Motivation and emotion/Book/2019/Anti-anxiety drugs

Anti-anxiety drugs:
What are anti-anxiety drugs, how do they work, and how effective are they?

Multimedia presentation (3 min)

Overview

 There are many ways to treat anxiety. One way is with medication. Benzodiazepines are an anti-anxiety medication that can either have a short acting life or a long acting life. 1 in 7 Australians are currently experiencing an anxiety condition. It's important to understand the benefits of Benzodiazepines, how effective they are and how they work 

The brain and anxiety

The emotional processing part of our brains is referred to as the Limbic system. The limbic cortex integrates sensory, effective and cognitive components of pain and processing information regarding the body's internal state.

In the limbic system, the hippocampus has control over the hypothalamic stress response system and the amygdala is responsible for the expression of fear and aggression as well as defensive behaviour. It also has a role in formatting and retrieving fear related memories. The general role of the thalamus is to control aspects of alertness and consciousness.

Anxiety is said to occur when there are changes in this system. Patients with anxiety disorders have more activity in the brain than normal in the limbic system.

Limbic system

In panic disorders: Amygdala hyperactivity may be caused by less GABA

In Generalised anxiety disorder: Larger amygdala and less controls so the brain processes more fear and react stronger to that.

In social anxiety: more stimuli can lead to extra activity in the amygdala.

Anti Anxiety drugs

There are many types of drugs that can be used to manage anxiety related disorders. They each target specific areas of the brain and work slightly differently, but all having the ability to help manage anxiety related issues. These drugs aren't specific to anxiety disorders and are used for other disorders including, but not limited to depression, insomnia, PTSD, bulimia and borderline personality disorder (BPD). These types of drugs include:

• Selective Serotonin Reuptake inhibitors (SSRIs), Increases level of serotonin
• Serotonin Norepinephrine Reuptake inhibitors (SNRIs)Blocking reuptake of serotonin and norepinephrine back into the nerve cells that release them, which increases the levels of active neurotransmitters in the brain
• Beta blockersUsed for the physical symptoms of anxiety. They prevent adrenaline, stress hormones, relax blood vessels
• Tricyclic antidepressants (TCA)Same effects as SNRI's
• Monoamine oxidase inhibitors (MAOs) Balance neurotransmitters

Although the drugs listed above are able to help manage anxiety, a specific type of drug called benzodiazepine is classified as an Anti-anxiety (Anxiolytic) drug.

Benzodiazepine is a depressant drug which means they slow down the activity of the central nervous system (CNS), meaning they are also classified as a CNS drug/depressant. They are a mild tranquilliser and are most commonly given to relieve stress and anxiety and to help with sleep (insomnia).

Benzodiazepine

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History of Benzodiazepine

Benzodiazepine have been known to be a controversial drug due to the high risk of addiction and dependency, But compared to previous medications that create the same effect, these are noted to be safer.

Opiates and Barbiturates were first used as medication for anxiety, but due the high addiction rate, it was apparent that other forms of medication needed to be developed and identified that were safer and less risk for patients. In the Late 1950's the first form of benzodiazepine known as chlordiazepoxide (Librium) was identified at Hoffmann-La Roche by Leo Sternbach.

By the 1960's this drug was marketed and further modifications were done to enhance the activity of the drug. Then in 1963 Valium, now known as Diazepam, was invented. This was an upgraded version of Chlordiazepoxide. These drugs became popular which helped expand the Hoffmann-La Roche empire and further pushed other companies to create other forms of Benzodiazepine.

How they work

All forms of Benzodiazepine affect key neurotransmitters in the brain called Gamma Aminobutyric Acid (GABA) receptor. GABA is most common neurotransmitter in the Central nervous system (CNS) which has high concentration in the cortex and limbic system. As benzodiazepine is used, it causes a sedating type effect and lowers somatic symptoms like muscle tension. Essentially benzodiazepine works by increasing the effects of GABA as well as the efficiency of synaptic transmission of the neurotransmitters by acting on the GABA receptors.

A video link demonstrated how Benzodiazepine works on the GABA receptor.

Benzodiazepine relaxes muscles and tension, induces sleep and presents a calming effect overall. It is also known as a horse tranquilliser.

Effectiveness

Some of the main forms of Benzodiazepines are listed in the table below as well as the effectiveness, type of acting, and structure.

Drug name	type of acting	Structure
Alprazolam	Short acting. The short acting effect of Alprazolam enables to give quicker relief for people dealing with panic related disorders. It calms the body and relaxes muscles (symptoms like stress and panic)	alprazolam
Diazepam	Long acting Diazepam has a longer relief time. This medication is often used to control muscle spasms, seizures and tremors from alcohol withdrawal symptoms.	diazepam
Lorazepam	Short acting Lorazepam is known to work well for insomnia or trouble sleeping related to anxiety disorders	lorazepam
Oxazepam	Short acting Works well for alcohol withdrawal, trembling and confusion. It is also used people who are not able to stay asleep	oxazepam
Clobazam	Long acting Studies show the benefits of clobazam and the significant improvement for patients with anxiety	Clobazam

There are slightly different risks associated between short acting and long acting benzodiazepine, but share many of the same characteristics. Both types seem to have similar withdrawal symptoms such as anxiety and sleep.

As long as there is the drugs present in the body, the effects and symptoms will persist. Due to the nature of benzodiazepine the main general effects include:

• Drowsiness
• Impaired coordination
• Confusion
• Drug interactions
• Altered mood
• Memory loss
• Dependency
• Unable to feel high and low emotions
• depression

Over time, the higher the dosage and longer time using benzodiazepine means there is a greater risk of addiction and dependency. Its important to manage anxiety, but its also important to not create other psychological and physical disorders in the process such as addiction. Using Benzodiazepine in conjunction with other anxiety targeted therapies show greater results rather than just medication type therapy.

Drug wheel facts. Know the different types of drugs and effects

Addiction and misuse

When benzodiazepine drugs are abused, it is often in conjunction with other forms of drugs such as alcohol and/or opiates. The use of benzodiazepine and opiates combined further sedate someone and can lead to health risks such as decreased cognitive function and suppressed breathing.

They are also commonly abused because of the calming and relaxed effect they have on the body as well as the toxic effect. They are also easily available making it easy to abuse and also get addicted to.

The three main risk factors are 1) when people are already predisposed to or have a history of substance abuse, 2) have other psychiatric disorders which can impact the outcome benzodiazepine has and 3) the risk of recreational use. Often when used in a recreational way, other forms of drugs are used as well to create more of an effect, which can also lead to serious everlasting cognitive and physical impairment and death.

Benzodiazepine have been idolised within the music industry for many decades. Songs such as Mother's little helper by The rolling stones and artists naming themselves after the popular drug 'xanax' like "lil Xan" have further pushed these drugs into the public eye and further emphasised these types of drugs.

We see in a list that there have been many deaths due to accidental overdoses of these types of drugs because they were used as recreational and used with other forms of drugs. The combination of xanax and fentanyl caused the death of artist Lil peep and the combination of anti-anxiety drugs with alcohol caused reality television personality Bobbi Kristina brown death.

Although deaths like these shouldn't happen, it stresses the impact of the misuse of drugs such as benzodiazepine. It also promotes awareness of what could happen no matter the cultural background of life you have build up. The position someone is in their life doesn't change the fact that anyone misusing drugs can be impacted.

Quiz

Benzodiazepine is only used for anxiety disorders.

	No.
	They are only used for alcohol withdrawal.
	They are only used for seizures.

Are Benzodiazepines the first drug used to treat anxiety?

	No.
	They were the first ever produced drug for anxiety.
	They are the newest form of drugs to treat anxiety.

Are benzodiazepines the same as anti-depressants?

	yes
	All drugs are the same, it just depends on the body's reaction.
	No. Benzodiazepine works on the GABA receptor whereas anti depressants such as SSRIs focus on serotonin.

Medical uses for Anti-anxiety drugs

Anti-anxiety drugs such as Benzodiazepine can be used for a number of different diagnoses. This can go from the use on anxiety, to insomnia and for alcohol abuse.

The main use of anti-anxiety drugs is for anxiety related disorders. According to the DSM, anxiety is excessive fear and anxiety related behavioural disturbances. Fear is the emotional response to real or perceived threat, where as anxiety is anticipation of future threat. Anxiety disorders are categorised by distress that can interfere in someone's life.

There are 5 major types of anxiety disorders but also included in the DSM-5 is seperation anxiety disorder and Selective Mutism.

In social anxiety, it is sought that being presented with more stimuli can lead to extra activity in the amygdala (Processing social situations with a layer of fear, making those environments stressful). The use of benzodiazepine in this form of anxiety helps people with avoidance of people and stressful situations

Agoraphobia (fear and avoidance of specific places or situations that cause panic) and panic disorders may be caused by less GABA receptors in the brain. This may cause less inhibitory signaling in the emotion circuit which can lead to more panic. Due to the effects benzodiazepine have on GABA receptors and the calming and relaxing effect these drugs have, the use of benzodiazepine is effective in treating sudden panics.

In alcohol withdrawal, symptoms can include anxiety, irritability and seizures. The effects of long term alcohol in the brain include the decrease in GABA levels and sensitivity. GABA becomes less responsive. This can then lead to an imbalance in the limbic system as well as in the central nervous system. Benzodiazepine stimulates the GABA receptors and increases GABA. It can also produce effects of reducing harsh withdrawal symptoms such as seizures.

Conclusion

Benzodiazepines are a versatile drug that can not only help manage anxiety disorders, but also help manage alcohol withdrawal symptoms and insomnia. Although there is the chance of dependency and addiction, it's important to understand any substance is able to have that effect. The way in which our limbic system changes depends on the types of drugs we use. Benzodiazepine focus on the GABA receptor and also have an effect on the limbic system.

The use of Benzodiazepine is well known from a psychiatric perspective and its becoming more noted in other industries such as the music industry. It's important to understand using drugs properly for the right reasons is important and that the misuse of drugs can have major effects on lives.

See also

• Benzodiazepine

External links

• BBC and BBC three.