Anxiolytics: Uses, common brands, and safety info

We all experience anxiety to some extent, be it apprehension about a project at work or even mild panic, with fear and heart racing. In a 2020 SingleCare survey, 62% of respondents reported symptoms of anxiety in the past year. For some though, anxiety can be intense and uncomfortable, or panic spells can be frequent. These feelings can be so disturbing or persistent that they affect work and relationships. Help can come in the form of therapeutic counseling, termed psychotherapy, or in the form of medications, termed pharmacotherapy. One class of anti-anxiety agents is anxiolytics. They are used in a variety of circumstances but always with a degree of caution. Use this guide to learn more about the types of anxiolytic drugs and their uses, side effects, and costs.

What are anxiolytics?

The term anxiety is frequently used, but it can be felt in very different ways. Excessive worrying is a classic manifestation. Others may feel restless and have trouble relaxing. Another common description is nervousness and fearfulness. Even irritability can come from anxiety. Sometimes, these feelings can be short-lived, and other times, they are more constant. Fast-acting anxiolytic medications can be used for all the various symptoms and durations of anxiety. They can be taken on an as-needed basis or taken regularly.

How do anxiolytics work?

Anxiolytics can help to stop and prevent anxiety symptoms. They do so by quieting nerve cell activity in the brain. They are often chosen for short-term use only because many members of the drug class are habit-forming. Accordingly, they’re mostly used for episodic anxiety symptoms and for help transitioning to other anti-anxiety drugs that can be used safely over a longer period of time. In the long term, people with anxiety are typically treated with antidepressants from the selective serotonin reuptake inhibitor (SSRI), serotonin-norepinephrine reuptake inhibitor (SNRI), or tricyclic antidepressant (TCA) classes. There are occasions when, despite the risk, extended use of anxiolytics is required.

What are anxiolytics used for?

• Generalized anxiety disorder (GAD)

• Panic disorder

• Social anxiety disorder

• Specific phobia (intense fear)

Types of anxiolytics

Benzodiazepines

Most anxiolytics are benzodiazepines. They increase the activity of gamma-aminobutyric acid (GABA), a chemical in our brains that quiet nerve cell activity. The onset of action and duration varies among members of the class. Some work within minutes, while others take more than an hour to start helping. 

Our bodies eliminate some benzodiazepines in less than a day and others can take a few days to be processed out of the body. For example, Ativan and Xanax usually hang around for shorter times in our systems than Valium and Klonopin. Differences in the speed and duration of action may explain why some benzodiazepines seem to be more habit-forming or more likely to lead to withdrawal than others.

Buspar

Buspar has some important differences in comparison to benzodiazepines. Its action relates to the neurotransmitter serotonin, and this activity may take days to weeks to achieve relief of symptoms. Fortunately, the trade-off for the slower onset of action is that Buspar does not have habit-forming potential. Buspar can be used independently for the treatment of anxiety disorders, but it is more commonly added to antidepressants when anxiety persists despite antidepressants alone.

RELATED: Medications that treat anxiety and depression

Vistaril

Somewhat surprisingly, the mechanism of action for Vistaril is blockage of histamine receptors. Histamine is well-known for its role in allergies, and antihistamines are a common treatment for allergies. However, histamine also plays a role in brain cell communication, and this likely explains why histamine blockers can be helpful for anxiety. Vistaril works quickly but unfortunately tends to cause a lot of sedation, so usage tends to be short-term.

Barbiturates

Barbiturates are older medications. They are very rarely used for anxiety anymore due to excessive side effects and better options being available.

Who can take anxiolytics?

Anxiolytics can be used by both men and women.

Can you take anxiolytics while pregnant or breastfeeding?

Benzodiazepines and Vistaril may cause problems for the fetus or, in the case of benzodiazepines, lead to withdrawal after delivery, so usage during pregnancy is limited. Likewise, the use of benzodiazepines and Vistaril while breastfeeding is often curtailed due to the potential for drowsiness in breastfed infants whose mothers are taking these medications. Conversely, Buspar can be used during pregnancy and breastfeeding since harms are not known, although scientific studies are scant on this topic.

Can children take anxiolytics?

The use of anxiolytics in children is much more limited than in adults. The lack of proven effectiveness and the concern for sedation are the likely reasons.

Can seniors take anxiolytics?

Anxiolytic effects increase the risk of drowsiness, falls, and drug interactions in seniors. These increased risks lead most healthcare providers to be quite cautious when prescribing anxiolytics to seniors and to strongly favor antidepressants.

Are anxiolytics safe?

Black box warnings

The FDA’s strongest warnings on medication labels are black box warnings. Within the anxiolytic class, there are multiple pertaining to benzodiazepines. The FDA calls attention to the potential for abuse and addiction with benzodiazepines and the possibility for dangerous withdrawal when these medicines are stopped. A specific warning is made against combining benzodiazepines and opiates based on the potential for decreased breathing and even death.

RELATED: What are opioids?

Recalls

Although no recalls are currently active for the most common anxiolytics, the FDA website can be searched for updates.

Restrictions

• Any history of hypersensitivity or allergy to an anxiolytic is a cause for the avoidance of that medicine and others related to it. 

• Benzodiazepines can be dangerous for those with significant kidney, liver, or lung problems. Sleep apnea, alcohol use, and preexisting drowsiness also increase their risk. A history of drug or alcohol abuse and a history of some types of glaucoma may also warrant avoidance of benzodiazepines.

• Buspirone should not be used in the setting of severe kidney problems or recent use of monoamine oxidase inhibitor (MAOI) medications.

• Vistaril use should be avoided by those with prolonged QT syndrome (a specific electrical problem of the heart) and deserves particular concern for those with other heart problems, kidney dysfunction, and asthma. Due to its sedative effects, Vistaril can be problematic for anyone taking other medications or substances like alcohol that affect the central nervous system (CNS), resulting in enhanced drowsiness.

Are anxiolytics controlled substances?

Benzodiazepines are listed by the Drug Enforcement Agency as controlled substances, specifically, Schedule IV substances. This speaks to their potential for abuse being greater than cough medicines with codeine (Schedule V) for example but less than barbiturates (Schedule III). 

Buspar and Vistaril are not controlled substances.

Common anxiolytics side effects

• Seizures

• Heart rhythm or heart rate problems

• Breathing problems

• Abuse, dependency, or withdrawal symptoms

• Suicidality

• Low blood pressure or fainting

• Drowsiness

• Difficulty urinating

• Mood changes, confusion, or trouble concentrating

• Dizziness, blurred vision, or headaches

• Nausea, vomiting, diarrhea, constipation, or abdominal pain

• Severe movement problems

• Serotonin syndrome

• Dry mouth or speech problems

• Headache or numbness

How much do anxiolytics cost?

For 30 tablets, anxiolytics can cost between $20 for Librium and $85 for Klonopin. The expense of medications can really add up, but fortunately, the SingleCare discount card is available to help you save money on prescription drugs.