I want to review some of the highlights
now of anxiolytic medication with you.
So common anxiolytics actually
include now antidepressants,
SSRIs are first line for
the treatment of anxiety.
Other antidepressants can be useful
as well, so that's important to note.
We’ll talk more in this
lecture about benzodiazepines
and then also hit upon the fact that that
beta-blockers can be useful for anxiety
and also antipsychotics at low
doses can have some benefits.
So first line treatment
again for anxiety is now
actually the antidepressant
class of medication.
This is great because these are
One drawback would be that antidepressants
can take about four to six weeks
before a patient gets full
benefit from the medications.
So that’s something
important to keep in mind
especially if your patient is really
struggling with anxiety in the acute phase.
Now, the mechanism of action of anxiolytics,
specifically the benzodiazepines,
is that they really work by depressing
the central nervous system.
So therefore, although
they calm people down,
they have that CNS depressant effect
that causes pretty extreme
sedation and even disinhibition.
So benzodiazepines though
nonetheless are amongst
some of the most commonly
prescribed medications in the U.S.
And some of the indications here
for benzodiazepines include
the anxiety disorders,
also muscle spasms,
seizures, sleep disorder,
and also they’re used in anesthesia.
So let met touch a little bit more
on the alcohol withdrawal point.
So alcohol, very similar
depresses the central
So when a patient’s
withdrawing from alcohol,
all of a sudden their brain
regions are lighting up
and this makes them susceptible
to having a seizure
and therefore, the treatment
and detox is actually to
administer benzodiazepine to help
calm down their brain regions.
Now, because the benzodiazepines
cause CNS depression,
we tend to try to use them for short term
use only or in acute treatment phase
Okay, they’re highly addictive substances
otherwise known as controlled substances,
something important to keep in mind.
So they’re actually not first
line anxiolytics anymore.
Now, we know the antidepressant are,
but benzodiazepines are still sometimes
used in the treatment of anxiety
and actually pretty
Some advantages of the benzodiazepine is
that when they’re used appropriately,
they’re fairly safe.
However, they do have this high addiction
potential and also can cause disinhibition.
It’s really important because
they’re so sedating,
that people not drive when
they’re using these medications.
Now, the duration of use of the
benzodiazepine is going to be variable.
Say if somebody’s withdrawing from alcohol,
you’re going to use it very short
term during their detox phase.
Let’s say you have a patient who has maybe
a social anxiety disorder or an
obsessive compulsive disorder
and they just get extremely anxious
off the charts to the point
where they’re panicking.
Well, maybe you start
that patient on an SSRI,
but because it can take a month or longer
for that SSRI to really start working,
you might, depending on the patient
profile and their tolerance
and whether or not they
have any addiction history,
but you might consider giving
them a short term benzodiazepine.
And again, this is working by
potentiating GABA receptors.
So there are both long and
intermediate acting benzodiazepines.
So you can see of the
examples of them here.
Longer acting ones like diazepam and
chlordiazepoxide will have pretty long half life
and therefore they can be used for
a variety of different things.
The intermediate acting or
shorting acting benzodiazepines
These really work instantaneously for the
patient who’s really having a panic attack.
Now, the side effects again are really
important to note for benzodiazepines.
There’s drowsiness, impairment of intellectual
functioning and reduced motor control.
So people should not be
driving or operating
important equipment or machinery
while taking these medicines.
There can be respiratory
depression and overdose,
which is a real caution in
prescribing a benzodiazepine
to any patient who might
be prone to suicide.
So I want to emphasize
again the ever importance
of doing a safety and suicide
risk assessment in psychiatry.
And especially when a benzodiazepine
is combined with alcohol,
it’s just amplifying
the effects of both,
it’s activating GABA, which is
an inhibitory neurochemical.
It’s causing severe CNS depression
and therefore the risk of a respiratory
depression is going to be even greater.
Again, another medication or
sometimes recreational substance
that can be used are opiates and we know
this huge opiate crisis happening right now.
So a patient who’s taking a benzodiazepine,
drinking alcohol and using an opiate
is going to be at very significant
risk for respiratory depression.
This is why it’s really important
to know your patient well
and get a detailed history before
prescribing any medication.
Now, I want to take a moment to shift gears
a little bit and talk about zolpidem,
which isn’t exactly
but it’s used for the
treatment of insomnia
and often in patients who have
insomnia because of anxiety.
Now, this can actually selectively
bind to the GABA receptor
and it doesn’t have any anticonvulsant
or muscle relaxant properties.
It really doesn’t have
a withdrawal problem,
but it can be used for the
treatment of insomnia.
A couple of things to note about
the use of zolpidem are that,
well, it can actually cause some
side effects like sleepwalking.
It can cause night terrors and it
can actually cause memory loss.
So that’s an important
note and for that reason,
we really try to use
it in a limited use.
And for women especially, we try
to use very, very low doses
because it does have a right risk of memory
and cognitive problems associated with it.
Now, another medication that can be useful
in the treatment of anxiety is buspirone.
Now, this medication is a great alternative
to an antidepressant or benzodiazepine.
It can treat generalized anxiety disorder
It has a slower onset of
action than the benzodiazepine
but it does work a bit quicker
than the antidepressants.
So this one, it has anxiolytic
action at the serotonin receptor
where it actually is
a partial agonist.
So that’s how it’s a bit different
from the antidepressants,
which really antagonize
So this doesn’t
potentiate CNS depression
and it also has low potential for abuse or
addictions, making it a good alternative.
Now another medication that can be
used for anxiety is a beta blocker,
something like propranolol.
Beta-blockers can treat
the autonomic effects
of panic attacks and performance anxiety.
It helps to alleviate palpitations,
sweating and tachycardia.
So it can also be used
to treat akithisia,
that’s sometimes seen as a side
effect of antipsychotic medication.
Now, one important side effect
to note with propranolol
is that it actually is
known to cause depression.
So you want to be a little
bit careful when using
it in somebody prone
to having depression.
And I want to make a final note here
just to highlight to you the fact that
antipsychotic medications can
actually be used for anxiety.
So in very low doses,
medications such as quetiapine
can be used to treat
different anxiety disorders.
Of course, you want to be
careful with these medicines
and monitor really closely
for side effects.
That’s a quick highlight and review
of the anxiolytic medications
and you should know that while
benzodiazepines are commonly prescribed,
there are other options, too, and certainly
medications that are less addictive.