ANXIETY:

Anxiety disorders form a category of mental health diagnoses that lead

to excessive nervousness, fear, apprehension, and worry.

These disorders alter how a person processes emotions and behave, also
causing physical symptoms.

Mild anxiety might be vague and unsettling, while severe anxiety may
seriously affect day-to-day living.

Anxiety disorders affect 40 million people in the United States. It is the

most common group of mental illnesses in the country. However,
only 36.9 percent of people with an anxiety disorder receive treatment.

The duration or severity of an anxious feeling can sometimes be out of

proportion to the original trigger, or stressor. Physical symptoms, such
as increased blood pressure and nausea, may also develop. These
responses move beyond anxiety into an anxiety disorder.

The APA describes a person with anxiety disorder as "having recurring

intrusive thoughts or concerns." Once anxiety reaches the stage of a
disorder, it can interfere with daily function.

The five major types of anxiety disorders are:

 Generalized Anxiety Disorder

 Obsessive-Compulsive Disorder (OCD)

 Panic Disorder

 Post-Traumatic Stress Disorder (PTSD).

 Social Phobia (or Social Anxiety Disorder)

Pathophysiology:
In the central nervous system (CNS), the major mediators of the
symptoms of anxiety disorders appear to be norepinephrine, serotonin,
dopamine, and gamma-aminobutyric acid (GABA). Other
neurotransmitters and peptides, such as corticotropin-releasing factor,
may be involved. Peripherally, the autonomic nervous system, especially
the sympathetic nervous system, mediates many of the symptoms. [5]
Positron emission tomography (PET) scanning has demonstrated
increased flow in the right parahippocampal region and reduced
serotonin type 1A receptor binding in the anterior and posterior
cingulate and raphe of patients with panic disorder. [6] MRI has
demonstrated smaller temporal lobe volume despite normal hippocampal
volume in these patients. [7] The CSF in studies in humans shows
elevated levels of orexin, also known as hypocretin, which is thought to
play an important role in the pathogenesis of panic in rat models.

Anxiolytics:
Anxiolytics (also termed anti-anxiety or anti-panic drugs) are
medications that are used to treat a health condition called anxiety. The
type of anxiety that requires treatment is called generalized anxiety
disorder (GAD). This disorder causes excessive worry and anxiety,
significant distress, and affects the ability for a person to function.
Moreover, the symptoms of anxiety occur on most days for at least six
months.
Classification of Anxiolytics:
1. Benzodiazepine is the most common family of anxiolyticscurrently
used. It acts on the substance GABA but it also acts on limbic
system, inhibiting the activity of serotonin in the brain. Examples
are bromazepam, alprazolam, clorazepate etc.
2. Barbiturates exert an anxiolytic effect linked to the sedation they
cause. The risk of abuse and addiction is high. Many experts
consider these drugs obsolete for treating anxiety but valuable for
 the short-term treatment of severe insomnia, though only after
benzodiazepines or non-benzodiazepines have failed. Examples
include Phenobarbital, amobarbital etc.
3. 5-HT 1A receptor agonist (i.e., buspirone)
4. Carbamates are marketed as a safer alternative to barbiturate
anxiolytics, meprobamate (Miltown, Equanil) was commonly used
to relieve anxiety in the late 1950s and 1960s. Like barbiturates,
therapeutic doses produce sedation and significant overdoses may
be fatal.
5. Anti-histamines
6. Opioids are drugs that are usually only prescribed for their
painkilling properties, but some research is beginning to find that
some varieties are effective at treating depression, obsessive
compulsive disorder, and other ailments often associated with or
caused by anxiety. They have a very high potential for abuse and
have one of the highest addiction rates for all drugs. Many people
become addicted to these drugs because they are so effective at
blocking emotional pain, including anxiety. Similarly to alcohol,
people with anxiety disorders are more likely to become addicted
to opioids due to their anxiolytic effect. These drugs range from
the commonly prescribed hydrocodone, to the often illegal heroin,
and all the way to much more potent varieties like fentanyl often
used in trauma or end of life pain management. Most people
purchasing these drugs illegally are seeking them out to get a
euphoric like high, but many others seek them out because they are
so effective at reducing both physical pain and emotional pain.
7. Antidepressant medications can reduce anxiety, and several
selective serotonin reuptake inhibitors have
been USFDA approved to treat various anxiety disorders.
Antidepressants are especially beneficial because anxiety
and depression often occur together.
8. Others like beta-blockers, alpha-blockers, SSRIs etc.