Anxiety

 

Anxiety is a normal stress response but can become a disorder when it is excessive, persistent, and interferes with daily activities. Anxiety disorders encompass a variety of conditions, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and others. These disorders often result in physical symptoms such as increased heart rate, sweating, tremors, and mental symptoms like excessive worry, fear, and tension.

Medicines Used in the Treatment of Anxiety (India)

Several classes of medications are used to manage anxiety disorders. Below is a list of common drugs, their mechanism of action, and popular brand names in India.

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1. Selective Serotonin Reuptake Inhibitors (SSRIs)

• Mechanism of Action: SSRIs increase serotonin levels in the brain by inhibiting its reuptake into presynaptic cells. Serotonin is a neurotransmitter that plays a key role in mood regulation.
• Common Drugs:
  • Escitalopram
  • Sertraline
  • Fluoxetine
  • Paroxetine
• Brand Names in India:
  • Cipralex (Escitalopram)
  • Lustral (Sertraline)
  • Fludac (Fluoxetine)
  • Paxil (Paroxetine)

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Mechanism of Action: SNRIs increase the levels of both serotonin and norepinephrine by inhibiting their reuptake into presynaptic neurons. This helps regulate mood and anxiety.
• Common Drugs:
  • Venlafaxine
  • Duloxetine
• Brand Names in India:
  • Veniz (Venlafaxine)
  • Duzela (Duloxetine)

3. Benzodiazepines

• Mechanism of Action: Benzodiazepines enhance the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that reduces neuronal excitability. This leads to sedative, anti-anxiety, and muscle relaxant effects. Benzodiazepines are typically used for short-term management of acute anxiety due to their potential for dependence.
• Common Drugs:
  • Alprazolam
  • Clonazepam
  • Lorazepam
  • Diazepam
• Brand Names in India:
  • Alprax (Alprazolam)
  • Clonotril (Clonazepam)
  • Ativan (Lorazepam)
  • Valium (Diazepam)

4. Buspirone

• Mechanism of Action: Buspirone is a serotonin (5-HT1A) receptor agonist and has minor effects on dopamine receptors. Unlike benzodiazepines, it does not cause sedation or physical dependence.
• Brand Names in India:
  • Buscalm
  • Buspin

5. Tricyclic Antidepressants (TCAs)

• Mechanism of Action: TCAs inhibit the reuptake of norepinephrine and serotonin, but they also affect other neurotransmitter systems. They are less commonly used due to side effects but can be effective for anxiety.
• Common Drugs:
  • Imipramine
  • Amitriptyline
• Brand Names in India:
  • Tofranil (Imipramine)
  • Amitone (Amitriptyline)

6. Beta-Blockers

• Mechanism of Action: Beta-blockers like propranolol reduce the physical symptoms of anxiety (e.g., rapid heart rate, tremors) by blocking the effects of adrenaline on beta-adrenergic receptors.
• Common Drugs:
  • Propranolol
• Brand Names in India:
  • Inderal
  • Ciplar

7. Monoamine Oxidase Inhibitors (MAOIs)

• Mechanism of Action: MAOIs inhibit the enzyme monoamine oxidase, which breaks down serotonin, norepinephrine, and dopamine. MAOIs are rarely used because of dietary restrictions and potential for serious drug interactions.
• Common Drugs:
  • Phenelzine
• Brand Names in India:
  • Nardil

8. Anticonvulsants

• Mechanism of Action: Certain anticonvulsants can have anti-anxiety effects by stabilizing mood and reducing overactivity in the brain. They are more commonly used in specific anxiety disorders like generalized anxiety disorder (GAD).
• Common Drugs:
  • Pregabalin
  • Gabapentin
• Brand Names in India:
  • Lyrica (Pregabalin)
  • Gabantin (Gabapentin)

9. Atypical Antipsychotics

• Mechanism of Action: Atypical antipsychotics affect various neurotransmitter systems, including serotonin and dopamine. They are occasionally used off-label for treatment-resistant anxiety.
• Common Drugs:
  • Quetiapine
  • Olanzapine
• Brand Names in India:
  • Seroquel (Quetiapine)
  • Oleanz (Olanzapine)

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Combination Therapies

Some patients may require a combination of these medications, depending on their specific symptoms and response to treatment. Combination therapies might involve the use of SSRIs or SNRIs with benzodiazepines (for short-term relief) or anticonvulsants with antidepressants for long-term management.

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Conclusion

Anxiety disorders are typically managed with medications like SSRIs, SNRIs, and benzodiazepines, often in combination with psychotherapy. The choice of medication depends on the severity of symptoms, the presence of coexisting conditions, and patient response. These medications are widely available under various brand names in India.