The Pharmacological Management of Stress Reactions

The armamentarium of available pharmacological agents for the treatment of stress-related syndromes and anxiety disorders is evolving as safer alternatives to the CNS-depressant drugs become available. Let us review some of the main points covered in this chapter: 1. Symptomatic improvement of the symptoms of acute stress can be addressed with a short-term course of CNS depressants, such as benzodiazepines. Use of benzodiazepines for longer term therapy has the liabilities of development of tolerance, dependence, and withdrawal symptoms. However, the benzodiazepines do represent a significant improvement in drug safety over barbiturates and non-barbiturate sedatives-hypnotics. 2. Situational anxiety may respond to as-needed treatment with beta-adrenergic blocking agents. These drugs directly antagonize the NE-mediated peripheral manifestations of the stress response. 3. Antihistamines may also be used episodically for sedation. 4. Over the long-term, most anxiety disorders are most appropriately treated with antidepressant drugs. Because these agents work by inducing long-term alterations in neurotransmitter receptor function and sensitivity, response may take several weeks of continuous treatment. However, improvements in the safety profiles of the newer antidepressants make these agents viable choices in the treatment of anxiety disorders.