Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012
Medication
Treatment
Three main types of drugs are used to treat anxiety: SSRIs, benzodiazepines, and beta-blockers.
SSRIs
You might be surprised to discover that anxiety is treated with SSRIs (selective serotonin reuptake inhibitors). SSRIs, after all, are popularly regarded as anti-depressants. They were certainly marketed as anti-depressants when they appeared on the scene in the late 1980s. But their ability to dampen down feelings of anxiety has made them the primary pharmaceutical option for these disorders. Indeed, some experts have argued that they are more effective at treating anxiety than depression.
Among the SSRIs commonly prescribed for anxiety problems are paroxetine, venlafaxine, and sertraline. Unlike the other drug options, they often take a few weeks to show benefits. Once SSRIs kick in, however, they can reduce our sense of threat and instead stimulate a feeling of calm contentment. How they do this is unknown. SSRIs increase the amount of serotonin in the brain, but what this means for anxiety isn’t well understood. As the psychiatrist David Healy has written: ’We know a lot about where drugs go in the brain but very little about how they work.’
Benzodiazepines
Like many other drugs, the success of benzodiazepines owed much to luck. A scientist named Leo Sternbach synthesized chlordiazepoxide in 1955 while working for the pharmaceutical giant Hoffmann-La Roche, but could see no reason to continue working on it.
Chlordiazepoxide sat in a corner of Sternbach’s lab for two years until a colleague, Earl Reeder, took another look. Reeder was astonished by the results, and the company was quick to see the potential. Chlordiazepoxide, renamed Librium, was introduced to the market in 1960, followed a few years later by diazepam (Valium).
Benzodiazepines appeared to offer a safe, quick-acting cure for the effects of anxiety, and they were astonishingly popular. It’s perhaps not surprising that the public were so keen: benzodiazepines produce a sense of relaxation that resembles the feeling produced by alcohol. They do this by enhancing the effect of a neurochemical called gamma aminobutyric acid (GABA), which relaxes us when we’re anxious.
Gradually, however, it was recognized that all was not quite as rosy in the benzodiazepine garden as it seemed. Unpleasant side effects were common, and stopping the drug could result in nasty withdrawal symptoms. In fact, the tide of scientific and popular opinion turned so conclusively that the brand name Valium was dropped.
Benzodiazepines (also known as ’minor tranquillizers’) are still widely prescribed for some anxiety problems, though are only recommended for short-term use: usually two to four weeks. Commonly used varieties include chlordiazepoxide (Librium) and diazepam (the former Valium), lorazepam (Ativan), bromazepam (Lexotan), alprazolam (Xanax), and clorazepate (Tranxene).
Beta-blockers
At the 2008 Beijing Olympics, North Korean competitor Kim Jong-su became the first ever pistol shooter to be expelled from the Games after testing positive for a banned substance. The substance in question was the drug propanolol, a beta-blocker, and it cost Kim Jong-su his silver and bronze medals.
Why a pistol shooter might be tempted to take a beta-blocker is no mystery. These drugs — of which propanolol was the first to be developed, in the late 1950s — quickly prevent many of the physiological symptoms of anxiety, such as elevated heart rate, perspiration, and trembling.
Beta-blockers are principally prescribed to treat cardiovascular problems such as high blood pressure or angina. But they are thought to be widely used by orchestral musicians and other performers to control the effects of nerves. While beta-blockers may help with specific, short-term situations, they aren’t recommended for long-term treatment of anxiety disorders.