What are the therapeutic actions of anxiolytic or hypnotic drugs on the body?
Anxiety or tension is the most common disorder among mental disorders which is an unpleasant state of tension or uneasiness (fear that originates from a known or unknown source). The symptoms of anxiety are similar to those of fear such as raise in heart rate (tachycardia), shivering, palpitations, and sweating, all following the activation of the sympathetic nervous system. Mild cases of anxiety-related problems are not harmful and do not require pharmacological treatment, while on the other hand in severe cases of anxiety one should opt for pharmacological treatment with the help of anxiolytics, and some classes of psychotherapeutic drugs. As some of the antianxiety drugs Xanax or Alprazolam or benzodiazepines also lead to sedation, they may be used as both anti-anxiety and hypnotic agents (sleep-inducing agents).
What are Xanax or alprazolam or benzodiazepines? Are they the same thing or is there any difference?
Among frequently prescribed drugs for the treatment of anxiety and insomnia, benzodiazepines are used at the most. Benzodiazepines have replaced barbiturates (amobarbital, phenobarbital) and meprobamate in the treatment of anxiety and sleeping disorders (insomnia) for being safer and therapeutically effective than barbiturates. Even then they are not the best choice for insomnia and anxiety. Some other antidepressant drugs with an anxiolytic action, such as selective serotonin reuptake inhibitors, are suggested in many cases. Non-benzodiazepines, hypnotics, and anti-allergic may be prescribed for insomnia or sleeping disorders.
There are the following benzodiazepines used for the treatment of anxiety:
- Xanax (alprazolam)
- Librium (chlordiazepoxide)
- Klonopin (clonazepam)
- Valium (diazepam)
- Ativan (lorazepam)
- Versed (midazolam)
- Halcion (triazolam)
Mechanism of action:
Gamma-amino-butyric acid (GABA) is the main inhibitory neurotransmitter in the central nervous system whose receptors known as gamma-aminobutyric acid receptors are targeted for the therapeutic action of benzodiazepines. GABAa contains five subunits (alpha, beta, and gamma, alpha-A, and alpha-B), which play an important role in the binding of benzodiazepine drugs and opening of chloride channels. The influx of chloride ions to the membrane decreases the neurotransmission due to hyperpolarization of neurons and inhibits the transmission of the action potential.
What are the pharmacological actions of Xanax?
Xanax (alprazolam) and other benzodiazepines perform the following pharmacological actions:
- Anxiety reduction: Benzodiazepines or alprazolam perform anti-anxiety effects at low doses, they boost up the GABAergic neuronal transmission to reduce the anxiety by binding with GABAa receptors, prohibiting the neuronal circuits in the brain’s limbic system.
- Sedative action:Alprazolam and other benzodiazepines have calming and sedative effects, and some of the drugs can produce artificially induced sleep by binding with the alpha-1 subunit of GABAa receptors.
- Amnesia:Memory impairment with the usage of alprazolam is also mediated by the alpha-1 subunit of GABA receptors. The formation of new memory and the ability to learn is also impaired.
- Anticonvulsant action:Alprazolam with many other benzodiazepines have anticonvulsant activity. This is partially mediated by the alpha-1 GABAa receptors.
- The action of muscles relaxation: By increasing presynaptic inhibition in the spinal cord, at higher doses, benzodiazepines relax the muscles that have undergone spasticity. Alpha-2 subunit of GABAa receptors plays an important role in the binding of anxiolytic drugs.
What are the therapeutic uses of alprazolam or Xanax?
All of the benzodiazepines show very little difference in their antianxiety, anticonvulsant, and hypnotic properties. However, the duration of the action and pharmacokinetic parameters play an important role in the selection of these drugs.
- Anxiety disorganization: There are different types of anxieties for which alprazolam and other benzodiazepines are used to reduce the symptoms. The types of anxiety are described as follows:
- Generalized anxiety disorder(GAD): GAD is differentiated by continuous worry about several different things and happenings. Patients with GAD are primarily concerned with money, family, health, and many other associated things. They feel more worried about the things that are yet to happen with trivial energy to prohibit tension.
- Social anxiety disorder:Social phobia is generally referred to as social anxiety disorder, a type of disorganization where there is extreme fear in social settings. People with this disorder have difficulty talking with new persons, attending social meetings, and feel fearful while traveling in social settings or visiting the hospitals.
- Performance anxiety: It is a fear about performing any type of task either it is speech, athletic games, or some other relative activities. People with performance anxiety may worry about the failure inactivity which even has not started yet.
- Posttraumatic stress disorder: Posttraumatic stress disorder (PTSD) is the type in which a patient remains worried about the accident or incident through which he/she has been gone through. An average of 5-10 percent of people feels this PTSD once a time in their life period.
- Obsessive-compulsive disorganization: Obsessive-compulsive disorder is the anxiety disorder of children and teens. People with OCD think that there is something wrong with them, there is something dirty or something could hurt them or is dangerous for them. It is extrapolated that over sixty lac people of the United States are suffering from obsessive-compulsive disorder. Physicians have not yet found the exact causes of OCD. Research studies suggest that the following parameters play an important part in developing obsessive-compulsive disease;
- Serotonin (a chemical messenger)
Alprazolam and some other benzodiazepines are also used to treat depression and schizophrenia. These medications are used to treat only severe types of anxiety and not for the usage of everyday routine life. Benzodiazepines should be used for a short period because they cause addiction and physical dependence. Long-acting agents such as lorazepam, diazepam, and alprazolam are used for the patient who required treatment for a longer period. Sedative and hypnotic effects of benzodiazepines are more subjected to tolerance as compared to the anxiolytic effects. Whereas, tolerance is the decreased response to the repeated doses of these drugs. Tolerance occurs when the drugs are taken more than 2 weeks which causes the decreased density of the GABAa receptors.
- Insomnia disorganization:
Alprazolam and some other types of benzodiazepines are used as hypnotic or sedative agents. These drugs boost up stage-II of non-rapid eye movement sleep. During the insomnia treatment, it is necessary to balance the hypnotic effect required at bedtime upon awakening. The most frequently prescribed benzodiazepines are temazepam and triazolam which or intermediate-acting while on the other hand, long-acting hypnotic agents are flurazepam and alprazolam.
- Amnesia disorganization:
Amnesia is a type of loss of memory. People suffering from amnesia have difficulties in the formation of new memories. On other hand, some people cannot recall their past events or experiences. Usually, people with amnesia persist in knowledge only about their own identity, as well as some skills like motor, and training.
A little bit of memory loss is part of aging but significant loss of memory or failure of the formation of new memories is the indication of the presence of amnestic chaos.
There are following four types of amnesia:
- Retrograde amnesia: In retrograde amnesia, recently formed memories are lost with more agility while older memories are affected more slowly. Dementia leads to gradual retrograde amnesia
- Anterograde amnesia: In this type of amnesia you are unable to form new memories due to damage in the area of the brain that is called the hippocampus has an important role in the formation of new memories.
- Transient global amnesia: TGA is a condition that is difficult to understand. If you are suffering from transient global amnesia you will experience confusion and agitation. Memory loss occurs just a few hours before the amnestic attack.
- Infantile amnesia: Some people cannot remember the first 3-5 years of their life, this situation is known as infantile or childhood amnesia.
- Seizures: Seizure may occur in the form of fits at the early age known as infantile seizure or seizure at adult age known as fits. These fits and epileptic disorders may occur due to disturbances in the peripheral and central nervous system. The appearance of fits as seizure may be of certain types, petit-mal seizure, tonic-clonic seizure, clonic seizure, tonic seizure, grand-mal seizure, etc. Alprazolam may be given to get relief from the attack of seizure as the drug may impart peace and depress the excitatory neurotransmitters bringing down the excitement phase.
- Muscular disorders: Alprazolam may bind with the beta-2 subunit of gamma amino-butyric acid imparting inhibition of excitatory neurotransmitters thus providing inhibition of muscular excitement. The depression of excitatory neurotransmitters gives relief from muscular disorders with the help of the drug acting on the peripheral nervous system.
Signs and Symptoms of Xanax Addiction In Yourself:
Regardless of the substance used, there are some common signs and symptoms of Xanax addiction. General warning signs that you may experience during Xanax addiction are:
- You may want to use or may use the drug on a more regular basis than before although you may experience that some of your symptoms are overwhelming but still the addictive habits bound you to take more intake.
- An urge inside you makes you bound intensely to focus on anything else rather you just want to use the drug. You become blind to all other causes of the world.
- Every time you take the drug, you need to use more of the drug to achieve the same high tolerance.
- You may feel the urge to take the drug for longer periods than intended.
- You try to keep a supply of the drug on hand.
- You try to keep a separate budget for the money to be spent on the purchase of the drug even when you have a tight budget.
- You try to steal or behave violently to obtain the drug.
- If you try to stop the drug, you may experience withdrawal symptoms.
- You try to stop the intake of a drug but the need and demand of the reward system of the brain become dominant making addiction win over wits.
Signs and Symptoms of Xanax Addiction in Others:
Your beloved ones may try to conceal from you about their addiction habits. You might witness if the reason behind is drugs or something else as any stressful event or job stress.
- Mood changes: A noticeable irritation or depression or anxiety feelings may become visible in your beloved one which may present a new version of their personality indicating any drug addiction. The person may become suddenly frightened or fearful or extra sensitive.
- Behavior changes: People may become aggressive in their behavior and become more secretive about themselves to hide their need for the drug.
- Appearance changes: Extra gain in weight or extra loss in weight may become the significant symptom for change in the appearance of the person.
- Disturbed sleep patterns: The addicted person may sleep for extra hours and still may feel sleepy and exhausted. Sleep patterns may differ a lot from a normal person and normal habits.
- Health distortion: The person may become sluggish, emaciated, and may suffer from gastrointestinal disturbances. The symptoms may appear as nausea, vomit, or headaches indicating severe distortion of health.
- Social changes: People may distance themselves from common people and social activities to avoid any exposure and confine themselves in solitude. They face relationship difficulties due to abstinence from attending ceremonies and gatherings.
- Depleted mental attendance: Poor work performance and lack of mental attendance in school or at the workplace may create grade lowering and poor outcomes.
- Monetary problems: People may face difficulties to pay bills and manage other issues without any logical reason due to extra expenses at the purchase and management of drugs.
Why doctors prescribe Xanax for Psychogenic Dizziness:
Although several problems and side effects are associated with the use of benzodiazepines as addiction, impaired memory, etc, still doctors prescribe Xanax for psychogenic dizziness. The biggest problem of dizziness can be treated by using lower doses of the drug, i.e.0.25mg in eight hours. In this dose, the drug may act as a vestibular suppressant but still may have chances of difficult withdrawal syndrome. Sleepiness and dizziness may have a slight difference in value and timings. The low dose values of Xanax may control chronic dizziness by decreasing vestibular gain and phase. This results in total response i.e. gain ×time constant that may be normal. Xanax may enhance cerebellar inhibition of vestibular neurons based on certain animal experiments since the mechanistic approach is undergoing a lot of research.