An anxiolytic (also antipanic or antianxiety agent) is a drug used for the treatment of anxiety, and its related psychological and physical symptoms. Anxiolytics have been shown to be useful in the treatment of anxiety disorders.
Anxiolytics are also known as minor tranquilizers. The term is less common in modern texts, and was originally derived from a dichotomy with major tranquilizers, also known as neuroleptics or antipsychotics.
Types of anxiolytics
Benzodiazepines are prescribed for short-term relief of severe and disabling anxiety. 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. There is a risk of a benzodiazepine withdrawal and rebound syndrome after continuous usage for longer than two weeks, and tolerance and dependence may occur if patients stay under this treatment for longer. There is also the added problem of the accumulation of drug metabolites and adverse effects. Benzodiazepines include:
- Alprazolam (Xanax)
- Chlordiazepoxide (Librium)
- Clonazepam (Klonopin)
- Diazepam (Valium)
- Etizolam (Etilaam)
- Lorazepam (Ativan)
- Tofisopam (Emandaxin and Grandaxin) is a drug that is a benzodiazepine derivative. Like other benzodiazepines, it possesses anxiolytic properties, but, unlike other benzodiazepines, it does not have anticonvulsant, sedative, skeletal muscle relaxant, motor skill-impairing, or amnestic properties.
Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor (SSRIs) are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. SSRIs are primarily classified as antidepressants and typically higher dosages are required to be effective against anxiety disorders than to be effective against depression but nevertheless most SSRIs have anxiolytic properties, but are anxiogenic when first initiating treatment, and in some individuals continue to be anxiety-provoking. For this reason, a low dose of a benzodiazepine is often used for several weeks when initiating SSRI/SNRI therapy in order to counteract the initial anxiety caused by the drugs until the therapeutic delay of the SSRI/SNRI is finished and the drug becomes effective. Older tricyclic antidepressants (TCAs) are very anxiolytic as well, however, side effects are greater. Examples include: imipramine, doxepin, amitriptyline, and the unrelated trazodone. Mono-amine oxidase inhibitors (MAOIs) are very effective for anxiety, but due to drug dangers, are rarely prescribed. Examples include: Nardil and Parnate.
Azapirones are a class of 5-HT1A receptor agonists. They lack the sedation and the dependence associated with benzodiazepines and cause much less cognitive impairment. They may be less effective than benzodiazepines in patients who have been previously treated with benzodiazepines as they do not provide the sedation that these patients may expect or equate with anxiety relief. Currently approved azapirones include buspirone (Buspar) and tandospirone (Sediel). Gepirone (Ariza, Variza) is also in clinical development.
Barbiturates exert an anxiolytic effect linked to the sedation they cause. The risk of abuse and addiction is high. Many experts consider these drugs obsolete for treating anxiety but valuable for the short-term treatment of severe insomnia, though only after benzodiazepines or non-benzodiazepines have failed. They are rarely prescribed anymore.
Hydroxyzine (Atarax) is an old antihistamine originally approved for clinical use by the FDA in 1956. It possesses anxiolytic properties in addition to its antihistamine properties and is also licensed for the treatment of anxiety and tension. It is also used for its sedative properties as a premed before anesthesia or to induce sedation after anesthesia. It has been shown to be as effective as benzodiazepines in the treatment of generalized anxiety disorder, while producing fewer side-effects.
Pregabalin's therapeutic effect appears after 1 week of use and is similar in effectiveness to lorazepam, alprazolam, and venlafaxine, but pregabalin has demonstrated superiority by producing more consistent therapeutic effects for psychic and somatic anxiety symptoms. Long-term trials have shown continued effectiveness without the development of tolerance, and, in addition, unlike benzodiazepines, it does not disrupt sleep architecture and produces less severe cognitive and psychomotor impairment; it also has a low potential for abuse and dependence and may be preferred over the benzodiazepines for these reasons.
Certain natural substances are reputed to have anxiolytic properties, including the following:
- Bacopa monnieri (Brahmi)
- Lactuca virosa (Opium Lettuce)
- Rhodiola rosea (Arctic Weed/Golden Root)
- Hypericum perforatum (St. John's Wort)
- Matricaria recutita (German Chamomile)
- Mitragyna speciosa (Kratom)
- Piper methysticum (Kava)
- Sceletium tortuosum (Kanna)
- Scutellaria spp. (Skullcap)
- Valeriana officinalis (Valerian)
- Salvia splendens (Not to be confused with Salvia divinorum)
- Coriandrum sativum (Coriander) 
- Myristica (Nutmeg)
- Salvia Elegans (Pineapple Sage) 
- Inositol  In a double-blind, controlled trial, myo-inositol (18 grams daily) was superior to fluvoxamine for decreasing the number of panic attacks and had fewer side-effects.
- Cannabidiol (Marijuana) 
Over-the-counter pharmaceutical drugs
Picamilon is a prodrug formed by combining niacin with GABA that is able to cross the blood-brain barrier and is then hydrolyzed into GABA and niacin. It is theorized that the GABA released in this process activates GABA receptors, with potential to produce an anxiolytic response.  Picamilon is sold in the United States as a dietary supplement, while in Russia it is sold over the counter.
Chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl) have hypnotic and sedative effects with mild anxiolytic-like properties (off-label use). These drugs are approved by the FDA for allergies, rhinitis, and urticaria.
Due to deficits with existing anxiolytics (either in terms of efficacy or side-effect profile), research into novel anxiolytics is active. Possible candidates for future drugs include:
Alternatives to medication
Psychotherapeutic treatment can be an effective alternative to medication. Exposure therapy is the recommended treatment for phobic anxiety disorders. Cognitive behavioral therapy (CBT) has been found to be effective treatment for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Healthcare providers can also help by educating sufferers about anxiety disorders and referring individuals to self help resources. CBT has been shown to be effective in the treatment of generalized anxiety disorder, and possibly more effective than pharmacological treatments in the long term. Sometimes medication is combined with psychotherapy but research has found that there is no benefit of combined pharmacotherapy and psychotherapy versus monotherapy.
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Look at other dictionaries:
anxiolytic — [aŋ΄zē ō lit′ik, aŋk΄sēmō lit′ik] adj. [< ANXI(ETY) + O + LYTIC (sense 2)] relieving tension or anxiety n. any anxiolytic drug or substance … English World dictionary
anxiolytic — noun Etymology: anxiety + o + lytic Date: 1965 a drug that relieves anxiety • anxiolytic adjective … New Collegiate Dictionary
anxiolytic — 1. SYN: antianxiety agent. 2. Denoting the actions of such an agent ( e.g., diazepam). [anxiety + G. lysis, a dissolution or loosening] * * * anx·io·lyt·ic .aŋ zē ō lit ik, .aŋ(k) sē n a drug that relieves anxiety anxiolytic adj relieving anxiety … Medical dictionary
anxiolytic — I noun a tranquilizer used to relieve anxiety and reduce tension and irritability • Syn: ↑minor tranquilizer, ↑minor tranquillizer, ↑minor tranquilliser, ↑antianxiety drug, ↑anxiolytic drug • Hypernyms: ↑ … Useful english dictionary
anxiolytic — Drug that reduces anxiety, for example benzodiazepines and barbiturates … Dictionary of molecular biology
anxiolytic — /ang zee euh lit ik/, adj. 1. anxiety relieving. n. 2. See antianxiety drug. [1960 65; ANXI(ETY) + O + LYTIC] * * * … Universalium
anxiolytic — 1. adjective That reduces anxiety; tranquilizing 2. noun A drug prescribed for the treatment of symptoms of anxiety … Wiktionary
anxiolytic — adj. relieving anxiety, suppressing feelings of anxiety, reducing anxiety (Medicine) … English contemporary dictionary
anxiolytic — anx·io·lyt·ic … English syllables
anxiolytic — adj. describing a group of drugs used for the short term treatment of anxiety of various causes. Formerly known as minor tranquillizers, they include the benzodiazepines and buspirone. Common side effects of these drugs are drowsiness and… … The new mediacal dictionary