What are the Different Types of Anxiolytics?

Anti-anxiety medications, or anxiolytics, are varied in their method of action. Most drugs used to treat anxiety conditions work on the balance of chemicals in the brain and can either alter or inhibit the amount or action of a targeted neurotransmitter. Some types of these anxiolytic drugs include benzodiazepines, serotonin selective reuptake inhibitors (SSRIs), and azapirones. Barbiturates, which are extremely strong tranquilizers, are included in the group as well, but are rarely prescribed because of their large side effect profile and overdose potential. Other drugs, like beta blockers, are used as anxiolytics because they inhibit some of the major physical manifestations of anxiety and panic, such as rapid heartbeat and sweating that are experienced with an overactive “fight or flight” response.

Benzodiazepines have become some of the most commonly-prescribed anti-anxiety medications. The drugs in this category work to encourage the functioning of the gamma-Aminobutyric acid (GABA) system in the brain. GABA is an inhibitory neurotransmitter needed to slow down the stress response, and treatment with a benzodiazepine drug ensures that GABA receptors are adequately activated. Benzodiazepines work well because they are fast-acting and carry a low side effect profile, but tolerance, dependence, and withdrawal risk deters many clinicians from prescribing them for long periods of time. Some commonly-prescribed benzodiazepine anxiolytics include alprazolam, clonazepam, and diazepam.

SSRIs, like sertraline HCl and paroxetine hydrochloride, are often prescribed as long-term treatment options for anxiety disorders. They carry significantly less abuse risk and have been proven in clinical trials to be effective as anxiolytics. SSRIs, as well as related antidepressants, work by blocking the reuptake of serotonin, which increases the amount of the substance available in the synapse, which then helps balance the chemical ratio in the brain. When the brain reaches a point of homeostasis during treatment with SSRIs, anxiety and worry are significantly decreased. One of the most glaring disadvantages to treatment with this type of medication is the time it takes for the drug to build up to pharmacologically active levels in the system, which is sometimes up to two months.

Azapirones, like buspirone, are a newer type of anxiolytic. They work in much the same way as an SSRI, but they address anxiety more thoroughly by not only increasing serotonin, but regulating dopamine uptake as well. The mechanism of azapirones is not fully understood, but many researchers agree that its effectiveness might also be due to a correlation with GABAergic pathways in the brain.