Other anxiolytic drugs

As indicated in Chapter 1 some antidepressant drugs, particularly SSRIs and SNRIs, are being used increasingly for the pharmacotherapy of anxiety 

Another alternative is buspirone, a non-benzodiazepine anxiolytic that seems to be free of untoward effects on cognitive performance (Ninan et ul., 1998). As indicated in Chapter 1, the anxiolytic effect of this compound ma take a few weeks to occur (and is often rather weak), meaning that buspirone is better suited for long-term treatment of anxiety syndromes than for immediate anxiolvsis. 

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Other serotonergic drugs that are direct receptor agonists or antagonists have been found to have anxiolytic effects (Stahl 1998 Bonhomme and Esposito 1998). A novel class of anxiolytic drugs called azapirones act as partial agonists at 5-HTlA receptors (Yocca 1990). Clinically, they are represented by BuSpar, which was approved for use in 1986 (Eison... 

Monitoring Effectiveness for more than 3 to 4 weeks has not been demonstrated in controlled trials. However, patients have been treated for a year without ill effect. If used for extended periods, periodically reassess the usefulness of the drug. interference with cognitive and motor performance Buspirone is less sedating than other anxiolytics and does not produce significant functional impairment. However, its CNS effect may not be predictable. Therefore, caution patients about driving or using complex machinery until they are certain that buspirone does not affect them adversely. 

The SSRls as a class are now widely considered to be appropriate first-line anxiolytic drugs in particular paroxetine, the most potent 5-HT reuptake blocker, has been licensed in the UK for the treatment of each of the major anxiety disorders. Short-term efficacy has been clearly demonstrated in randomised controlled trials, but in common with other antidepressants, research evidence is lacking for long-term efficacy and necessary duration of treatment. 

Benzodiazepines, the most commonly used anxiolytic drugs in the treatment of chronic anxiety states, have also been investigated in the treatment of social phobia. These agents have been shown to be effective in the treatment of other anxiety disorders, including panic disorder and generalized anxiety disorder. Three benzodiazepines, all in the high-potency class of benzodiazepines have been investigated in the treatment of social phobia. 

Griffiths, R.R., Sannerud, Ch.A. Abuse of and dependence on benzodiazepines and other anxiolytic sedative drugs. In Meltzer, H.Y. (ed.) Psychopharmacology the Third Generation of Progress. Raven, New York. 1987, pp. 1535-1541. 

Precautions Use benzodiazepines cautiously in treating patients with liver disease. They potentiate alcohol and other CNS depressants. Benzodiazepines are, however, considerably less dangerous than other anxiolytic and hypnotic drugs. As a result, a drug overdose is seldom lethal, unless other central depressants, such as alcohol, are taken concurrently. 

Pharmacodynamic interactions. Many TCAs cause sedation and therefore co-prescription with other sedative agents such as opioid analgesics, antihistamines, anxiolytics, hypnotics and alcohol may lead to excessive drowsiness and daytime somnolence. The majority of TCAs can have undesirable cardiovascular effects, in particular prolongation of the QT interval. A similar risk of QT prolongation arises with many other cardiovascular drugs including amiodarone, disopyramide, procainamide, propa-... 

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