Anxiety Medication, Drug Treatments
Most of the psychopharmacological treatments currently used by psychiatry act chemically on the neurotransmission systems trying to regulate, conveniently, the activity of certain areas of the nervous system involved in the disorder to be treated.
In the treatment of anxiety, two types of drugs are usually used: anxiolytics, and antidepressants.
Anxiety Medication : Anxiety as an adaptive defense mechanism gives rise to psychological, physiological and behavioral changes in the body. It is generated and manifested at the level of the nervous system, which is mainly composed of cells called neurons. Neurons constitute the elementary units for the transmission of information of the nervous system. The information inside the same cell travels from one end to the other by electrical impulses. But this electrical impulse cannot pass directly from one neuron to the other, since there is a space between them (the so-called synaptic space) and they do not touch each other. The communication of one neuron with another occurs using neurotransmitters, which are chemicals released by the neural terminals. These neurotransmitters, which to understand us are like chemical keys, are released into the synaptic space (which separates one neuron from the next) where they travel to reach the receptors (let’s say they are like chemical locks) of the next neuron, causing changes in the permeability of its membrane which generates an electrical impulse or potential, which will travel along the cell, to the other end, and so on until necessary.
The most commonly used anxiolytics belong to the group of high-potency benzodiazepines (Alprazolam, Lorazepam, Diazepam, Chlorazepam, etc.). They produce a tranquilizing effect. They act by reducing anxiety symptoms in a matter of minutes and decreasing both the intensity and frequency of episodes of distress.
The main adverse effects of bezodiazepines consist of drowsiness, memory disturbances, attention and concentration disturbances. The deterioration of these cognitive functions is usually transient (it is experienced while the medication is being taken) and only occurs with high doses and prolonged over time. Another drawback is that its prolonged consumption can generate effects of dependence (addiction) and tolerance (progressive loss of effectiveness).
The antidepressants commonly used today in the treatment of anxiety disorders are SSRIs (Selective Serotonin Reuptake Inhibitors). They constitute the primary treatment of choice. Several studies point to the involvement of serotonin as the main neurotransmitter involved in anxiety disorders, although there are others. The group of SSRIs consists of Fluoxetine, Paroxetine, Fluvoxamine, Sertraline, Citalopram and Escitalopram. They have a high specificity against anxiety and few side effects (mainly weight gain, drowsiness, and sexual dysfunction). They hardly have interactions with other drugs and do not create dependence.
As disadvantages of SSRIs we will cite the side effects of the first days (nausea, headaches, transient increase in anxiety, etc.) Therefore it is convenient to start treatment with low doses, and associate tranquilizers the first weeks. In some patients, depending also on the drug chosen, they can cause some weight gain, or some loss of appetite or sexual response. Normally, the doctor will inform the patient about the mild and transient nature of these possible adverse symptoms. Another drawback is that the therapeutic effect does not begin until 2-3 weeks after starting the antidepressant.
There is very often an initial reluctance to psychopharmacological treatment, based mainly on the patient’s lack of knowledge about medication and the fear on his part of becoming dependent on the taking of these medications, or that it will cause excessive sedation.
In many cases, after the therapeutic effect has been achieved and the symptoms have subsided or disappeared, the patient already believes himself cured and sometimes hastily and abruptly abandons the medication. The professional should warn you of the risks inherent in this abrupt or premature suspension. The withdrawal of the medication should be scheduled by the doctor at the appropriate time and gradually. Likewise, the professional should insist on the correct compliance with the drug intake as the only way to achieve the desired therapeutic effect. The patient should also be informed about the possibility of other pharmacological alternatives other than benzodiazepines and SSRIs in the event that a favorable clinical evolution is not achieved with them. In the same way he will inform the patient about the risks of self-medication.
As a co-assistant to the psychopharmacological treatment, a modification of possible habits that could negatively influence the improvement of anxiety should be attempted (for example: consumption of caffeine, alcohol, cannabis, etc.)
The psychotherapeutic approach to anxiety disorders consists mainly of eliminating the fears that can give rise to the somatic symptoms that the patient perceives, as well as suppressing the erroneous interpretations of the different bodily sensations, along with the cancellation of possible avoidance behaviors with respect to anxiogenic stimuli.
There are numerous studies that demonstrate the advantages of combined treatments (psychopharmacological and psychotherapeutic) of anxiety disorders.
It seems that even in certain cases the strategy of using combined treatments produces an immediate therapeutic result superior to that obtained with a psychotherapeutic or psychopharmacological approach separately. It has also been observed that in the long term, and on certain occasions that these advantages seem to be less or even disappear. The proper sequencing of pharmacotherapy and cognitive behavioral psychotherapy can offer very good results. Cognitive-behavioral techniques can also help in the processes of discontinuation of anxiety medication, particularly in the case of long periods of consumption of anxiolytics.
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