Anxiolytic

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Anxiolytic (plural: anxiolytic) literally means fear (dissolver). The term refers to drugs that are used for anxiolysis, i.e. to reduce excessive or pathological fears . The terms ataractic ("sedative") or minor tranquilizer ( English for "weak sedative") are also used synonymously .

The main group of the most effective anxiolytics are the benzodiazepines . Their main risks and side effects are the deliberate abuse of these substances and the rapid and severe development of an addiction under certain circumstances . In Germany, therefore, anxiolytics from other classes of active ingredients are prescribed instead.

Drug groups

Benzodiazepines

Benzodiazepines are effective drugs that work quickly. Although their side effect profile is usually rather uncritical, there is always the risk of rapid and sometimes very strong addiction development . Benzodiazepines are therefore usually only used for a short time, for example for the treatment of panic attacks or as reliever medication for severe underlying mental illnesses . Another problem with the use of benzodiazepines is rebound phenomena when they are discontinued after prolonged use.

Benzodiazepines include:

Thienodiazepines

The thienodiazepines were created as derivatives of the benzodiazepines ; these are heterocycles that contain a diazepine ring and a fused thiophene ring instead of a benzene ring.

The thienodiazepines include:

H1 antihistamines

Some older antihistamines of the first generation (histamine H1 receptor antagonists) also have sedating or anxiolytic effects and are used for these purposes. Like the benzodiazepines, they are characterized by a rapid onset of action, but without the risk of physical addiction. However, sedating antihistamines show a somewhat poorer side effect profile than benzodiazepines due to their pronounced anticholinergic effects . For this reason, the use of this class of active ingredients in people over 65 years of age is viewed critically by some authors. The best known active ingredient of this group is hydroxyzine .

Antidepressants

Antidepressants are often used for long-term treatment of anxiety disorders . These substances often take several weeks to take before they are sufficiently effective. They are therefore partly unsuitable for short-term treatment or for selective use in acute panic attacks. Antidepressants are divided into different groups of active ingredients that have certain properties in common and are individually suitable for anxiolysis in different ways.

Neuroleptics

So-called low - potency neuroleptics can also be used for anxiolysis. Due to their potential side effects, these active ingredients are usually the second choice for anxiety disorders. However, if there are pronounced symptoms of anxiety in the context of severe mental or physical illness, they can be the first choice. Well-known anti-anxiety substances from this group are promethazine , melperon and pipamperon .

Other drugs

In the case of anxiety disorders, the following are also used:

  • Buspirone - onset of action after a few weeks. Physical addiction not described in the literature.
  • Opipramol - onset of action after a few days. Physical addiction unlikely, however withdrawal phenomena possible after long-term and / or high-dose use.
  • Pregabalin - Rapid onset of action after a few days. Physical addiction potential likely, extent not yet known.
  • Fabomotizol

Herbal medicines

Herbal medicine and folk medicine also know some anti-anxiety substances. These include:

Individual evidence

  1. ^ Richard Finkel, Michelle Alexia Clark, Luigi X. Cubeddu: Pharmacology . Lippincott Williams & Wilkins, 2009, ISBN 978-0-7817-7155-9 , p. 105.
  2. ↑ M. Lader, A. Tylee, J. Donoghue: Withdrawing benzodiazepines in primary care. In: CNS Drugs. 23 (1), 2009, pp. 19-34.
  3. ↑ M. Gelder, R. Mayou, J. Geddes: Psychiatry. 3. Edition. Oxford, New York 2005.
  4. ↑ Otto-Albrecht Neumüller (Ed.): Römpps Chemie-Lexikon. Volume 2: Cm-G. 8th revised and expanded edition. Franckh'sche Verlagshandlung, Stuttgart 1981, ISBN 3-440-04512-9 , p. 930.
  5. ↑ Otto-Albrecht Neumüller (Ed.): Römpps Chemie-Lexikon. Volume 6: T-Z. 8th revised and expanded edition. Franckh'sche Verlagshandlung, Stuttgart 1988, ISBN 3-440-04516-1 , p. 4234.
  6. ↑ Otto Benkert: Psychotropic drugs: drugs, effects, risks. 5th edition. Munich 2009.
  7. ↑ a b c Borwin Bandelow, Stefan Bleich, Stefan Kropp: Handbuch Psychopharmaka . 3rd, completely revised edition. Göttingen 2012.
  8. ↑ Gerd Laux, Hans-Jürgen Möller: Memorix Psychiatrie und Psychotherapie . 2nd updated edition. Thieme, 2011.
  9. ^ RT Owen: Pregabalin: its efficacy, safety and tolerability profile in generalized anxiety. In: Drugs Today . 43 (9), Sep 2007, pp. 601-610.
  10. ↑ Drugs Commission of the German Medical Association: Potential for addiction to pregabalin (Lyrica®) (from the UAW database) In: Deutsches Ärzteblatt. Volume 108, Issue 4, January 28, 2011, accessed on November 16, 2014.
  11. ↑ Dieter Melchart: Naturopathic Treatment: Guide for medical training, further education and training. Study edition. 1. Reprint. Stuttgart 2008.