Talk:Anxiolytic

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[edit] SSRIs?

SSRIs are commonly prescribed for anxiety. Are they considered anxiolytics? Other than St John's Wort they aren't really mentioned in the article. --Galaxiaad 21:22, 30 July 2005 (UTC)

SSRIs are not anxiolytic, and St John's Wort is a multiple-reuptake inhibitor, amongst other things. To be considered anxiolytic, immediate relief of symptoms is required, and SSRIs take weeks to provide symptom relief, when at all effective. Studies have shown remarkably low long-term efficiacy of SSRIs in managing anxiety, although intermediate-term efficiacy is usually considered acceptable at sufficiently high doses once the "right one" has been found. Nardil (an MAOI) is generally the best long-term treatment for anxiety, if the patient is capable of following the dietary restrictions. Benzodiazepines, barbituates and carisoprodol are examples of short-term treatments for anxiety -Unregistered
Don't forget clonazepam. --Jeffreykopp 10/18/2005
Sure, there are like a million different drugs out there acting on the GABAergic system, and clonazepam is considered a highly potent benzodiazepine, which was covered by the GP.
More relevantly, do not forget opiates. The anxiolytic effects of opiates have been known for some time. My SO was fortunate enough to find a doctor willing to prescribe buprenorphine 0.2mg sublingual tablets for as-needed use; it takes about 15 minutes for a fullblown panic attack to fully subside, with no cognitive impairment, and the effect lasts for about 8-12 hours (some patients could theoretically have effect for 48 hours, based on the halflife). At the frequency she was getting the attacks at the time, there was no tolerance buildup at all; rebound effects appear to be nonexistent. Concurrent kappa-antagonism reduces the likelyhood of dependance in case of excessive use, and there will typically also be a significant antidepressant effect (attributable to both µ-agonism and K-antagonism).
Apart from benzos, barbs, soma, THC and opiates, there are (to my knowledge) no drugs that exhibit what I would call viable intrinsic anxiolytic activity. Sure, some neuroleptics will make you not give a damn about whether you even live or die, but most people I know who have taken them say they'd rather have the attacks; I can relate.
What these drugs have in common, is that they affect systems that are GABAergic or have efferent connections to GABAergic systems. Drugs lacking this property can safely be assumed to not have any significant short-term anxiolytic potential (exceptional claims and all that), though they may well exhibit long-term anxiolytic effects.
For management of continous, near-continous or high-frequency anxiety, the gold standard remains Nardil, even in the new formula (which appears to have reduced bioavailability for some patients; the cause has not been investigated, and it would presumably not be economically viable to do so). The reason is simple: it is a GABA-transaminase inhibitor whose primary metabolite is a potent (1mg/kg/dy will do) unselective and irreversible inhibitor of MAO, so it will give both tonic and phasic elevation of GABA, 5HT and DA, the three neurotransmitters that appear to be of primary relevance to the biological basis for anxiety.
Zuiram 03:43, 3 January 2007 (UTC)

[edit] Beta blockers

I would not consider beta blockers 'anxiolytic' by definition as they work solely on somatic symptoms. Have amended article but could poss. take out.

Beta blockers are not anxiolytic per se. However, they can have an anxiolytic effect for some people. The reason for this is that the somatic symptoms frequently end up aggravating the anxiety, which becomes a kind of feedback loop. When the somatic symptoms are alleviated, the anxiety will lessen somewhat for these patients, at least breaking the loop, and occasionally helping the patient to recover from an attack as the relief can aid in restoring mental calm.
Removing them from the page makes little sense, but one could make a note that they do not have any intrinsic anxiolytic properties, rather having an indirect effect that is useful for some patients. That is to say, they will not calm down a person inhaling a high concentration of carbon dioxide, which the other anxiolytics will do; this is a classic test of efficacy. Note that buspirone has a very limited efficacy, and most people who have tried other anxiolytics report no effect whatsoever if switched over to buspirone.
Zuiram 03:26, 3 January 2007 (UTC)

[edit] Copyvio?

Some of the information on this page appears to be copied from http://www.absoluteastronomy.com/ref/anxiolytic and has been removed by me. This leaves some 'gaps' in the article, there are several other sentences that have been modified by other posters I've kept in. To be honest, I think this needs a complete rewrite - the structure was based on the material taken from the webpage and it's not now in any real order. That's why I added the cleanup tag.Berry 18:57, 25 April 2006

absoluteastronomy is a Wikipedia mirror. This is not a copyright issue. The text could be restored. Colin°Talk 09:41, 27 April 2006 (UTC)

[edit] Rewrite

I have spent some time rewriting this page. Some things to remember for future editors: anxiolytics are agents used to treat the symptoms of anxiety - not an underlying anxiety pathology such as Generalized Anxiety Disorder. A lot of medications seem to have crept into this article that are not anxiolytics (such as neuroleptics). I've weeded them out. Ifnord 20:44, 24 July 2006 (UTC)

Thank you! The link dependence goes to a disambiguation page. I was going to change it to physical dependence but I wanted to make sure that was what was intended. I thought "dependence" was used for the physical aspect, and "addiction" for the psychological aspect, but it seems they aren't that well-defined and that it's basically a mess (in usage and on Wikipedia). Anyway, just wanted to check that it does indeed mean physical dependence here. --Galaxiaad 21:32, 24 July 2006 (UTC)
Indeed it's supposed to be physical dependence. I'll correct it. Ifnord 20:10, 25 July 2006 (UTC)

[edit] Etifoxine and Stresam

Could someone please add some information about the non-benzodiazepine anxiolytic etifoxine. It seems Stresam, a popular drug particularly in France for treating anxiety, makes use of this. Someone I know was on it, so I'm eager to find out more, but there doesn't seem to be info on Wikipedia yet. —The preceding unsigned comment was added by Steve Kroon (talk • contribs) 06:54, 26 March 2007 (UTC).

[edit] Other related medications where anxiety is not indicated

Opiates were mentioned which while definitely having an instant effect on anxiety are also a drug class all to themselves. (( Perhaps a warning about the extreme addictiveness of opiate drugs (from the relatively safe synthetic codine to definitely not safe 'recreational' class A drugs) would be insulting everyone's intelligence. ))

Etifoxine appears to have effects very similar to benzodiazapines, including having a molecular structure that includes a benzoxazine group - I can't determine if it is significantly different - it appears to be a GABA enhancer which is what benzos are.

There are many substances that have secondary anxiolytic effects and are used to treat GAD and panic symptoms. Several tricyclic antidepressants (eg doxepin) and the non-tricyclic (and extremely unusual) mirtazapine (all by virtue of having antihistamine effects) and most antipsychotic medications have major sedative side effects and they are often prescribed as if they were anxiolyics, usually given in smaller doses than is recommended for their primary use. Both of these classes of drug tend to loose their beneficial side effects after long term use.

There are several other drugs which have sedative and anxiolytic properties as side effects (one should not confuse sedation with anxiolytic properties as a patient may be quite physically sedated but still experience mental panic or stress - a problem with using antipsychotics for their sedative properties). (( a drug for treating some kinds of parethesia is indicated for panic attacks but I can't remember what it is called )) Even if they belong to another official class of drug, they may be worth a mention as drugs sometimes used in conjunction with more traditional anxiolytic medications, ie the anticonvulsant carbamazepine. Carbamazepine has some popularity as an assistant to antidepressants and anxiolytics.

I don't know what the official status of alcohol is (apart from being a general menace to the community) but, as a drug (ethyl as opposed to cleaning fluid), it is very non specific and prone to paradoxical effects vs being a strong CNS depressant - it can cause rage and mania as well as worsening depression. Also it is rather addictive in some individuals, to state the obvious. But, non-the-less, it acts instantly and often has strong anti-anxiety effects. It's ability to consistently reduce social phobia is well known by any 'social drinker'.

Marijuana also suffers from paradoxical effects vs being a CNS depressant, including causing panic attacks and paranoia. Rage, mood swings and violent behaviour are not known effects, though intoxication and, rarely, psychotic episodes are a problem. I suggest the reference to Marijuana remain as it is for now, though, as always, some citations would be useful (hint hint).

I'll leave it to someone with actual medical training (hehe) to decide for or against additions to this article re medications that touch anxiolytics while not strictly being a part of the classification. —Preceding unsigned comment added by Jp adelaide (talk • contribs) 15:02, 31 October 2007 (UTC)

Marijuana is in no way an anxiolytic. It actually increases anxiety in a huge number of people who use it. —Preceding unsigned comment added by 76.109.190.197 (talk) 01:09, 21 February 2008 (UTC)

I think that the section on marijuana should be edited. Marijuana does not have antipsychotic or anxiolytic effects, one of the chemicals contained in it has that effect. The reference is for CBD not marijuana, and the opening line of that reference states "A high dose of ∆9-tetrahydrocannabinol, the main Cannabis sativa (cannabis) component, induces anxiety and psychotic-like symptoms in healthy volunteers." So it would be good to clarify that.Essent (talk) 18:51, 28 February 2008 (UTC)

This article is not meant to be a guide on taking cannabis. There is noting really wrong in simply stating that cannabidiol is found in cannabis and is an anxiolytic drug. Even though I understand your reasoning I don't think we should talk about drugs that are not anxiolytic (like THC) in an article about anxiolytics. Also although I respect your opinion I don't think it's right to state that cannabis cannot be used as an anti-psychotic if that's what you were implying. There are about 1400 different varieties of cannabis, some have low THC values and although THC can induce those symptoms in healthy volunteers, when at such low doses in some varieites of cannabis, and with such high levels of CBD someone could use cannabis as a treatment for schizophrenia because THC does have theareputic effects. Cannabis has been used to treat anxiety disorders in the past, it's used to treat social anxiety disorders at least that I know. Also, there are what about 400 different chemicals in cannabis? I'm sure some others have anxiolytic type effects, but the main thing to point out is cannabdiol is only second to THC in quantity and as I've pointed out, in some varieties there is more CBD than THC, thus any negative effect of THC is cancelled out, and that's not original research the article itself aludes to this. Supposed (talk) 04:10, 19 May 2008 (UTC)

[edit] use of marijuana

marijuana can cause anxiety as well, this should definitely mentioned. —Preceding unsigned comment added by 86.154.155.214 (talk) 17:26, 26 March 2008 (UTC)

Cannabidiol does not induce anxiety, it's an anxiolytic drug! Stop referring to it as "marijuana".Supposed (talk) 16:29, 17 May 2008 (UTC)

[edit] Hydroxyzine?

Why is this drug not mentioned? TimL (talk) 13:36, 17 May 2008 (UTC)

Good point, it should be listed. I just added it to the article with a citation.--Literaturegeek | T@1k? 14:19, 17 May 2008 (UTC)

[edit] Herbal treatments

http://en.wikipedia.org/wiki/Coriander links to this page but is not listed under the Herbal section, if someone could edit that in properly. I don't know how. 64.105.35.105 (talk) 09:39, 22 May 2008 (UTC) (Just wandering through)