Mechanism Of Action Clinical Effects And Types Of Benzodiazepines
It is widely believed that benzodiazepines enhance the effects of the neurotransmitter gamma-aminobutyric acid . They do so through action at benzodiazepine receptors. Alleviation of fear is a result of GABA-induced inhibition of neuronal transmission that occurs in the amygdala, located in the brain stem, and thought to mediate brain circuits involved in the appraisal of threat and experience of fear.
Benzodiazepines produce a calming effect, decrease anxiety, relax tense muscles, alleviate symptoms of fear-related bodily arousal , and promote sleep. It appears that soon after taking a benzodiazepine, many people experience a pleasant glowing feeling and a sense of remoteness from or indifference to their worries or fears, but it is unclear whether these effects play a significant role in motivating people with anxiety disorders to continue taking benzodiazepines. Perhaps the key characteristic of benzodiazepines is that when dosed correctly, they calm and relax without causing drowsiness, and therefore do not interfere with routine, everyday activities and functioning.
Box 2 lists commonly used benzodiazepines. The similarities between benzodiazepines are greater than their differences, and the main characteristic that distinguishes them is the duration of their action. They are usually divided into short-acting , intermediate-acting and long-acting , although this division is not very clear. However, classification on these grounds has several practical implications.
Best Medication For Anxiety And Panic Attacks
The medications used to treat anxiety focus on alleviating anxious feelings, and lessening the severity and frequency of panic attacks. They make patients feel calmer even when theres agitation. Feeling anxious from time to time is part of life. Anxiety is a component of the human bodys natural defense system and is closely linked to the flight and fright response.
However, its best to keep in mind that theres a difference between being afraid of stepping out of the house and feeling anxious before facing new people or a crowd. Essentially, anyone who battles an anxiety disorder can be put on anxiety medication. However, just because someone experiences anxiety doesnt mean he/she should take anxiety medication because psychotherapy and exercise may be equally effective. That said, here are some common medications for anxiety and panic attacks:
Ranking The Best Medication For Anxiety Of 2021
Medication for anxiety can relieve anxious feelings, reduce the frequency and severity of panic attacks, and produce a sense of calm where there was agitation.
Millions of Americans use these medications on a daily basis to deal with general anxiety, panic attacks, various phobias, PTSD, obsessive-compulsive disorder, and more.
If you believe anxiety is interfering with your day-to-day life, consult your doctor or mental health professional to find out if anxiety medication is right for you.
Below are the best medications for anxiety of 2021.
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Selective Serotonin Reuptake Inhibitors For Anxiety
SSRIs are commonly used to treat both depression and anxiety, and they work by helping balance out the chemistry in an individuals brain. Serotonin is a chemical messenger in the brain that allows brain nerve cells to communicate, which helps transmit certain emotions. By stopping the brain from reabsorbing serotonin, there is more of the chemical available, which can have a calming effect on moods and minimize anxiety symptoms.
Some of the most common SSRIs for anxiety include:
What Else Should I Consider Before Taking Benzodiazepines
Benzodiazepines do not have any known effects on sexual performance. But drowsiness might have an impact on your sex life.
Benzodiazepines should not be used regularly during pregnancy. They should only be used to help control seizures. If benzodiazepines are taken during pregnancy, this can affect the baby when it is born. The baby can get withdrawal symptoms. The baby can have breathing problems and low body temperature.
Tell your midwife and other healthcare professionals if you’ve been taking benzodiazepines through your pregnancy.
But there is no evidence to say that taking benzodiazepines before pregnancy will have a negative effect on pregnancy or birth.
You should not breastfeed while taking benzodiazepines. Medication you take will be in your breast milk.
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Evaluation For Other Psychiatric Disorders
The evaluation for other psychiatric disorders is probably the most challenging aspect of patient evaluation because the symptoms of GAD overlap with those of other psychiatric disorders and because these disorders often occur concomitantly with GAD. Generally, GAD should be considered a diagnosis of exclusion after other psychiatric disorders have been ruled out. Because of the overlap and comorbidity associated with other psychiatric disorders, some authors have questioned whether GAD is a distinct entity and have posited that it is a variant of panic disorder or major depression.18,19
Symptoms of GAD can occur before, during or after the onset of the symptoms of major depression or panic disorder.12 Some patients have symptoms of anxiety and depression but do not meet the full criteria as delineated in DSM-IV,10 for GAD, panic disorder or major depression. In these cases, the term mixed anxiety-depressive disorder can be applied, although it is not yet part of the official nosology. Despite the confusion, anxious patients should be asked about the symptoms of panic attacks and the neurovegetative symptoms that are associated with major depression. When more than one psychiatric condition exists, an attempt should be made to determine which disorder occurred first. Some distinguishing characteristics of GAD, panic disorder and major depression are listed in Table 3.10,19
Symptoms remit but may recur
Major depression, alcohol abuse
Referral To A Specialist
If you have tried the treatments mentioned above and have significant symptoms of GAD, you may want to discuss with your GP whether you should be referred to a mental health specialist.
A referral will work differently in different areas of the UK, but you’ll usually be referred to your community mental health team.
These teams include a range of specialists, including:
- occupational therapists
- social workers
An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition.
They’ll ask you about your previous treatment and how effective you found it.
They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends.
Your specialist will then be able to devise a treatment plan for you, which will aim to treat your symptoms.
As part of this plan, you may be offered a treatment you haven’t tried before, which might be one of the psychological treatments or medications mentioned above.
Alternatively, you may be offered a combination of a psychological treatment with a medication, or a combination of 2 different medications.
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Clonidine: A Good Second
Many people are not aware of the medication Clonidine, which is primarily used to treat hypertension. Although not approved by the FDA for anxiety, its anxiolytic effects have been documented in various studies. Many doctors use it to help patients with anxiety during drug withdrawal and favor it over benzodiazepines due to its non-addictive nature. People using clonidine dont typically build a tolerance and it can actually help improve cognition.
- Reduces anxiety: There is substantial evidence suggesting that Clonidine for anxiety is a great option. It is primarily used to reduce a persons blood pressure, thus treating hypertension. However, many have found that upon reducing blood pressure, it produces an anxiolytic response eliminating many symptoms of anxiety.
- Improves cognition: Not only will Clonidine not impair your memory over the long-term like a benzodiazepine, it can actually improve cognitive functioning. This medication is clinically approved by the FDA for the treatment of ADHD, suggesting that you may be better able to concentrate while taking it.
- Long-term option: This medication is considered relatively safe when taken over a long-term. Despite the fact that there isnt a lot of long-term research regarding Clonidine, most published research suggests that it is pretty safe. You arent going to experience memory impairment or increased dementia risk like you would with other classes.
Can I Take My Benzodiazepines Overseas
Benzodiazepines are a controlled drug. Controlled drugs mean that there are legal controls that must be followed.
If you travel overseas with your benzodiazepines you need to:
- prove it is prescribed to you, or
- get a personal licence if youre travelling for at 3 months or more. Or carrying enough medication to last you 3 months or more.
How do I prove my medication is prescribed to me?
You need to get a letter from the professional who prescribed you the medication. The letter must include:
- your name,
- what countries you are going to,
- when you are going to these countries,
- a list of your medicine,
- your dose and strength of medication, and
- the signature of the professional who gave you the medication.
How do I get a personal licence?
You will need to:
- fill in an application form,
- get a letter to prove your medication is prescribed to you
- send your application and letter to
- apply at least 10 days before travel
You can fill out your application form through the below website link:
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Do I Need This Treatment
A certain amount of anxiety or insomnia is a normal reaction to what is happening in your life. You may worry or feel stressed, and sometimes these feelings can keep you up at night. Most often, these feelings pass and are not a problem. However, these feelings can become a problem when they continue over a longer term, cause severe distress, make you feel physically ill and affect your behaviour. This kind of anxiety may be triggered by a challenging life event. It can also be a symptom of a mental health problem.
The ability to fall asleep and to sleep through the night can be affected by many types of health problems. These include physical conditions that cause pain or trouble breathing, as well as mental health problems. When sleep is disrupted, health can be further affected.
While each situation is unique and different treatment approaches may be called for, benzodiazepines can help to provide relief.
What Are Anxiety Disorders
Anxiety disorders affect 31.9 percent of people between the ages of 13 and 18, and women are twice as likely to develop an anxiety disorder as men. Common examples of anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder, substance-induced anxiety disorder and specific phobias.
An anxiety disorder does more than make you anxious. They can affect your entire life. Plus, untreated anxiety can lead to other mental health disorders and physical conditions, Alonzo said. We have no way of predicting what will cause someone to develop an anxiety disorder. However, you can take steps to reduce the impact of symptoms such as getting help from a health care professional early and avoiding the use of non-prescribed drugs and alcohol.
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Alternatives To Benzodiazepines For Anxiety: What Works
For millions of Americans living with anxiety disorders, medication management is part of their treatment plan. And for years, benzodiazepines for anxiety have been a popular treatment option. But their risk for addiction is significant, and many people with anxiety already struggle with addiction to benzodiazepines. For this reason, alternatives to benzodiazepines for anxiety are sometimes a key part of treatment.
So what are the best non-addictive anti-anxiety medications? And are benzodiazepines for anxiety safe? Keep reading for answers to your questions about non-habit-forming anxiety medication.
Benzodiazepines: Most Effective But Most Problematic
For short-term treatment of anxiety or treating anxiety on an as-needed basis, theres nothing that will work better than a benzodiazepine. The problem with benzodiazepines is that using them can deplete the brains GABA levels, which results in rapid-tolerance development and increased anxiety upon withdrawal. Additionally, many people dont like the impaired cognition and sedation that this class of drugs causes.
- Universally effective: For most people with severe anxiety, there is nothing that will work better than taking a benzodiazepine like Xanax. These are drugs that affect GABA in the brain, which depresses the central nervous system, and leads to sedation. They have a powerful anxiolytic effect in nearly everyone who takes them.
- Rapid anxiety relief: This class of drugs works quicker than any other class as well. Meaning you should notice reductions in anxiety within a few minutes of taking the drug. Certain benzodiazepines work for a longer period of time than others .
- Powerful anxiolytic: Benzodiazepines tend to result in the most potent anxiolytic effects. Meaning you should feel highly relaxed after taking this class of medication. Unfortunately these powerful anxiolytic effects cannot be maintained due to tolerance.
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Will Buspar Work For Everyone
No. No medication class other than benzodiazepines are considered universally effective for anxiety. Although Buspar may not adequately address anxiety in some individuals, it was approved for anxiety because it is significantly effective for many people when compared to a placebo. If Buspar doesnt work for you, it doesnt mean that its a bad drug for everyone it may work for another individual.
It should also be mentioned that many people find that Buspar takes awhile to work. For many individuals, it can take several weeks to a full month before they notice their anxiety levels drop. It is considered a slow-acting drug and requires constant administration for weeks before a person may feel the anxiolytic effects. For people seeking immediate relief, this discomfort while waiting for the drug to work may be a drawback.
Evaluation For Medical Disorders
Nonpsychiatric disorders must be ruled out before GAD can be diagnosed as the etiology of a patient’s complaint of anxiety. Neurologic and endocrine diseases, such as hyperthyroidism and Cushing’s disease, are the most frequently cited medical causes of anxiety.17 Other medical conditions commonly associated with anxiety include mitral valve prolapse, carcinoid syndrome and pheochromocytoma.17 It must be stressed that these conditions, although often cited, are clinically uncommon, and all patients who present with the complaint of anxiety do not require an extensive work-up to exclude these other medical conditions. Medications such as steroids, over-the-counter sympathomimetics, selective serotonin reuptake inhibitors , digoxin, thyroxine and theophylline may cause anxiety.17 The physician should also inquire about the use of herbal products or vitamins. If possible, all exogenous substances should be removed before initiating treatment of patients with GAD.
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What Are The Dangers Of Benzodiazepine Withdrawal
When benzodiazepine treatment is stopped abruptly, patients may develop withdrawal symptoms. Factors that increase the risk and severity of withdrawal symptoms include high doses and long term benzodiazepine use. Additionally, withdrawal symptoms tend to occur earlier with benzodiazepines with short elimination half-lives.
Common symptoms of benzodiazepine withdrawal include anxiety, trouble sleeping, restlessness, muscle tension, and irritability. Less commonly, patients may also experience nausea, malaise, blurred vision, sweating, nightmares, depression, muscle coordination problems,tremors, and muscle twitching or spasms. In rare cases, hallucinations, delusions, seizures, and ringing in the ears may also occur. Risk of withdrawal seizures is higher with high benzodiazepine dose, long treatment duration, and concurrent use of medications that lower the seizure threshold. Prompt recognition and treatment of benzodiazepine withdrawal is crucial as this condition may be life threatening. Benzodiazepine withdrawal is treated with intravenous benzodiazepines such as diazepam which tends to work over a longer period of time.