Anxiolytic: Difference between revisions
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== History == | == History == | ||
The first monoamine oxidase inhibitor (MAOI), [[iproniazid]], was discovered accidentally when developing the new [[Tuberculosis management|antitubercular]] drug [[isoniazid]]. The drug was found to induce euphoria and improve the patient's appetite and sleep quality.<ref>{{Cite journal |last1=Van Der Walt |first1=Martie |last2=Keddy |first2=Karen H. |date=2021-06-01 |title=The Tuberculosis-Depression Syndemic and Evolution of Pharmaceutical Therapeutics: From Ancient Times to the Future |journal=Frontiers in Psychiatry |volume=12 | | The first monoamine oxidase inhibitor (MAOI), [[iproniazid]], was discovered accidentally when developing the new [[Tuberculosis management|antitubercular]] drug [[isoniazid]]. The drug was found to induce euphoria and improve the patient's appetite and sleep quality.<ref>{{Cite journal |last1=Van Der Walt |first1=Martie |last2=Keddy |first2=Karen H. |date=2021-06-01 |title=The Tuberculosis-Depression Syndemic and Evolution of Pharmaceutical Therapeutics: From Ancient Times to the Future |journal=Frontiers in Psychiatry |volume=12 |article-number=617751 |doi=10.3389/fpsyt.2021.617751 |doi-access=free |issn=1664-0640 |pmc=8203803 |pmid=34140898}}</ref> | ||
The first tricyclic antidepressant, [[imipramine]], was originally developed and studied to be an [[antihistamine]] alongside other first-generation antihistamines of the time, such as [[promethazine]].<ref name="Hillhouse">{{Cite journal |last1=Hillhouse |first1=Todd M. |last2=Porter |first2=Joseph H. |title=A brief history of the development of antidepressant drugs: From monoamines to glutamate. |url=http://dx.doi.org/10.1037/a0038550 |journal=Experimental and Clinical Psychopharmacology |year=2015 |volume=23 |issue=1 |pages=1–21 |doi=10.1037/a0038550 |pmid=25643025 |pmc=4428540 |issn=1936-2293}}</ref> TCAs can increase the level of norepinephrine and serotonin by inhibiting their reuptake transport proteins.<ref>{{Citation |last1=Moraczewski |first1=Jordan |title=Tricyclic Antidepressants |date=2023 |url=https://www.ncbi.nlm.nih.gov/books/NBK557791/ |work=StatPearls |access-date=2024-01-15 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491723 |last2=Awosika |first2=Ayoola O. |last3=Aedma |first3=Kapil K.}}</ref> The majority of TCAs exert greater effect on norepinephrine, which leads to side effects like drowsiness and memory loss. {{citation needed|date=January 2024}} | The first tricyclic antidepressant, [[imipramine]], was originally developed and studied to be an [[antihistamine]] alongside other first-generation antihistamines of the time, such as [[promethazine]].<ref name="Hillhouse">{{Cite journal |last1=Hillhouse |first1=Todd M. |last2=Porter |first2=Joseph H. |title=A brief history of the development of antidepressant drugs: From monoamines to glutamate. |url=http://dx.doi.org/10.1037/a0038550 |journal=Experimental and Clinical Psychopharmacology |year=2015 |volume=23 |issue=1 |pages=1–21 |doi=10.1037/a0038550 |pmid=25643025 |pmc=4428540 |issn=1936-2293}}</ref> TCAs can increase the level of norepinephrine and serotonin by inhibiting their reuptake transport proteins.<ref>{{Citation |last1=Moraczewski |first1=Jordan |title=Tricyclic Antidepressants |date=2023 |url=https://www.ncbi.nlm.nih.gov/books/NBK557791/ |work=StatPearls |access-date=2024-01-15 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491723 |last2=Awosika |first2=Ayoola O. |last3=Aedma |first3=Kapil K.}}</ref> The majority of TCAs exert greater effect on norepinephrine, which leads to side effects like drowsiness and memory loss. {{citation needed|date=January 2024}} | ||
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=== Antiepileptics === | === Antiepileptics === | ||
Antiepileptics are rarely prescribed as an off-label treatment for anxiety disorders and post-traumatic stress disorders.<ref>{{Cite web |date=2014-10-28 |title=What is the Best Anticonvulsant for Anxiety? |url=https://psychcentral.com/anxiety/antipsychotics-anticonvulsants-for-anxiety-disorders |access-date=2023-10-19 |website=Psych Central |language=en}}</ref> There have been some suggestions that they may help with anxiety symptoms but there is generally a lack of research on its use.<ref name="Garakani 2020">{{Cite journal |last1=Garakani |first1=Amir |last2=Murrough |first2=James W. |last3=Freire |first3=Rafael C. |last4=Thom |first4=Robyn P. |last5=Larkin |first5=Kaitlyn |last6=Buono |first6=Frank D. |last7=Iosifescu |first7=Dan V. |date=2020 |title=Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options |journal=Frontiers in Psychiatry |volume=11 |doi= 10.3389/fpsyt.2020.595584|doi-access=free |pmid=33424664 |pmc=7786299 |issn=1664-0640}}</ref> | Antiepileptics are rarely prescribed as an off-label treatment for anxiety disorders and post-traumatic stress disorders.<ref>{{Cite web |date=2014-10-28 |title=What is the Best Anticonvulsant for Anxiety? |url=https://psychcentral.com/anxiety/antipsychotics-anticonvulsants-for-anxiety-disorders |access-date=2023-10-19 |website=Psych Central |language=en}}</ref> There have been some suggestions that they may help with anxiety symptoms but there is generally a lack of research on its use.<ref name="Garakani 2020">{{Cite journal |last1=Garakani |first1=Amir |last2=Murrough |first2=James W. |last3=Freire |first3=Rafael C. |last4=Thom |first4=Robyn P. |last5=Larkin |first5=Kaitlyn |last6=Buono |first6=Frank D. |last7=Iosifescu |first7=Dan V. |date=2020 |title=Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options |journal=Frontiers in Psychiatry |volume=11 |article-number=595584 |doi= 10.3389/fpsyt.2020.595584|doi-access=free |pmid=33424664 |pmc=7786299 |issn=1664-0640}}</ref> | ||
One antiepileptic, [[pregabalin]], has been found to be better at treating GAD than a placebo, and comparable effects to benzodiazepines. It has also been shown be potentially efficient in treating social anxiety disorder. [[Gabapentin]] has been prescribed off-label for anxiety despite a lack of research evidence supporting such use, although some studies have indicated that it may relieve anxiety symptoms. The potential anxiolytic effect of [[tiagabine]] has been observed in some pre-clinical trials, but its effectiveness has not yet been proved. Similarly, there is a lack of research on [[valproate]] for the treatment of anxiety disorders.<ref name="Garakani 2020" /> | One antiepileptic, [[pregabalin]], has been found to be better at treating GAD than a placebo, and comparable effects to benzodiazepines. It has also been shown be potentially efficient in treating social anxiety disorder. [[Gabapentin]] has been prescribed off-label for anxiety despite a lack of research evidence supporting such use, although some studies have indicated that it may relieve anxiety symptoms. The potential anxiolytic effect of [[tiagabine]] has been observed in some pre-clinical trials, but its effectiveness has not yet been proved. Similarly, there is a lack of research on [[valproate]] for the treatment of anxiety disorders.<ref name="Garakani 2020" /> | ||
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=== Selective serotonin reuptake inhibitors === | === Selective serotonin reuptake inhibitors === | ||
[[Selective serotonin reuptake inhibitors]] (SSRIs) are a class of medications used in the treatment of [[Major depressive disorder|depression]], [[anxiety disorder]]s, [[Obsessive–compulsive disorder|OCD]] and some [[personality disorder]]s.<ref>{{cite journal |last1=Kanba |first1=S. |year=2004 |title=Although antidepressants and anxiolytics are frequently used together to treat depression in the acute phase, how effective is the concomitant use of these drugs? |journal=Journal of Psychiatry & Neuroscience |volume=29 |issue=6 |pages=485 |pmc=524966 |pmid=15644990}}</ref><ref name="BARLOW">{{cite book |author=Barlow, David H. |title=Abnormal Psychology: An Integrative Approach |author2=Durand, Mark V |publisher=Wadsworth Cengage Learning |year=2009 |isbn=978-0-495-09556-9 |edition=Fifth |location=Belmont, CA |page=239 |chapter=Chapter 7: Mood Disorders and Suicide |oclc=192055408}}{{page needed|date=August 2016}}</ref> SSRIs are the first-line anti-anxiety medications.<ref name="Lochmann 2018">{{Citation |last1=Lochmann |first1=Dee |title=Selective Serotonin Reuptake Inhibitors |date=2018 |url=http://link.springer.com/10.1007/164_2018_172 |work=Antidepressants |volume=250 |pages=135–144 |editor-last=Macaluso |editor-first=Matthew |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/164_2018_172 |isbn=978-3-030-10948-6 |access-date=2022-03-16 |last2=Richardson |first2=Tara |pmid=30838457 |editor2-last=Preskorn |editor2-first=Sheldon H.|url-access=subscription }}</ref> Serotonin is one of the crucial neurotransmitters in mood enhancement, and increasing serotonin level produces an anti-anxiety effect.<ref>{{Cite web |title=Serotonin: What Is It, Function & Levels |url=https://my.clevelandclinic.org/health/articles/22572-serotonin |access-date=2024-01-15 |website=Cleveland Clinic |language=en}}</ref> SSRIs increase the serotonin level in the brain by inhibiting serotonin uptake pumps on serotonergic systems, without interactions with other receptors and ion channels. SSRIs are beneficial in both acute response and long-term maintenance treatment for both depression and anxiety disorder.<ref name="Lochmann 2018" /> | [[Selective serotonin reuptake inhibitors]] (SSRIs) are a class of medications used in the treatment of [[Major depressive disorder|depression]], [[anxiety disorder]]s, [[Obsessive–compulsive disorder|OCD]] and some [[personality disorder]]s.<ref>{{cite journal |last1=Kanba |first1=S. |year=2004 |title=Although antidepressants and anxiolytics are frequently used together to treat depression in the acute phase, how effective is the concomitant use of these drugs? |journal=Journal of Psychiatry & Neuroscience |volume=29 |issue=6 |pages=485 |doi=10.1139/jpn.0448 |pmc=524966 |pmid=15644990}}</ref><ref name="BARLOW">{{cite book |author=Barlow, David H. |title=Abnormal Psychology: An Integrative Approach |author2=Durand, Mark V |publisher=Wadsworth Cengage Learning |year=2009 |isbn=978-0-495-09556-9 |edition=Fifth |location=Belmont, CA |page=239 |chapter=Chapter 7: Mood Disorders and Suicide |oclc=192055408}}{{page needed|date=August 2016}}</ref> SSRIs are the first-line anti-anxiety medications.<ref name="Lochmann 2018">{{Citation |last1=Lochmann |first1=Dee |title=Selective Serotonin Reuptake Inhibitors |date=2018 |url=http://link.springer.com/10.1007/164_2018_172 |work=Antidepressants |volume=250 |pages=135–144 |editor-last=Macaluso |editor-first=Matthew |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/164_2018_172 |isbn=978-3-030-10948-6 |access-date=2022-03-16 |last2=Richardson |first2=Tara |pmid=30838457 |editor2-last=Preskorn |editor2-first=Sheldon H.|url-access=subscription }}</ref> Serotonin is one of the crucial neurotransmitters in mood enhancement, and increasing serotonin level produces an anti-anxiety effect.<ref>{{Cite web |title=Serotonin: What Is It, Function & Levels |url=https://my.clevelandclinic.org/health/articles/22572-serotonin |access-date=2024-01-15 |website=Cleveland Clinic |language=en}}</ref> SSRIs increase the serotonin level in the brain by inhibiting serotonin uptake pumps on serotonergic systems, without interactions with other receptors and ion channels. SSRIs are beneficial in both acute response and long-term maintenance treatment for both depression and anxiety disorder.<ref name="Lochmann 2018" /> | ||
SSRIs can increase anxiety initially due to negative feedback through the serotonergic [[autoreceptors]]; for this reason a concurrent benzodiazepine can be used until the anxiolytic effect of the SSRI occurs.<ref>{{Cite journal |last1=Dunlop |first1=Boadie W. |last2=Davis |first2=Paula G. |date=2008 |title=Combination Treatment With Benzodiazepines and SSRIs for Comorbid Anxiety and Depression: A Review |journal=Primary Care Companion to the Journal of Clinical Psychiatry |volume=10 |issue=3 |pages=222–228 |doi=10.4088/pcc.v10n0307 |issn=1523-5998 |pmc=2446479 |pmid=18615162}}</ref> | SSRIs can increase anxiety initially due to negative feedback through the serotonergic [[autoreceptors]]; for this reason a concurrent benzodiazepine can be used until the anxiolytic effect of the SSRI occurs.<ref>{{Cite journal |last1=Dunlop |first1=Boadie W. |last2=Davis |first2=Paula G. |date=2008 |title=Combination Treatment With Benzodiazepines and SSRIs for Comorbid Anxiety and Depression: A Review |journal=Primary Care Companion to the Journal of Clinical Psychiatry |volume=10 |issue=3 |pages=222–228 |doi=10.4088/pcc.v10n0307 |issn=1523-5998 |pmc=2446479 |pmid=18615162}}</ref> | ||
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[[diazepam]] (Valium), | [[diazepam]] (Valium), | ||
[[lorazepam]] (Ativan), | [[lorazepam]] (Ativan), | ||
[[clobazam]] (Frisium), | |||
[[oxazepam]], | [[oxazepam]], | ||
[[temazepam]], and [[Triazolam]]. | [[temazepam]], and [[Triazolam]]. | ||
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==See also== | ==See also== | ||
* | * [[List of investigational anxiety disorder drugs]] | ||
==References== | ==References== | ||
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[[Category:Anxiolytics| ]] | [[Category:Anxiolytics| ]] | ||
[[Category:Anxiety disorder treatment]] | [[Category:Anxiety disorder treatment]] | ||