ANXIOLYTICS

Anxiety breakers

Benzodiazepines ("benzos") are the most important anxiolytic class; however, they are a bit controversial. Here are the 1st line indications for Benzos: Panic attacks (to break or lyse anxiety, hence anxio-lytics), Status Epilepticus, Alcohol Withdrawal, Benzo Withdrawal, NREM Parasomnias (sleepwalking and night terrors) and to provide anesthesia for a minor medical procedure (Midazolam). They are NOT to be taken everyday for anxiety disorders, because Benzos are addictive, dangerous, have serious tolerance and have huge abuse potentials. The main side effect with benzos is also their major indication: sedation. Benzos depress all parts of the CNS, including the cardiorespiratory reflex centers in the brainstem, which results in a low respiratory rate. 

• • Alprazolam (Xanax) has the shortest half-life, and therefore the quickest time to action and most serious withdrawals (Benzo withdrawals are fatal, see the Addiction section). 

  • Lorazepam (Ativan) has a medium half-life. In my experiences in the ER, this was the most commonly used Benzo. The LOT benzos (Lorazepam, Oxazepam and Tamazepam) aren’t metabolized in the liver, making them safe to use in patients with liver disease (like alcoholics in withdrawal, hint hint)

  • Clonazepam (Klonopin) has the longest half-life (C-LONG-epam), thus the fewest withdrawal effects.