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Tranquilizers/Anxiolytics: Definition, Indications, Contraindications, and Treatment

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NeuroPsychopharmacotherapy

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Abstract

The term “anxiolytics” has been more commonly used recently instead of “tranquilizers” or “minor tranquilizers” to describe this group of substances and medications used in the treatment of states of anxiety, tension, fear, agitation, and anxiety disorders.

Although benzodiazepines are commonly perceived as the main drugs representing this group, other and newer compounds targeting neurobiological and neurotransmitter systems including but not limited to the gamma-aminobutyric acid (GABA) system and the monoaminergic (serotonin/norepinephrine) systems have been increasingly studied and used in clinical practice.

This chapter provides an introduction and overview of the book section “Tranquilizers/Anxiolytics” on current and evolving pharmacological approaches in the treatment of anxiety disorders, anxiety states, and symptoms. Mechanisms of action, pharmacokinetic aspects, indications and contraindications, general information and principles, potential clinical limitations and barriers of treatment with anxiolytic medications, as well as novel agents are summarized.

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References

  • Ahmed S, Stanciu CN, Kotapati PV, Ahmed R, Bhivandkar S, Khan AM, et al. Effectiveness of gabapentin in reducing cravings and withdrawal in alcohol use disorder: a meta-analytic review. Prim Care Companion CNS Disord. 2019;21(4):19r02465.

    PubMed  Google Scholar 

  • Aquin JP, El-Gabalawy R, Sala T, Sareen J. Anxiety disorders and general medical conditions: current research and future directions. Focus (Am Psychiatr Publ). 2017;15(2):173–81.

    PubMed  Google Scholar 

  • Arbex MA, Varella Mde C, Siqueira HR, Mello FA. Antituberculosis drugs: drug interactions, adverse effects, and use in special situations. Part 2: second line drugs. J Bras Pneumol. 2010a;36(5):641–56.

    PubMed  Google Scholar 

  • Arbex MA, Varella MCL, Siqueira HR, Mello FAF. Drogas antituberculose: interações medicamentosas, efeitos adversos e utilização em situações especiais – parte 2: fármacos de segunda linha. J Bras Pneumol. 2010b;36:641–56.

    PubMed  Google Scholar 

  • Arunogiri S, Lubman DI. Anxiety and substance use disorders: a worrying combination. Australas Psychiatry. 2015;23(4):382–7.

    PubMed  Google Scholar 

  • Bailey L, Ward M, Musa MN. Clinical pharmacokinetics of benzodiazipines. J Clin Pharmacol. 1994;34(8):804–11.

    CAS  PubMed  Google Scholar 

  • Baldwin DS, Ajel K, Masdrakis VG, Nowak M, Rafiq R. Pregabalin for the treatment of generalized anxiety disorder: an update. Neuropsychiatr Dis Treat. 2013;9:883–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Bandelow B. Current and novel psychopharmacological drugs for anxiety disorders. Adv Exp Med Biol. 2020;1191:347–65.

    CAS  PubMed  Google Scholar 

  • Barnes P, Davies PD, Gordon SB. Clinical tuberculosis. London: CRC Press; 2008.

    Google Scholar 

  • Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897–910.

    CAS  PubMed  Google Scholar 

  • Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010;49(10):661–9.

    CAS  PubMed  Google Scholar 

  • Bossard JB, Ponté C, Dupouy J, Lapeyre-Mestre M, Jouanjus E. Disproportionality analysis for the assessment of abuse and dependence potential of pregabalin in the French Pharmacovigilance Database. Clin Drug Investig. 2016;36(9):735–42.

    CAS  PubMed  Google Scholar 

  • Bystritsky A. Treatment-resistant anxiety disorders. Mol Psychiatry. 2006;11(9):805–14.

    CAS  PubMed  Google Scholar 

  • Cascade E, Kalali AH. Use of benzodiazepines in the treatment of anxiety. Psychiatry (Edgmont). 2008;5(9):21–2.

    PubMed  Google Scholar 

  • Castaneda R, Sussman N, Westreich L, Levy R, O’Malley M. A review of the effects of moderate alcohol intake on the treatment of anxiety and mood disorders. J Clin Psychiatry. 1996;57(5):207–12.

    CAS  PubMed  Google Scholar 

  • Chessick CA, Allen MH, Thase M, Batista Miralha da Cunha AB, Kapczinski FF, de Lima MS, et al. Azapirones for generalized anxiety disorder. Cochrane Database Syst Rev. 2006;3:Cd006115.

    Google Scholar 

  • Cobham VE, Hickling A, Kimball H, Thomas HJ, Scott JG, Middeldorp CM. Systematic review: anxiety in children and adolescents with chronic medical conditions. J Am Acad Child Adolesc Psychiatry. 2020;59(5):595–618.

    PubMed  Google Scholar 

  • Coryell W, Fiedorowicz JG, Solomon D, Leon AC, Rice JP, Keller MB. Effects of anxiety on the long-term course of depressive disorders. Br J Psychiatry. 2012;200(3):210–5.

    PubMed  PubMed Central  Google Scholar 

  • Craske MG, Stein MB. Anxiety. Lancet. 2016;388(10063):3048–59.

    PubMed  Google Scholar 

  • Crocker CE, Carter AJE, Emsley JG, Magee K, Atkinson P, Tibbo PG. When cannabis use goes wrong: mental health side effects of cannabis use that present to emergency services. Front Psychol. 2021;12:640222.

    Google Scholar 

  • Cross AL, Viswanath O, Sherman AL. Pregabalin. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC.; 2021.

    Google Scholar 

  • Cvjetkovic-Bosnjak M, Soldatovic-Stajic B, Babovic SS, Boskovic K, Jovicevic M. Pregabalin versus sertraline in generalized anxiety disorder. An open label study. Eur Rev Med Pharmacol Sci. 2015;19(11):2120–4.

    CAS  PubMed  Google Scholar 

  • Dong G, Bai X, Aimila A, Aisa HA, Maiwulanjiang M. Study on lavender essential oil chemical compositions by GC-MS and improved pGC. Molecules. 2020;25(14):3166.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Doroshyenko O, Rokitta D, Zadoyan G, Klement S, Schläfke S, Dienel A, et al. Drug cocktail interaction study on the effect of the orally administered lavender oil preparation silexan on cytochrome P450 enzymes in healthy volunteers. Drug Metab Dispos. 2013;41(5):987–93.

    CAS  PubMed  Google Scholar 

  • El-Gabalawy R, Mackenzie CS, Shooshtari S, Sareen J. Comorbid physical health conditions and anxiety disorders: a population-based exploration of prevalence and health outcomes among older adults. Gen Hosp Psychiatry. 2011;33(6):556–64.

    PubMed  Google Scholar 

  • Erhorn S. Buspirone. In: Enna SJ, Bylund DB, editors. xPharm: the comprehensive pharmacology reference. New York: Elsevier; 2007. p. 1–5.

    Google Scholar 

  • Gair SL, Brown HR, Kang S, Grabell AS, Harvey EA. Early development of comorbidity between symptoms of ADHD and anxiety. Res Child Adolesc Psychopathol. 2021;49(3):311–23.

    PubMed  PubMed Central  Google Scholar 

  • Gao K, Kemp DE, Conroy C, Ganocy SJ, Findling RL, Calabrese JR. Comorbid anxiety and substance use disorders associated with a lower use of mood stabilisers in patients with rapid cycling bipolar disorder: a descriptive analysis of the cross-sectional data of 566 patients. Int J Clin Pract. 2010;64(3):336–44.

    CAS  PubMed  Google Scholar 

  • Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD, et al. Pharmacotherapy of anxiety disorders: current and emerging treatment options. Front Psychol. 2020;11:595584.

    Google Scholar 

  • Gilman SE, Dupuy JM, Perlis RH. Risks for the transition from major depressive disorder to bipolar disorder in the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2012;73(6):829–36.

    PubMed  PubMed Central  Google Scholar 

  • Goodman CW, Brett AS. A clinical overview of off-label use of gabapentinoid drugs. JAMA Intern Med. 2019;179(5):695–701.

    PubMed  Google Scholar 

  • Greenblatt HK, Greenblatt DJ. Gabapentin and pregabalin for the treatment of anxiety disorders. Clin Pharmacol Drug Dev. 2018;7(3):228–32.

    CAS  PubMed  Google Scholar 

  • Griffin CE 3rd, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013;13(2):214–23.

    PubMed  PubMed Central  Google Scholar 

  • Gudex C. Adverse effects of benzodiazepines. Soc Sci Med. 1991;33(5):587–96.

    CAS  PubMed  Google Scholar 

  • Guina J, Merrill B. Benzodiazepines I: up** the care on downers: the evidence of risks, benefits and alternatives. J Clin Med. 2018;7(2):17.

    PubMed  PubMed Central  Google Scholar 

  • Heger-Mahn D, Pabst G, Dienel A, Schläfke S, Klip** C. No interacting influence of lavender oil preparation silexan on oral contraception using an ethinyl estradiol/levonorgestrel combination. Drugs R D. 2014;14(4):265–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Hershenberg R, Gros DF, Brawman-Mintzer O. Role of atypical antipsychotics in the treatment of generalized anxiety disorder. CNS Drugs. 2014;28(6):519–33.

    CAS  PubMed  Google Scholar 

  • Hofmann SG. D-cycloserine for treating anxiety disorders: making good exposures better and bad exposures worse. Depress Anxiety. 2014;31(3):175–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Huang X, Yang J, Yang S, Cao S, Qin D, Zhou Y, et al. Role of tandospirone, a 5-HT1A receptor partial agonist, in the treatment of central nervous system disorders and the underlying mechanisms. Oncotarget. 2017;8(60):102705–20.

    PubMed  PubMed Central  Google Scholar 

  • Kasper S, Müller WE, Volz HP, Möller HJ, Koch E, Dienel A. Silexan in anxiety disorders: clinical data and pharmacological background. World J Biol Psychiatry. 2018;19(6):412–20.

    PubMed  Google Scholar 

  • Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(Suppl 1):S1.

    PubMed  PubMed Central  Google Scholar 

  • Koulivand PH, Khaleghi Ghadiri M, Gorji A. Lavender and the nervous system. Evid-based Compl Alternat Med: eCAM. 2013;2013:681304.

    Google Scholar 

  • Krystal JH, Petrakis IL, Limoncelli D, Nappi SK, Trevisan L, Pittman B, et al. Characterization of the interactive effects of glycine and D-cycloserine in men: further evidence for enhanced NMDA receptor function associated with human alcohol dependence. Neuropsychopharmacology. 2011;36(3):701–10.

    CAS  PubMed  Google Scholar 

  • Lader M. Antianxiety drugs: clinical pharmacology and therapeutic use. Drugs. 1976;12(5):362–73.

    CAS  PubMed  Google Scholar 

  • López V, Nielsen B, Solas M, Ramírez MJ, Jäger AK. Exploring pharmacological mechanisms of lavender (Lavandula angustifolia) essential oil on central nervous system targets. Front Pharmacol. 2017;8:280.

    PubMed  PubMed Central  Google Scholar 

  • López-Muñoz F, Ucha-Udabe R, Alamo C. The history of barbiturates a century after their clinical introduction. Neuropsychiatr Dis Treat. 2005;1(4):329–43.

    PubMed  PubMed Central  Google Scholar 

  • Malcolm BJ, Tallian K. Essential oil of lavender in anxiety disorders: ready for prime time? Ment Health Clin. 2017;7(4):147–55.

    PubMed  Google Scholar 

  • Mason BJ, Quello S, Shadan F. Gabapentin for the treatment of alcohol use disorder. Expert Opin Investig Drugs. 2018;27(1):113–24.

    CAS  PubMed  Google Scholar 

  • Mataix-Cols D, Fernández de la Cruz L, Monzani B, Rosenfield D, Andersson E, Pérez-Vigil A, et al. D-Cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data. JAMA Psychiat. 2017;74(5):501–10.

    Google Scholar 

  • Mikuriya TH. Marijuana in medicine: past, present and future. Calif Med. 1969;110(1):34–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Mula M, Pini S, Cassano GB. The role of anticonvulsant drugs in anxiety disorders: a critical review of the evidence. J Clin Psychopharmacol. 2007;27(3):263–72.

    CAS  PubMed  Google Scholar 

  • Murrough JW, Yaqubi S, Sayed S, Charney DS. Emerging drugs for the treatment of anxiety. Expert Opin Emerg Drugs. 2015;20(3):393–406.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Nemeroff CB. Anxiolytics: past, present, and future agents. J Clin Psychiatry. 2003;64(Suppl 3):3–6.

    CAS  PubMed  Google Scholar 

  • Offe H. Historical introduction and chemical characteristics of antituberculosis drugs. In: Antituberculosis drugs. Berlin: Springer; 1988. p. 1–30.

    Google Scholar 

  • Ori R, Amos T, Bergman H, Soares-Weiser K, Ipser JC, Stein DJ. Augmentation of cognitive and behavioural therapies (CBT) with d-cycloserine for anxiety and related disorders. Cochrane Database Syst Rev. 2015;5:Cd007803.

    Google Scholar 

  • Owen RT. Pregabalin: its efficacy, safety and tolerability profile in generalized anxiety. Drugs Today (Barc). 2007;43(9):601–10.

    CAS  PubMed  Google Scholar 

  • Patel S, Hill MN, Cheer JF, Wotjak CT, Holmes A. The endocannabinoid system as a target for novel anxiolytic drugs. Neurosci Biobehav Rev. 2017;76(Pt A):56–66.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Pies R. Should psychiatrists use atypical antipsychotics to treat nonpsychotic anxiety? Psychiatry (Edgmont). 2009;6(6):29–37.

    PubMed  Google Scholar 

  • Quintero GC. Review about gabapentin misuse, interactions, contraindications and side effects. J Exp Pharmacol. 2017;9:13–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Rissardo JP, Caprara ALF. Buspirone-associated movement disorder: a literature review. Prague Med Rep. 2020;121(1):5–24.

    PubMed  Google Scholar 

  • Roy-Byrne P. Treatment-refractory anxiety; definition, risk factors, and treatment challenges. Dialogues Clin Neurosci. 2015;17(2):191–206.

    PubMed  PubMed Central  Google Scholar 

  • Schade S, Paulus W. D-Cycloserine in neuropsychiatric diseases: a systematic review. Int J Neuropsychopharmacol. 2016;19(4):pyv102.

    PubMed  Google Scholar 

  • Schanzer B, Rivas-Grajales AM, Khan A, Mathew SJ. Novel investigational therapeutics for generalized anxiety disorder (GAD). Expert Opin Investig Drugs. 2019;28(11):1003–12.

    CAS  PubMed  Google Scholar 

  • Schuwald AM, Nöldner M, Wilmes T, Klugbauer N, Leuner K, Müller WE. Lavender oil-potent anxiolytic properties via modulating voltage dependent calcium channels. PLoS One. 2013;8(4):e59998.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Shim IH, Bae DS, Bahk WM. Anxiety or agitation in mood disorder with mixed features: a review with a focus on validity as a dimensional criterion. Ann Clin Psychiatry. 2016;28(3):213–20.

    PubMed  Google Scholar 

  • Sieghart W. Pharmacology of benzodiazepine receptors: an update. J Psychiatry Neurosci. 1994;19(1):24–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Smith JP, Book SW. Anxiety and substance use disorders: a review. Psychiatr Times. 2008;25(10):19–23.

    PubMed  PubMed Central  Google Scholar 

  • Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160–74.

    PubMed  PubMed Central  Google Scholar 

  • Sumiyoshi T, Matsui M, Nohara S, Yamashita I, Kurachi M, Sumiyoshi C, et al. Enhancement of cognitive performance in schizophrenia by addition of tandospirone to neuroleptic treatment. Am J Psychiatry. 2001;158(10):1722–5.

    CAS  PubMed  Google Scholar 

  • Turna J, Patterson B, Van Ameringen M. Is cannabis treatment for anxiety, mood, and related disorders ready for prime time? Depress Anxiety. 2017;34(11):1006–17.

    PubMed  Google Scholar 

  • Wick JY. The history of benzodiazepines. Consult Pharm. 2013;28(9):538–48.

    PubMed  Google Scholar 

  • Wilson TK, Tripp J. Buspirone. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC.; 2021.

    Google Scholar 

  • Yap WS, Dolzhenko AV, Jalal Z, Hadi MA, Khan TM. Efficacy and safety of lavender essential oil (Silexan) capsules among patients suffering from anxiety disorders: a network meta-analysis. Sci Rep. 2019;9(1):18042.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Zhu M, Zhao W, Jimenez H, Zhang D, Yeola S, Dai R, et al. Cytochrome P450 3A-mediated metabolism of buspirone in human liver microsomes. Drug Metab Dispos. 2005;33(4):500–7.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Stefan Kloiber

  2. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Gerasimos Konstantinou

  3. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Gerasimos Konstantinou

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  1. Stefan Kloiber
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  2. Gerasimos Konstantinou
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Correspondence to Stefan Kloiber .

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Editors and Affiliations

  1. Clinic and Policlinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital Wuerzburg, Wuerzburg, Germany

    Peter Riederer

  2. Institute of Psychological Medicine (IPM), Soyen, Germany

    Gerd Laux

  3. Centre for Research Promotion and Support, Fujita Health University, Toyoake, Aichi, Japan

    Toshiharu Nagatsu

  4. Center Translational Res Neurol Diseases, Dalian Med Uni Shanghai Inst Health Sc Center Translational Res Neurol Diseases, Dalian, China

    Weidong Le

  5. Würzburg, Germany

    Christian Riederer

Section Editor information

  1. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Stefan Kloiber

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Kloiber, S., Konstantinou, G. (2022). Tranquilizers/Anxiolytics: Definition, Indications, Contraindications, and Treatment. In: Riederer, P., Laux, G., Nagatsu, T., Le, W., Riederer, C. (eds) NeuroPsychopharmacotherapy. Springer, Cham. https://doi.org/10.1007/978-3-030-62059-2_59

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  • DOI: https://doi.org/10.1007/978-3-030-62059-2_59

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