or non-benzodiazepines have failed. benzodiazepines benzodiazepines are prescribed to quell panic attacks. benzodiazepines are also prescribed in tandem with an antidepressant for the latent period of efficacy associated with many ads for anxiety disorder. there is risk of benzodiazepine withdrawal and rebound syndrome if bzds are rapidly discontinued. tolerance and dependence may occur. the risk of abuse in this class of medication is smaller than in that of barbiturates. cognitive and behavioral adverse effects are possible. benzodiazepines include: alprazolam (xanax), bromazepam, chlordiazepoxide (librium), clonazepam (klonopin), diazepam (valium), lorazepam (ativan), oxazepam, temazepam, and triazolam. therapeutic use drug indication common side effect lorazepam -short term use in anxiety -short term use in insomnia associated anxiety -conscious sedation for procedures -premedication -status epilepticus/febrile convulsions/convulsions caused by poisoning -anxiety -decreased alertness -ataxia, confusion (more in elderly) diazepam -muscle spasm of varied aetiology -anxiety -acute drug-induced dystonic reactions -sedation for minor surgical and medical procedures -abnormal appetite -concentration impairment -gastrointestinal disorder -movement disorder -muscle spasm -vomiting alprazolam -short term use in anxiety -as all benzodiazepine adverse effect benzodiazepines lead to central nervous system depression, resulting in common adverse effects like drowsiness, oversedation, light-headedness. memory impairment can be a common adverse effect especially in elderly, hypersalivation, ataxia, slurred speech, psychomotor effects. sympatholytics sympatholytics are a group of anti-hypertensives which inhibit activity of the sympathetic nervous system. beta blockers reduce anxiety by decreasing heart rate and preventing shaking. beta blockers include propranolol, oxprenolol, and metoprolol. the alpha-1 agonist prazosin could be effective for ptsd. the alpha-2 agonists clonidine and guanfacine have demonstrated both anxiolytic and anxiogenic effects. buspirone buspirone (buspar) is a 5-ht1a receptor agonist used to treated generalized anxiety disorder. if an individual has taken a benzodiazepine, buspirone will be less effective. pregabalin pregabalin (lyrica) produces anxiolytic effect after one week of use comparable to lorazepam, alprazolam, and venlafaxine with more consistent psychic and somatic anxiety reduction. unlike bzds, it does not disrupt sleep architecture nor does it cause cognitive or psychomotor impairment. hydroxyzine hydroxyzine (atarax) is an antihistamine originally approved for clinical use by the fda in 1956. hydroxyzine has a calming effect which helps ameliorate anxiety. hydroxyzine efficacy is comparable to benzodiazepines in the treatment of generalized anxiety disorder. phenibut phenibut (anvifen, fenibut, noofen) is an anxiolytic used in russia. phenibut is a gabab receptor agonist, as well as an antagonist at α2δ subunit-containing voltage-dependent calcium channels (vdccs), similarly to gabapentinoids like gabapentin and pregabalin. the medication is not approved by the fda for use in the united states, but is sold online as a supplement. mebicar mebicar is an anxiolytic produced in latvia and used in eastern europe. mebicar has an effect on the structure of limbic-reticular activity, particularly on the hypothalamus, as well as on all 4 basic neuromediator systems – γ aminobutyric acid (gaba), choline, serotonin and adrenergic activity. mebicar decreases noradrenaline, increases serotonin, and exerts no effect on dopamine. fabomotizole fabomotizole (afobazole) is an anxiolytic drug launched in russia in the early 2000s. its mechanism of action is poorly-defined, with gabaergic, ngf and bdnf release promoting, mt1 receptor agonism, mt3 receptor antagonism, and sigma agonism thought to have some involvement. bromantane bromantane is a stimulant drug with anxiolytic properties developed in russia during the late 1980s. bromantane acts mainly by facilitating the biosynthesis of dopamine, through indirect genomic upregulation of relevant enzymes (tyrosine hydroxylase (th) and aromatic l-amino acid decarboxylase (aaad)). emoxypine emoxypine is an antioxidant that is also a purported anxiolytic. its chemical structure resembles that of pyridoxine, a form of vitamin b6. menthyl isovalerate menthyl isovalerate is a flavoring food additive marketed as a sedative and anxiolytic drug in russia under the name validol. racetams some racetam based drugs such as aniracetam can have an antianxiety effect. alpidem alpidem is a nonbenzodiazepine anxiolytic with similar anxiolytic effectiveness as benzodiazepines but reduced sedation and cognitive, memory, and motor impairment. it was marketed briefly in france but was withdrawn from the market due to liver toxicity. etifoxine etifoxine has similar anxiolytic effects as benzodiazepine drugs, but does not produce the same levels of sedation and ataxia. further, etifoxine does not affect memory and vigilance, and does not induce rebound anxiety, drug dependence, or withdrawal symptoms. alcohol alcohol is sometimes used as an anxiolytic by self-medication. fmri can measure the anxiolytic effects of alcohol in the human brain. alternatives to medication cognitive behavioral therapy (cbt) is an effective treatment for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder, while exposure therapy is the recommended treatment for anxiety related phobias. healthcare providers can guide those with anxiety disorder by referring them to self-help resources. sometimes medication is combined with psychotherapy but research has not found a benefit of combined pharmacotherapy and psychotherapy versus monotherapy. if cbt is found ineffective, both the canadian and american medical associations then suggest the use of medication.