Typical indications for anxiolytics

About one-third of all adults suffer at some time in their lives from states of anxiety and tension that can considerably impair their quality of life (Lader, 1981). The majority of these individuals seek medical help sooner or later, about half of them within a year after the outbreak of the symptoms. Statistics from the UK show that some 10% of these patients are referred to a psychiatrist. Psychiatrists consequently only see a small proportion of patients suffering from states of anxiety, generally the rather severe, chronic, neurotic, perhaps socially decompensated cases. The remaining 90% of patients mostly turn to their general practitioner they are predominantly persons who react to burdensome circumstances with acute anxiety or stress symptoms. States of this nature are generally known to wane after some 6 weeks, although this remission can be facilitated by taking a tranquillizer. 

Panic disorders are sudden attacks of severe anxiety accompanied or even dominated by physical symptoms such as heart palpitations, difficulty in breathing and a constrictive feeling in the chest, which can intensify the anxiety attack and put the subject m fear of his life. Panic attacks often arise spontaneously without detectable cause or are associated with particular situations such as being in a crowd, in a small, enclosed space or on an exposed street. Both syndromes can be treated successfully with benzodiazepines. Alternatives to tranquillizers include certain antidepressants, e.g. SSRIs, and non-drug therapeutic procedures (see below). 

Independently of these specific indications, the symptomatic efficacy of tranquillizers on mental and physical anxiety and tension symptoms has been demonstrated in hundreds of individual investigations. According to a survey by Freedman (1980), 80 90% of all controlled studies with tranquillizers show a clear superiority compared with placebo. The success rate appears to be independent of the nature of the functional symptoms. 

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