Stress is considered the epidemic of the 21st century. That is why many pharmacological researches have tried to find a solution to it that involves the administration of drugs.
Although what causes stress will hardly be solved by pills, being psychotherapy a totally necessary resource for the person to know how to face this emotion, the truth is that pharmacology is useful to treat the symptoms.
Here we’ll look at all the main groups of stress medicines currently in use , plus explain how they work on the body and some side effects and precautions to be aware of.
What does stress involve at the organic level?
Stress is a response by the body to the demands of the environment. Our body has to face a possible threat or risk that can harm our physical and mental integrity, for this reason it activates the sympathetic nervous system and prepares itself to carry out one of the following two responses: fight or flight.
This physiological activation mechanism is adaptive; however, if it is kept active for too long it sets off the parasympathetic nervous system , which tries to reach homeostasis. In other words, it tries to bring the body back to organic levels before the appearance of the threatening phenomenon.
Stress becomes a long-term problem, affecting both the physical and psychological health of those who are chronically stressed. The fact that this stress becomes chronic may be due to various factors, real or perceived, and its interpretation is highly variable depending on each person and the circumstance that causes it.
This is why the treatments, both psychological and pharmacological, aimed at treating this emotion are very varied, and there are options for practically each of the anxiety disorders listed in the DSM-5 . The combination of both treatments is very effective, given that psychotherapy provides the patient with strategies to detect the focus of their problem and medication helps to reduce the symptoms.
Next we will see the main drugs for stress, grouped into anxiolytics, antidepressants, neuroleptics and sympathictics.
Among the pharmacological options that exist to treat anxiety disorders, anxiolytics are the drugs of reference. In fact, their very name indicates that they are designed to treat stress, especially when it reaches pathological levels such as anxiety. These drugs control the physical symptoms, such as tremors, sweating or tachycardia .
Its mechanism of action is to depress the central nervous system, which causes the reduction of anxiety without the need to numb the person, although technically these drugs can be used for that purpose. Within the group of the anxiolytics, we can find the barbiturates and the benzodiazepines.
Barbiturates are a type of drug that act by lowering the level of activity of the central nervous system, giving as their main effect a state of generalised relaxation in the body , although at moderate and high doses they induce sedation.
Despite being effective, these drugs are known to be dangerous, since in addition to being highly addictive, an overdose can lead to death . This is why their use has been reduced over the decades, and many psychiatrists advise against their prescription.
Barbiturates can be used as a second option for treating insomnia when benzodiazepines have not worked well for a patient who suffers from sleep problems.
Benzodiazepines, as with barbiturates, induce depression of the central nervous system, decreasing nerve excitability. At low doses they calm the person, while at high doses they induce sleep and are used as a treatment for sleep disorders .
In anxiety and generalized stress disorders, they serve to reduce anxious symptoms for a few hours. This effect is beneficial in the short term, but there is a risk that the patient will make irresponsible use of the drug, becoming addicted by consuming them too often, and without psychotherapy they do not help solve the source of the problem.
The sustained and habitual consumption of benzodiazepines makes the organism accustomed to this type of drugs , making it more difficult to induce a state of relaxation over time, and contributing to the patient’s tendency to increase the dose.
In addition to stress and insomnia, benzodiazepines are also prescribed for muscle pain.
Some anxiolytics and their indications
As barbiturates have been used less and less, benzodiazepines have been gaining more prominence as the main therapeutic option for stress, and now we will look at the uses of some of them.
Clonazepam is used for the treatment of social phobia and Generalized Anxiety Disorder (GAD). Alprazolam, also known by its trade name, Xanax , is used for panic attacks, an indication shared with lorazepam, and also GAD. Buspirone is also used for GAD, although its therapeutic effects are not immediate. The patient must consume it for at least two weeks to begin to see results.
Another well known benzodiazepine is Valium , a drug that alters the transmission of nerve impulses, which promotes a decrease in the time needed to fall asleep, makes sleep longer and also decreases the REM phase.
Valium also reduces blood pressure and heart rate, the two main physiological symptoms of stress when it appears.
Because they induce sleep, anti-anxiety drugs are not indicated to be used before driving heavy machinery, such as vehicles . If this contraindication is not respected, there is a high risk of suffering a traffic accident.
Women who are trying to stay in shape should not take these drugs unless their doctor or psychiatrist sees that the benefits of taking them will outweigh the possible risks. It has been shown that anti-anxiety drugs can significantly reduce the life expectancy of older people.
The name of antidepressants may give the misconception that their sole purpose is to treat the symptoms of depression, which is not entirely the case. These drugs are also used for other psychological problems, including stress and anxiety disorders. Antidepressants prescribed for anxiety are usually started at low doses and then gradually increased.
The reason for this is its mechanism of action, which contributes to increased levels of serotonin in the central nervous system . This neurotransmitter is key to manifesting euthymia, that is, presenting healthy mood changes, which range from non-pathological sadness to joy, without reaching a manic state.
As with benzodiazepines, the antidepressants that are prescribed vary depending on the type of disorder the person is suffering from and its degree of intensity.
1. Selective serotonin reuptake inhibitors (SSRIs)
This type of antidepressant increases the levels of serotonin among the neurons, promoting the regulation of anger, aggression and organic changes such as body temperature, heart rate…
In addition to depression, SSRIs are used for several anxiety disorders, including GAD, obsessive-compulsive disorder (OCD) and social phobia, as well as eating disorders (ED) and premature ejaculation. The most commonly used SSRIs are fluoxetine, escitalopram, citalopram, paroxetine and sertraline .
Although they are effective for all the disorders we have mentioned, it should be noted that they have side effects, which usually occur between the first and fourth week of treatment. Among the most common are nausea, vomiting and other gastrointestinal problems such as diarrhea. Sleep problems such as drowsiness and, paradoxically, insomnia. Headaches, episodes of bruxism, i.e. tooth grinding, can also occur.
2. Tricyclic antidepressants
Tricyclic antidepressants were originally synthesized as a treatment for allergies, although they were later found to have therapeutic effects for psychosis and depression.
This type of antidepressant, whose chemical structure is composed of three rings, prevents the reuptake of serotonin and noradrenaline, causing a greater amount in the synaptic cleft and regulating, consequently, the mood.
This is why they are not only useful for depression, but also for anxiety disorders since, as with SSRIs, they help to have a euthymic mood.
However, they also have side effects, mostly due to their anticholinergic effects on the body. This means that bronchodilation, heart problems, as well as sexual dysfunction and weight gain can occur.
3. Monoamine oxidase inhibitors (MAOIs)
Its mechanism of action is to block the action of the monoamine oxidase enzyme . They have similar effects on mood as the antidepressants described above.
The main precaution of this type of drug is to avoid the consumption of foods containing tyramine, a substance that occurs in high quantities in fermented foods such as cheese and pickles. If consumed, the interaction of MAOIs with tyramine could result in a stroke.
Neuroleptics, better known as antipsychotics, are also prescribed for stress and anxiety problems, as long as they are consumed in low doses. Some of the best known are risperidone, quetiapine and olanzapine , used for GAD, OCD and panic attacks.
Despite their effectiveness with this type of disorder, they are not considered a good option compared to benzodiazepines and some antidepressants, as they have particularly serious side effects . This is why they are prescribed only when the other options do not seem to be working, or the person has been diagnosed with an especially serious disorder such as schizophrenia.
The sympathicolitic ones exert their action on the sympathetic nervous system, by reducing the catecholaminergic activity. For this reason their main use is to be prescribed as hypertensive drugs, although they are also indicated for anxiety problems , mainly GAD, panic disorder and post-traumatic stress disorder (PTSD). The drugs included in this group are the following:
As the name suggests, these drugs block beta-adrenergic receptors. This involves the control of somatic manifestations associated with this type of receptor, which involve the sympathetic nervous system, such as palpitation, tremors, excessive sweating, tachycardia and hot flushes .
However, this mechanism only affects the more physiological than psychological manifestations of stress, that is, they calm the physical but do not reduce, for example, the anticipatory ideas or perfectionism characteristic of OCD. Its action is merely symptomatic.
2. Alpha-2 adrenergic agonists
They are basically guanfacine and clonidine, drugs that act on noradrenergic receptors . This inhibits the activation of neurons that are associated with symptoms of panic disorder and other anxiety problems.
Selective GABA reuptake inhibitors
They act on the main neurotransmitter of the central nervous system: GABA. Within the selective inhibitors of GABA reuptake we can find the antiepileptic drugs, traditionally used for epilepsy, such as gabapentin and pregabalin, useful for treating anxious symptoms.
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- Baldwin, D. S et al. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology. 28 (5): 403-439.