Anxiety is a state of pervasive apprehension that may be triggered by specific environmental or personal factors. Anxiety states are generally combined with emotions such as fear, anger, or depression. A person with anxiety may complain of physical symptoms such as palpitations, nausea, dizziness, headaches, and chest pains, as well as sleeplessness and fatigue. When such apprehension is severe and incapacitating, the person may require treatment with both medication and psychotherapy.
After World War II, Swiss pharmacologists discovered muscle-relaxant properties in a compound under investigation as an antibiotic. Modification of that compound led to the tranquilizing drug meprobamate. Another discovery showed that the benzodiazepines, which are complex ringed compounds, had even greater relaxing properties. Hundreds of analogs of the basic benzodiazepine ring were subsequently synthesized. Different formulations of the basic benzodiazepine structure in higher dosages are used as muscle relaxants, antiepileptics, and sedative-hypnotics.
Neurons in the brain exhibit highly specific, high-affinity binding sites that can selectively recognize, or bind, the benzodiazepine compounds. The cellular and subcellular locations of these sites are near ion channels in the membrane that can admit chloride ions into the cell and also near sites where a neurotransmitter known as gamma-aminobutyric acid (GABA) acts. GABA exerts inhibitory actions on certain neurons and thereby reduces the transmission of nerve impulses. Benzodiazepines in general enhance the effects of GABA. One of the most widely prescribed of these agents is alprazolam (Xanax), which is used in the treatment of anxiety and panic disorder.
Acute treatment with benzodiazepines generally begins with doses taken before bedtime to facilitate sleep. Tolerance may develop to the sedation. Because of the alterations in the effectiveness of inhibitory transmitter actions of GABA, which are profound in the cerebellum and cerebral cortex, the patient may also exhibit confusion and loss of motor coordination as side effects of the drug.
Zolpidem and saleplon are antianxiety drugs that are GABA agonists, though structurally they are not benzodiazepines. The probability of developing dependence to these drugs is limited, even with repeated or prolonged use. They are used in the short-term treatment of insomnia.
Buspirone is another antianxiety drug that is unrelated to the benzodiazepines. It does not affect the GABA receptor, nor does it have any muscle-relaxant or anticonvulsive properties. It also lacks the prominent sedative effect that is associated with other drugs used to treat anxiety. Instead, buspirone is thought to be a partial agonist at a specific receptor for serotonin, a neurotransmitter found in the brain that is associated with mood changes. It has a much lower potential for abuse and is not associated with any withdrawal phenomena.