Category:Anxiolytics: Difference between revisions

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[[~~Fluoxetine~~]]

The '''anxiolytics''' are the medicines given to reduce anxiety, and the class has a clear moment of origin: the mid-1950s and a small laboratory in New Jersey. Frank Berger, a Czech-born pharmacologist who had studied in Prague and then worked in London before emigrating to the United States, was running research at Wallace Laboratories when his team settled on a compound, meprobamate, that calmed animals more selectively than the barbiturates then dominating psychiatric prescribing. When meprobamate reached the United States market in 1955 under the name Miltown, it was the first medicine promoted explicitly as a treatment for anxiety. Within two years it was the most prescribed medicine in the United States.<ref name=tone>Tone A. ''The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers''. New York: Basic Books; 2009. ISBN 978-0-465-08638-2.</ref>

The cultural response was without precedent. Celebrities were reported to take it; cartoons appeared in newspapers; the word tranquilizer passed into ordinary speech. The pattern Miltown established, a medicine for anxiety, eagerly prescribed, enthusiastically taken, eventually found troubling, would repeat itself. In the late 1950s, Leo Sternbach's laboratory at Hoffmann-La Roche in Nutley, New Jersey, inadvertently produced chlordiazepoxide, the first benzodiazepine, in the course of tidying a shelf of old compounds, and by the early 1970s the benzodiazepines had displaced meprobamate and the barbiturates alike to become the most prescribed class of medicines in the world.<ref name=lopez>López-Muñoz F, Alamo C, García-García P. The discovery of chlordiazepoxide and the clinical introduction of benzodiazepines: half a century of anxiolytic drugs. ''Journal of Anxiety Disorders''. 2011 May;25(4):554–562. PMID: 21315551.</ref>

The benefits were real. Against the barbiturates, whose overdose risk had claimed too many lives, the benzodiazepines were a genuine improvement in safety, and they controlled anxiety, insomnia, muscle spasm, and seizures reliably. The hazard came from long-term use. By the early 1980s, researchers including Malcolm Lader and Peter Tyrer had established that ordinary therapeutic doses taken over weeks or months could produce physical dependence, with a withdrawal syndrome on stopping that was sometimes prolonged and severe.<ref name=lader>Lader M. Benzodiazepines revisited: will we ever learn? ''Addiction''. 2011 Dec;106(12):2086–2109. PMID: 21714826.</ref> The crisis of dependence reoriented prescribing and sent pharmacology looking for alternatives.

Two things arrived in the 1980s that reshaped the class. In 1980 the third edition of the Diagnostic and Statistical Manual (DSM-III) separated anxiety neurosis into a set of distinct conditions, among them panic disorder, generalized anxiety disorder, social anxiety disorder, and post-traumatic stress disorder. That act of taxonomy had a practical consequence: medicines could be trialed against defined diagnoses, and the trials that followed showed that the selective serotonin reuptake inhibitors, the SSRIs, developed for depression, also worked against anxiety at several of these newly named conditions. By the 1990s the SSRIs had become first-line for most anxiety disorders, not because they surpassed the benzodiazepines in speed, but because they lacked the dependence risk and were already in wide use for the depression that so frequently accompanies anxiety.<ref name=bandelow>Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. ''Dialogues Clin Neurosci''. 2017;19(2):93–107. PMID: 28867934.</ref>

The other development was buspirone, approved in 1986 as the first anxiolytic with a mechanism outside the GABA system. Buspirone is a partial agonist at the serotonin 5-HT1A receptor; it has no meaningful action at the GABA-A receptor where the benzodiazepines act. It does not produce sedation on the first dose, does not appear to cause dependence, and does not interact dangerously with alcohol. Those properties made it attractive, but in practice it is slow, taking one to four weeks for benefit to accumulate, and patients accustomed to the rapid action of benzodiazepines often find it unsatisfying.<ref name=buspirone>Taylor DP. Buspirone, a new approach to the treatment of anxiety. ''FASEB J''. 1988;2(9):2445–2452. PMID: 2836252.</ref> It remains an option, used mainly in generalized anxiety disorder, but it has not dislodged the benzodiazepines or the SSRIs.

Anxiolytic names a desired effect rather than a mechanism, and the medicines gathered under the word span most of psychopharmacology. This category collects the wiki's pages for the medicines used to reduce anxiety, grouped by class.

== Anxiolytics indexed ==

The anxiolytics are a pharmacologically mixed group, united by clinical use rather than by shared mechanism. They are grouped here by class.

* '''[[:Category:Benzodiazepines|Benzodiazepines]]''': the founding class for anxiety treatment in the modern era, and still the most widely used for acute and situational anxiety. They act at the GABA-A receptor, where they strengthen the effect of the inhibitory neurotransmitter GABA without activating it directly. Fast-acting short-course members include [[alprazolam]] and [[lorazepam]]; longer-acting members such as [[diazepam]] and [[clonazepam]] are used in anxiety, in epilepsy, and in alcohol withdrawal. The benzodiazepines are indexed collectively at [[:Category:Benzodiazepines|Benzodiazepines]].

* '''[[:Category:Azapirones|Azapirones]]''': [[buspirone]], the only approved member of the class, a partial agonist at the serotonin 5-HT1A receptor. Used for generalized anxiety disorder. It is slower to act than the benzodiazepines but carries no dependence risk.

* '''Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)''': now the first-line medicines for most anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and post-traumatic stress disorder. They were not designed as anxiolytics, but their regulatory approvals extend across the anxiety diagnostic landscape. Relevant members are indexed under [[:Category:Selective Serotonin Reuptake Inhibitors (SSRIs)|SSRIs]] and [[:Category:Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)|SNRIs]] and appear here as cross-listed members because the treatment of anxiety is, for many of them, their primary clinical role.

* '''Antihistamines''': [[hydroxyzine]], a first-generation antihistamine with regulatory approval in several jurisdictions for anxiety and tension. It acts at histamine H1 receptors and at serotonin receptors; it is sedating, takes effect quickly, and carries no dependence potential.

* '''Beta-blockers''': [[propranolol]] is used off-label for the physical symptoms of situational anxiety, particularly performance anxiety: the rapid heartbeat and the tremor, without the sedation the benzodiazepines can produce. It does not reduce the subjective sense of worry. It belongs primarily to [[:Category:Beta Blockers|Beta Blockers]] and appears here for its anxiolytic-indication use.

* '''Gabapentinoids''': [[pregabalin]] holds regulatory approval for generalized anxiety disorder in the European Union, though not in the United States, where its anxiety use is off-label. [[gabapentin]] is used similarly in some settings. Both act at voltage-gated calcium channels and reduce neuronal excitability; their anxiolytic action does not involve GABA-A receptor modulation, despite the class name.

* '''Historical agents''': [[meprobamate]] (Miltown), the founding commercial anxiolytic of 1955, now largely discontinued; and the [[barbiturates]], which preceded the modern era. Both are retained in the wiki for their historical place in the class.

== Notes on scope ==

This category indexes the medicines used specifically to reduce anxiety, by regulatory approval or by established clinical practice, across the class boundaries of pharmacology.

Anxiolytic names a therapeutic effect, not a mechanism. The benzodiazepines and meprobamate act on the GABA system; buspirone acts on serotonin; the SSRIs and SNRIs act on monoamine reuptake; hydroxyzine acts on histamine receptors; the gabapentinoids act on calcium channels. The shared criterion for inclusion is clinical use against anxiety, either by regulatory approval or by well-established prescribing practice.

Several classes indexed here have canonical home categories and appear in this category as multi-membership cross-listings: the benzodiazepines under [[:Category:Benzodiazepines|Benzodiazepines]], the SSRIs under [[:Category:Selective Serotonin Reuptake Inhibitors (SSRIs)|SSRIs]], the SNRIs under [[:Category:Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)|SNRIs]], propranolol under [[:Category:Beta Blockers|Beta Blockers]], and the gabapentinoids under their respective categories. This page assembles them by clinical use; it is not their primary home.

The wiki maintains a parallel category for herbal anxiolytics, [[:Category:Anxiolytic herbs|Anxiolytic herbs]], which collects the plant-medicine pages where anxiety relief is a documented traditional or clinical indication, among them valerian, passionflower, lemon balm, and kava. Those pages are not indexed here; this category covers pharmaceutical-origin medicines.

== About these pages ==

Each medicine indexed here has its own page, built on the wiki's standard structure for a medicine: a history-first account, then pharmacology, indications, adverse effects, and interactions.

This is one of the wiki's MedCategory class-overview pages. It carries the [[:Category:MedCategory|MedCategory]] and [[:Category:MedCategoryFull|MedCategoryFull]] marker tags; the second suppresses the member list that MediaWiki would otherwise generate automatically, leaving the curated index above as the only one the reader sees. The category sits beneath [[:Category:Medicines|Medicines]] and beneath [[:Category:Pharmaceutical|Pharmaceutical]], the origin category for medicines that came into use through scientific discovery rather than traditional practice.

== References ==

[[Category:MedCategory]]

[[Category:MedCategoryFull]]

[[Category:Medicines]]

[[Category:Pharmaceutical]]

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