Medications for acute anxiety
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Acute Anxiety Medications: Benzodiazepines and Alternatives
Benzodiazepines are the most commonly used medications for acute anxiety due to their rapid onset of action and effectiveness in quickly reducing severe anxiety symptoms. However, their use is generally recommended only for short-term or emergency situations because of the risks of dependence, tolerance, and withdrawal syndromes. Long-term use is discouraged, especially in individuals with a history of substance use disorders, due to the high risk of misuse and addiction 146710.
Other medications sometimes used for acute anxiety include antihistamines like hydroxyzine and anxiolytics such as buspirone, but these are often considered less effective for immediate relief compared to benzodiazepines 27.
SSRIs, SNRIs, and Antidepressants: Role in Acute Anxiety
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered first-line treatments for most anxiety disorders, including panic disorder, generalized anxiety disorder, and social anxiety disorder. While these medications are highly effective and well-tolerated, they are primarily used for long-term management rather than immediate relief, as their therapeutic effects take several weeks to become noticeable 14678910.
Beta Blockers, Antimuscarinics, and Novel Combinations
Beta blockers, such as propranolol and atenolol, can be used to manage the physical symptoms of acute anxiety, especially in situations like performance anxiety. A novel combination of atenolol (a beta blocker) and scopolamine (an antimuscarinic agent) has shown promise in rapidly reducing both sympathetic and parasympathetic symptoms of acute anxiety, particularly in patients who cannot use benzodiazepines. This combination provided a calming effect within 25–30 minutes and lasted for several hours in a case of post-traumatic stress disorder (PTSD) 27.
Other Options: Antipsychotics, Anticonvulsants, and Emerging Treatments
In cases of severe or psychotic anxiety, atypical antipsychotics may be used for acute symptom control. Anticonvulsants and other agents like gabapentin and pregabalin have also shown some efficacy in acute anxiety, though more research is needed to confirm their effectiveness 15710.
Emerging treatments, including neuropeptides, glutamatergic agents, and cannabinoids, are being studied, but most have not yet demonstrated consistent benefits for acute anxiety in clinical trials .
Conclusion
For acute anxiety, benzodiazepines remain the most effective and rapid-acting medications, but their use should be limited to short-term situations due to safety concerns. Alternatives such as antihistamines, beta blockers, and novel drug combinations may be considered, especially when benzodiazepines are not appropriate. SSRIs and SNRIs are essential for long-term management but are not suitable for immediate relief. Ongoing research is exploring new options, but current evidence supports a cautious, individualized approach to medication selection for acute anxiety.
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