SEDATIVES AND ANXIOLYTICS
WITH OTHER MAJOR USES
Several H1
histamine antagonists (e.g., diphenhydra-mine, promethazine, and hydroxyzine)
have been used as sedative–hypnotics, since they produce some degree of
sedation. While this sedation is usually considered a side effect of their
antihistaminic activity, in some cases the sedation is sufficient to allow the
drugs to be used in the treatment of anxiety and sleep disturbances. For these
drugs, the anxiolytic properties are
thought to be a direct consequence of
their ability to produce se-dation.
Hydroxyzine hydrochloride (Atarax, Vistaril) is the antihistamine
with the greatest use in the treatment of anxiety. It is often used to reduce
the anxiety that is as-sociated with anesthesia and surgery. It also produces
sedation, dries mucous membranes (via an anticholiner-gic mechanism), and has
antiemetic activity.
β-Adrenoceptor antagonists,
such as propranolol (Inderal), have
been widely used in the treatment of cardiovascular diseases. These β-blockers
also are useful in some forms of anxiety, par-ticularly those that are
characterized by somatic symp-toms or by performance anxiety (stage fright).
There is general agreement that β-blockers can lessen the sever-ity and perhaps
prevent the appearance of many of the autonomic responses associated with
anxiety. These symptoms include tremors, sweating, tachycardia, and
palpitations.
Antidepressant drugs, such as
the tricyclic antidepres-sants and
the selective serotonin reuptake
inhibitors (SSRIs), are very
important for the treatment of psy-chotic depression . They have been shown to
be effective when used in the treatment of several anxiety disorders, including
general anxiety, ob-sessive-compulsive disorder, and several phobias,
in-cluding agoraphobia. Because the SSRIs are less toxic than the tricyclic
antidepressants, their use in the treat-ment of anxiety is safer and less
likely to produce seri-ous side effects.
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