History of Pharmacological Treatment for Anxiety

As noted earlier, prior to the advent of DSM-IIl in 1980, the anxiety disorders were collectively subsumed under some variation of the single diagnostic entity, anxiety neurosis. Consequently, the history of pharmacological treatment for the discrete anxiety syndromes is relatively brief, only approximately 20 years. Prior to 1980, we can only speak in a general manner as to how well medicines relieved anxiety in the broad sense of the term. Consequently, weTl present the more extensive history of pharmacological treatment for anxiety in this broader sense before launching into a more detailed discussion of the treatment of the individual anxiety disorders. 

Alcohol. Along with several bromide preparations and paraldehyde, alcohol has often been used to relieve anxiety. Due to the marked untoward social and medical consequences of frequent use, alcohol has no place in the treatment of anxiety. Unfortunately, the inappropriate use of alcohol to self-medicate anxiety, depression, insomnia, or other symptoms often leads to alcoholism and therefore contributes to a signihcant public health problem. 

Barbiturates. The hrst barbiturate, barbital, was introduced in 1903 and was followed a few years later by phenobarbital. The barbiturates effectively relieve anxiety, but they are never used as anxiolytics today due to toxicity and abuse concerns. However, several barbiturates, including phenobarbital (Luminal), secobarbital (Seconal), and pentobarbital (Nembutal), remain available and are occasionally used to treat epilepsy and rarely to manage acute alcohol withdrawal. 

The side effects of barbiturates include sedation, poor physical coordination, and impaired mental performance. They also potentiate the intoxicating effects of alcohol. Barbiturates can be extremely dangerous in overdose, causing anesthesia, coma, and even death. In addition, barbiturates can cause dangerous suppression of breathing in patients with sleep apnea or other respiratory disorders. With repeated use over just a few weeks, physical dependence and tolerance to their effects can develop, leading to increasing doses to maintain the desired therapeutic effect. If a 

Nonbarbiturates. After the introduction of the barbiturates, there was little progress in the medical treatment of anxiety until meprobamate (Equanil, Miltown) was introduced in 1950. Soon after its introduction, a series of similar medicines entered the market, including carisoprodol (Soma), glutethimide (Doriden), methaqualone (Qaalude, Sopor), methyprylon (Noludar), and ethchlorvynol (Placidyl). These medications have all been used to treat anxiety, insomnia, and muscle spasms. 

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