Anxiolytics

# Overview
An anxiolytic is a drug prescribed for the treatment of symptoms of anxiety. Some anxiolytics have been shown to be useful in the treatment of anxiety disorders as have antidepressants such as the class of selective serotonin reuptake inhibitors (SSRIs).
Though not anxiolytics, beta-receptor blockers such as propranolol and oxprenolol can be used to combat the somatic symptoms of anxiety.

# Types of Anxiolytics
Anxiolytics are generally divided into two groups of medication, benzodiazepines and non-benzodiazepines.

## Benzodiazepines
- Main article: Benzodiazepine
Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. Common medications are lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), and diazepam (Valium). Benzodiazepines may also be indicated to cover the latent periods associated with the medications prescribed to treat an underlying anxiety disorder. They are used to treat a wide variety of conditions and symptoms and are usually a first choice when short-term CNS sedation is needed. Longer term uses include treatment for severe anxiety and psychosis. There is a risk of withdrawal symptoms and rebound syndrome after continuous usage past two weeks. There is also the added problem of the accumulation of drug metabolites and adverse effects.

## Non-Benzodiazepines
Buspirone (Buspar) is a serotonin 1A agonist. It lacks the sedation and the dependence associated with benzodiazepines and causes much less cognitive impairment. It may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as the medication does not provide the sedation that these patients may expect or equate with anxiety relief.

## Barbiturates
Barbiturates and meprobamate exert an anxiolytic effect linked to the sedation they cause. The risk of abuse and addiction is high. Many experts consider these drugs as obsolete for treating anxiety, although they may be valuable for the short term treatment of severe insomnia.

## Herbal Treatments
Certain herbs, such as St. John's wort, kava (kava kava), chamomile, bacopa monniera and Valerian are reputed to have anxiolytic properties. With the exception of kava kava, only limited evidence exists for their efficacy.
Use of marijuana as an anxiolytic has seen promising results in regions where its practical study is possible, but its status as a controlled substance in many countries make its study as such difficult.

# Alternatives to Medication
Psychotherapy (e.g. cognitive or behavior therapy) is often useful as an adjunct to pharmacotherapy or as an alternative to medication.

# Anxiolytic Withdrawal

## Differential Diagnosis
- Alcohol withdrawal
- Anxiety disorders
- Essential tremor
- Hypoglycemia
- Diabetic ketoacidosis
- Seizure due to infections, head injury, poisonings

## DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Withdrawal

# Anxiolytic Intoxication

## Differential Diagnosis
- Alcohol use disorders
- Alcohol intoxication
- Delirium
- Traumatic brain injury

## DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Intoxication

# Anxiolytic Use Disorder

## Differential Diagnosis
- Alcohol use disorder
- Clinically appropriate use of the medication
- Generalized anxiety disorder
- Multiple sclerosis
- Subdural hematoma

## Epidemiology and Demographics of Sedative, Hypnotic, or Anxiolytic Use Disorder

### Prevalence
The 12 month prevalence of hypnotic or anxiolytic use disorder is:
- 300 per 100,000 (0.3%) among adults 12-17 years old
- 200 per 100,000 among adults 18 years and older

## Risk Factors
- Availability of the substances
- Alcohol use disorder
- Environmental factors
- Early onset of use
- Genetic predisposition
- Peer use of the substance

## DSM-V Diagnostic Criteria for Sedative, Hypnotic, or Anxiolytic Use Disorder