Anxiolytics

Anxiolytics are medications used to reduce anxiety symptoms and associated distress. They encompass several pharmacologic classes, including benzodiazepines (for example diazepam, lorazepam, alprazolam), which enhance the effects of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor to produce calming effects. Non-benzodiazepine anxiolytics include buspirone, a serotonin 5-HT1A partial agonist, and certain antidepressants with anxiolytic properties such as selective serotonin reuptake inhibitors (SSRIs like escitalopram and sertraline) and serotonin-norepinephrine reuptake inhibitors (SNRIs like venlafaxine). Beta blockers such as propranolol may be used to reduce somatic symptoms of anxiety in performance situations. Gabapentinoids (gabapentin, pregabalin) and some antihistamines are also used in some settings, though not all are approved solely for anxiety.

Indications commonly include generalized anxiety disorder, panic disorder, social anxiety disorder, and other anxiety-related conditions; anxiolytics may also be employed to manage acute anxiety states or procedure-related anxiety in some contexts. Benzodiazepines typically have rapid onset and are often used for short-term relief, whereas buspirone and antidepressants require longer periods to achieve effect.

Safety considerations are central to their use. Adverse effects can include sedation, cognitive impairment, and motor incoordination. There is a risk of dependence and withdrawal with many agents, particularly benzodiazepines, and tolerance can develop with long-term use. Interactions with alcohol or other central nervous system depressants can be dangerous. Special considerations apply to older adults and during pregnancy or breastfeeding. Tapering is usually required to discontinue, especially for long-acting or high-dose regimens.

Nonpharmacologic approaches, such as cognitive-behavioral therapy, psychotherapy, exercise, and mindfulness, are commonly recommended alongside or prior to pharmacotherapy.