MODULE 5: CHEMOTHERAPIES

UNIT 2: ANTI-ANXIETY DRUGS (ANXIOLYTICS)

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks,
or extreme fear and worry. The most common anti-anxiety medications are called
benzodiazepines. Benzodiazepines can treat generalized anxiety disorder. In the case
of panic disorder or social phobia (social anxiety disorder), benzodiazepines are usually
second-line treatments, behind SSRIs or other antidepressants.

Neurotransmitters such as serotonin, norepinephrine GABA are all associated with anxiety.
That’s why anti-anxiety medications, also known as anxiolytics, help by altering the levels
of these neurotransmitters. This leads the person to feel more calm and relaxed, reduce
anxiety and remove the troubling symptoms. They have a sedative, central muscle
relaxant, anti- convulsant effect.

CLINICAL I NDICATI ONS

Anti-anxiety medications are indicated for:

⮚ Generalized anxiety
⮚ Acute anxiety
⮚ Chronic anxiety states in different conditions such
as phobias, dissociative reactions, OCD and PTSD

The common anti-anxiety medications prescribed are

benzodiazepines, buspirone, SNRI and SSRI. (Note: SNRI and
SSRI are also used in treating depression.)

BENZODIAZEPINES - increase activity at receptors for the neurotransmitter gamma-aminobutyric acid

(GABA). This transmitter inhibits the activity of neurons, slowing down the brain and nervous system.
Thus, benzodiazepines are relaxing and calming and promote sleep when taken at bedtime.

Clonazepam, Alprazolam (Xanax), Lorazepam, Diazepam (Valium), Chlordiazepoxide (Librium, Librax,

Libritabs).

Dosage Mode of Action Side Effects

Benzodiazepines are relatively Benzodiazepines act upon

fast-acting medications. Most
benzodiazepines will begin to
take effect within hours, some
in even less time.
Benzodiazepines differ in
duration of action in different
benzodiazepine receptors in the
central nervous system. It binds
to a specific receptor site on
the GABA-A receptor and
facilitates GABA inhibitory
effects.
The most common side effects
are drowsiness and dizziness.
Other possible side effects
include: Nausea, Blurred vision,

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 individuals; they may be taken
two or three times a day, or
sometimes only once a day.
Dosage is generally started at a
low level and gradually raised
until symptoms are diminished
or removed. The dosage will
vary a great deal depending on
the symptoms and the
individual’s body chemistry.
BUSPIRONE - another type of medication used to treat anxiety disorders or in the short-term
treatment of symptoms of anxiety. Initially, it was developed as an antipsychotic and used to treat
psychosis, but was found to be ineffective.
Unlike benzodiazepines,
buspirone must be taken every
day for a few weeks to reach
its full effect. It is not useful on
an “as-needed” basis.
BETA-BLOCKERS - are used to treat the short-term symptoms of anxiety.
Taking these medications for a
short period of time can help
the person keep physical
symptoms under control and
can be used “as needed” to
reduce acute anxiety.
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Buspirone has been found to
act as a partial agonist to the
5HT1 receptor (a receptor for
Serotonin). It also acts as a
weak antagonist on Dopamine
D2 receptors.
Beta-blockers help manage
physical symptoms of anxiety,
such as trembling, rapid
heartbeat, and sweating that
people with phobias (an
overwhelming and
unreasonable fear of an
object
or situation, such as public
Headache, Confusion,
Tiredness, Nightmares.
Call your doctor immediately
for these symptoms: Rash,
Hives, Swelling of the eyes,
face, lips, tongue, or throat,
Difficulty breathing or
swallowing, Hoarseness,
Seizures, Yellowing of the skin
or eyes, Depression, Difficulty
speaking, Yellowing of the skin
or eyes, Thoughts of suicide or
harming yourself, Difficulty
breathing
Some patients reported
experiencing side effects such
as:
- Effects to the central nervous
system including abnormal
dreams, dizziness, drowsiness,
headache, and ataxia (a loss of
control of bodily movements)
- Blurred vision, Chest pain,
Tinnitus, Nasal congestion, Skin
rash, Tremor, Nausea,
Nervousness, Lightheadedness,
Excitement, Trouble sleeping
Common side effects of beta-
blockers include Fatigue, Cold
hands, Dizziness or light-
headedness, Weakness
Beta-blockers generally are
not recommended for people
with
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 speaking) experience in difficult asthma or diabetes because
situations. they may worsen
symptoms related to both.

SELECTIVE SEROTONIN REUPTAKE INHIBITOR (SSRI) - Selective serotonin reuptake inhibitors are
commonly used to treat depression. However, they are also prescribed for a range of anxiety
disorders (except for specific phobia)

Common SSRis used are Fluoxetine, Sertraline, Paroxetine, Citalopram

Fluvoxamine

SSRIs usually need to be taken
for 2 to 4 weeks before
experiencing the effect. Side
effects might be experienced
early on, but these effects will
usually disappear. It is
important to continue the
medication despite
experiencing the side effects.
From the name itself, SSRIs SSRIs have relatively fewer side
prevents the reuptake of effects. Nonetheless, patients
serotonin. This results to have reported experiencing
increased serotonin activity. Feeling agitated, shaky or
SSRIs inhibit the serotonin anxious, Dizziness, Blurred
transporter at the presynaptic vision, Sexual dysfunction
axon terminal, resulting in an (delayed ejaculation, lower sex
increased amount of serotonin drive), Weight changes,
in the synapse, and stimulate Gastrointestinal distress
postsynaptic receptors for a
longer period of time.

SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRI) - Just like SSRIs, SNRIs are also used to
treat depression and anxiety. SNRIs' primary function is to prevent the reuptake of the
neurotransmitters, serotonin and norepinephrine.

Common SNRIs include: Venlafaxine, Desvenlafaxine, Levomilnacipran

Certain SNRIs are not precribed
for patients who are below 18
years old. Like SNRIs, it takes
approximately 2 to 6 weeks to
produce an initial partial
response. Full benefit or effect
of medication may take for
about another 4 to 6 weeks or
longer. Lower dosages are seen
as effective as higher dosages.
However, in certain conditions,
higher dosages are linked with
a better response.
SNRIs work similarly to SSRIs.
They block the reuptake of
serotonin and norepinephrine,
prolonging the presence of the
neurotransmitters involved in
the synapse.
Reported side effects of SNRIs
are similar to SSRIs. These
include: Headache, Nausea,
Insomnia, Decreased libido,
Constipation, Anxiety, Tremor,
Blurred vision
“Serotonin syndrome” - a result
when taking medication that
cause high levels of serotonin
to accumulate in the body.
Abnormal levels of serotonin
can cause mild symptoms such

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 as diarrhea to severe
symptoms such as seizures,
muscle rigidity and even death.

ELABORATE: Note additional pointers in each

category

Additional Remarks:

 Chronic benzodiazepine use has been associated with:

A. Physiological dependence
B. Short-term cognitive impairment
C. Psychomotor impairment

 Consultation with the doctor is a must before discontinuing benzodiazepine. A

withdrawal reaction may occur if the treatment is abruptly stopped. Symptoms may
include anxiety, shakiness, headache, dizziness, sleeplessness, loss of appetite, and
, in more severe cases, fever, seizures, and psychosis. A withdrawal reaction may be
mistaken for a return of the anxiety, since many of the symptoms are similar. Thus, after
benzodiazepines are taken for an extended period, the dosage is gradually tapered
off before being completely stopped.

 In 2004, a black box warning for SSRIs and other antidepressant medications was
issued. This was due to a possible increased risk of suicidality among pediatric
and young adults (up to age 25) populations. In some cases, SSRI use can lead to
cardiac problems such as tachycardia and fatal arrhythmia.

 Although benzodiazepines, buspirone, tricyclic antidepressants, or SSRIs are

preferred medications for most anxiety disorders, occasionally, for specific reasons,
one of the following medications may be prescribed: antipsychotic medications;
antihistamines (such as Atarax, Vistaril, and others); barbiturates such as
phenobarbital; and beta- blockers such as propranolol (Inderal, Inderide).
Propanediols such as meprobamate (Equanil) were commonly prescribed prior to
the introduction of the benzodiazepines, but today rarely are used.

 In addition, prescription of anti-anxiety medication would depend on the specific

anxiety disorder being treated. For instance, first-line of treatment of obsessive-

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mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited.
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 compulsive disorder include benzodiazepines, SNRIs and SSRIs. Meanwhile, first-line of
treatment of panic disorder include SNRIs and SSRIs. Benzodiazepines are often
used as second-line treatments.

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mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of SLU, is strictly prohibited.
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