Top 8 Stress Medications

A review of the most important stress medications and their effects on the brain.

Stress is considered the epidemic of the 21st century. That is why there is no shortage of pharmacological research that has tried to find a solution involving the administration of drugs.

Although it is difficult to solve what causes stress with pills, being psychotherapy a necessary resource for the person to know how to cope with this emotion, the truth is that pharmacology is useful to treat the symptoms.

Here we will see all the main groups of medications for stress that are currently used, as well as explaining how they act on the symptoms of stress.We will also explain how they act on the organism and some side effects and precautions to be taken into account.

What does stress imply at the organic level?

Stress is a response of the organism to the demands of the environment. Our body has to face a possible threat or risk that may harm our physical and mental integrity, for this reason it activates the sympathetic nervous system and prepares to carry out one of the following two responses: fight or flight.

This mechanism of physiological activation is adaptive; however, However, if it remains active for too long, it triggers the parasympathetic nervous system, which tries to reach homeostasis.which tries to achieve homeostasis. In other words, it tries to bring the body back to organic levels prior to the onset of the threatening phenomenon.

Stress becomes a long-term problem, affecting both the physical and psychological health of those who manifest it chronically. The fact that this stress becomes chronic may be due to various factors, real or perceived, and its interpretation is highly variable depending on each person and the circumstance that causes it.

It is for this reason that the treatments, both psychological and pharmacological, focused on treating this emotion are very varied, There are options for practically each of the anxiety disorders listed in the DSM-5.. The combination of both treatments is very effective, since psychotherapy provides the patient with strategies to detect the focus of his or her problem and medication helps to reduce symptoms.

Medications for stress

The following are the main medications for stress, grouped into anxiolytics, antidepressants, neuroleptics and sympatholytics.

Anxiolytics

Among the pharmacological options that exist to treat anxiety disorders, anxiolytics are the reference drugs. In fact, their very name indicates that they are designed to treat stress, especially when it reaches pathological levels as in the case of anxiety. These drugs control physical symptoms such as tremors, sweating or tachycardia..

Their mechanism of action consists of depressing the central nervous system, which causes the reduction of anxiety without the need to numb the person, although technically these drugs can be used for that purpose. Within the group of anxiolytics, we can find barbiturates and benzodiazepines.

1. Barbiturates

Barbiturates are a class of drugs that act by lowering the level of activity of the central nervous system, giving as their main effect a state of generalized relaxation in the organism.although at moderate and high doses they induce sedation.

Despite their efficacy, these drugs are known to be dangerous, since, in addition to being highly addictive, they are also very dangerous. in addition to being highly addictive, an overdose can lead to death.. It is for this reason that their use has been reduced over the decades, and not a few psychiatrists advise against prescribing them.

Barbiturates can be used as a second option for the treatment of insomnia when benzodiazepines have not worked well with a patient who suffers from sleep problems.

2. Benzodiazepines

Benzodiazepines, as with barbiturates, induce central nervous system depression, decreasing nervous excitability. At low doses they calm the person, while at high doses they induce sleep and are used as a treatment for sleep disorders..

In generalized anxiety and stress disorders they serve to reduce anxiogenic symptoms for a few hours. This effect is beneficial in the short term, but there is a risk that the patient may use the drug in an irresponsible way, becoming addicted by taking them too often, and without psychotherapy they do not help to solve the source of the problem.

The sustained and habitual consumption of benzodiazepines makes the organism get used to this type of drugs, causing that with the passage of time the patient becomes addicted to them.This makes it more difficult to induce a state of relaxation over time, and contributes to the patient's tendency to increase the dose.

In addition to stress and insomnia, benzodiazepines are also prescribed for muscular pain.

Some anxiolytics and their indications

Since barbiturates have been less and less used, benzodiazepines have been gaining more prominence as the main therapeutic option for stress, and now we are going to see the uses of some of them.

Clonazepam is used for the treatment of social phobia and Generalized Anxiety Disorder (GAD). Alprazolam, also known by its trade name, Xanaxis used for panic attacks, an indication shared with lorazepam, and also GAD. Buspirone is also used for GAD, although its therapeutic effects are not immediate. The patient must take it for at least two weeks to start seeing results.

Another of the best known benzodiazepines is Valium.Valium, a drug which alters the transmission of nerve impulses, which promotes a decrease in the time needed to fall asleep, makes sleep longer and, in addition, decreases the REM phase.

Valium also reduces blood pressure and heart rate, the two main physiological symptoms of stress when it appears.

Precautions

Because they induce sleep, anxiolytics are not indicated for use before operating heavy machinery, such as vehicles.. If this contraindication is not respected, there is a high risk of suffering a traffic accident.

Women who are trying to become pregnant should not take these drugs unless their doctor or psychiatrist sees that the benefits of taking them will outweigh the possible risks. It has been shown that anxiolytics can significantly reduce the life expectancy of elderly people.

Antidepressants

The name of antidepressants may give the misconception that their sole purpose is to treat the symptoms of depression, which is not entirely the case. These drugs are also used for other psychological problems, including stress and anxiety disorders. Generally, antidepressants prescribed for anxiety are started at low doses and gradually increased.

The reason for this is their mechanism of action, which contributes to the increase of serotonin levels in the central nervous system.. This neurotransmitter is key to manifest euthymia, that is, to present healthy mood changes, ranging from non-pathological sadness to joy, without reaching a manic state.

As with benzodiazepines, the antidepressants prescribed vary according to the type of disorder the person suffers from and its degree of intensity.

1. Selective serotonin reuptake inhibitors (SSRIs)

This type of Antidepressant increases serotonin levels among neurons, promoting the regulation of anger, aggressiveness and organic changes such as body temperature, heart rate...

SSRIs are used, in addition to depression, for various anxiety disorders, such as GAD, obsessive compulsive disorder (OCD) and social phobia, as well as eating disorders (ED) and premature ejaculation. The most commonly used SSRIs are fluoxetine, escitalopram, citalopram, paroxetine and sertraline..

Although they are effective for all the disorders mentioned above, it should be noted that they do have side effects, which usually occur between the first and fourth week of treatment. Among the most common are nausea, vomiting and other gastrointestinal problems such as diarrhea. Sleep problems such as drowsiness and, paradoxically, insomnia. There may also be headaches, episodes of bruxism, i.e., teeth grinding.

2. Tricyclic antidepressants

Tricyclic antidepressants were originally synthesized as a treatment for allergies, although they were later found to have therapeutic effects for psychosis and depression.

This type of antidepressant, whose chemical structure is composed of three rings, prevent the reuptake of serotonin and norepinephrine, causing more of them to be present in the synaptic cleft. and consequently regulating the mood.

That is why they are not only useful for depression, but also for anxiety disorders since, as with SSRIs, they help to achieve a euthymic mood.

However, they also have side effects, mostly due to their anticholinergic effects on the body. This means that bronchodilation, cardiac problems, as well as sexual dysfunction and weight gain may occur.

3. Monoamine oxidase inhibitors (MAOIs)

Their mechanism of action is to block the action of the monoamine oxidase enzyme.. They have effects on mood similar to the antidepressants described above.

The main precaution of this type of drugs is to avoid the consumption of foods containing tyramine, a substance which is present in high amounts in fermented foods such as cheese and pickles. If consumed, the interaction of MAOIs with tyramine could lead to stroke.

Neuroleptics

Neuroleptics, better known as antipsychotics, are also prescribed for stress and anxiety problems, as long as they are taken in low doses. Some of the best known ones are risperidone, quetiapine and olanzapine, used for GAD, OCD, anxiety and depression.used for GAD, OCD and panic attacks.

Despite their effectiveness with these types of disorders, they are not considered a good choice compared to benzodiazepines and some antidepressants, since they have particularly serious side effects. That is why they are prescribed only when other options do not seem to be working, or when the person has been diagnosed with a particularly serious disorder such as schizophrenia.

Sympatholytics

Sympatholytics exert their action on the sympathetic nervous system by reducing catecholaminergic activity. That is why they are their main use is to be prescribed as hypertensives, although they are also indicated for anxiety problems, mainly GAD, panic disorder and panic disorder.The drugs that fall into this category are those for GAD, panic disorder and post-traumatic stress disorder (PTSD). The drugs that fall into this group are the following:

1. beta-blockers

As their name suggests, these drugs block beta-adrenergic receptors. This involves control over somatic manifestations associated with this type of receptors, which involve the sympathetic nervous system, such as palpitation, tremors, excessive sweating, tachycardia and hot flashes..

However, this mechanism only affects more physiological than psychological manifestations of stress, i.e., they calm the physical but do not reduce, for example, anticipatory ideas or perfectionism typical of OCD. Its action is merely symptomatic.

2. Alpha-2-adrenergic agonists

These are mainly guanfacine and clonidine, drugs that act on noradrenergic receptors.. This inhibits the activation of neurons that are associated with symptoms of panic disorder and other anxiety problems.

Selective GABA reuptake inhibitors

They act on the main neurotransmitter of the central nervous system: GABA. Within the selective GABA reuptake inhibitors we can find antiepileptics, traditionally used for epilepsy, such as gabapentin and pregabalin, useful to treat anxiogenic symptoms.

Bibliographic references:

• Varcarolis. E (2010). Manual of Psychiatric Nursing Care Planning: Assessment Guides, Diagnoses and Psychopharmacology. 4th ed. New York: Saunders Elsevier. p 109.
• Baldwin, D. S et al. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology. 28 (5): 403–439.