Top 8 medications for stress

Stress is considered the epidemic of the 21st century. That is why there are many pharmacological investigations that have tried to find a solution that involves the administration of medications.

Although what causes stress will hardly be solved with pills, psychotherapy being a totally necessary for the person to know how to cope with this emotion, the truth is that pharmacology is useful to treat symptom.

Here we will look at all the major groups of stress medications in use today, in addition to explaining how they act on the body and some side effects and precautions to take into account.

• Related article: "Types of stress and their triggers"

What does stress imply at an organic level?

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

This physiological activation mechanism is adaptive; However,

if you stay active for too long the parasympathetic nervous system kicks in, which tries to achieve homeostasis. That is, it tries to make the body return to organic levels prior to the appearance 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, In addition, its interpretation is highly variable depending on each person and the circumstance that provoke.

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 included in the DSM-5. The combination of both treatments is very effective, since with psychotherapy it is given to the patient strategies to detect the focus of their problem and medications help reduce the symptom.

Medications for stress

Next we will see the main drugs for stress, grouped into anxiolytics, antidepressants, neuroleptics and sympatholytics.

Anxiolytics

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

Its mechanism of action consists of depressing the central nervous system, which causes the reduction of the anxiety without making the person sleepy, although these medications can technically be used with that purpose. Within the group of anxiolytics, we can find barbiturates and benzodiazepines.

1. Barbiturates

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

Despite being effective, these drugs are known to be dangerous, since In addition to being highly addictive, an overdose can lead to death. It is for this reason that its use has been reduced over the decades, and there are not a few psychiatrists who advise against its prescription.

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

2. Benzodiazepines

Benzodiazepines, as with barbiturates, induce central nervous system depression, reducing 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 stress and anxiety disorders, they serve to reduce anxiety symptoms for a few hours. This effect is beneficial in the short term but there is a risk that the patient will make an unresponsible use of the product. drug, becoming addicted when consuming them very often, in addition to that without psychotherapy they do not help to solve the source of the trouble.

The sustained and habitual consumption of benzodiazepines makes the body get used to this type of drug, making it more difficult over time to induce a state of relaxation, and helping the patient tend to increase the dose.

In addition to stress and insomnia, benzodiazepines are also prescribed for muscle aches.

• You may be interested: "Benzodiazepines (psychotropic): uses, effects and risks"

Some anxiolytics and their indications

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

Clonazepam is used to treat social phobia and Generalized anxiety disorder (TAG). Alprazolam, also known by its trade name, Xanax, is 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 consume it for at least two weeks to begin to see results.

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

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

Precautions

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

Women trying to stay healthy should not take these drugs, unless their doctor or psychiatrist sees that the benefits of taking them will outweigh the possible risks. Anxiolytics have been shown to significantly reduce the life expectancy of people in the elderly.

Antidepressants

The name of antidepressants can give the misconception that their only purpose is to treat the symptoms of depression, something that 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 administered at low doses, to be progressively increased.

The reason for this is its mechanism of action, which contributes to increased levels of serotonin in the central nervous system. This neurotransmitter is key to manifest euthymia, that is, to present changes in the state of healthy moods, which range from non-pathological sadness to joy, without reaching a state maniac.

As with benzodiazepines, the antidepressants that are prescribed vary depending on the type of disorder that the person suffers and the degree of intensity of it.

1. Selective serotonin reuptake inhibitors (SSRIs)

This type of antidepressant increases serotonin levels between neurons, promoting the regulation of anger, aggressiveness and organic changes such as body temperature, heartbeat rate ...

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

Although they are effective for all the disorders we have mentioned, it should be noted that they have side effects, which usually appear between the first and fourth week of starting treatment. Among the most common are nausea, vomiting, and other gastrointestinal problems such as diarrhea. Sleep problems such as drowsiness and, paradoxically, insomnia. Headaches, bruxism episodes, that is, teeth grinding, can also occur.

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 made up of three rings, prevent the reuptake of serotonin and norepinephrine, causing more of it to be in the synaptic cleft and regulating, consequently, the mood.

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

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

3. Monoamine oxidase inhibitors (MAOI)

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

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

Neuroleptics

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

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

• You may be interested: "Types of antipsychotics (or neuroleptics)"

Sympatholytics

Sympatholytics exert their action on the sympathetic nervous system, by reducing catecholaminergic activity. It is because of that their main use is to be prescribed as hypertensive, although they are also indicated for anxiety problems, being mainly GAD, panic disorder and post-traumatic stress disorder (PTSD). The drugs that are included within 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, rapid heart rate and hot flashes.

However, this mechanism only affects the physiological rather than psychological manifestations of stress, that is, In other words, they calm the physical but do not reduce, for example, anticipatory ideas or the perfectionism of the TOC. Its action is merely symptomatic.

2. Alpha-2 adrenergic agonists

They are mainly guanfacine and clonidine, drugs that act on noradrenergic receptors.. This causes the activation of neurons that are associated with symptoms of panic disorder and other anxiety problems to be inhibited.

Selective GABA reuptake inhibitors

They act on the main neurotransmitter of the central nervous system: GABA. Among the selective GABA reuptake inhibitors we can find antiepileptic drugs, traditionally used for epilepsy, such as gabapentin and pregabalin, useful for treating symptoms crave us.

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.