramine) 3
- Monoamine oxidase inhibitors (MAOIs) 3
- Azapirones (e.g. buspirone) 6, 7
Mechanism of Action
- Anxiolytic medications work by modulating the activity of various neurotransmitters in the brain, including serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) 3, 5, 6.
- SSRIs and SNRIs increase the levels of serotonin and norepinephrine in the brain by inhibiting their reuptake, which can help to reduce anxiety symptoms 3, 4, 5, 6.
- Benzodiazepines enhance the activity of GABA, which can help to calm the brain and reduce anxiety symptoms 3, 7.
Efficacy and Safety
- Anxiolytic medications can be effective in reducing anxiety symptoms, but their efficacy and safety can vary depending on the specific medication and individual patient 3, 4, 5, 6, 7.
- Common side effects of anxiolytic medications include gastrointestinal disorders, insomnia, dizziness, and withdrawal symptoms 3, 7.
- Benzodiazepines can be associated with dependence and withdrawal symptoms, and are generally recommended for short-term use only 3, 7.