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Medication Strategies for Stress Relief

Harry Mills, Ph.D., Natalie Reiss, Ph.D. and Mark Dombeck, Ph.D.

Because stress manifests as a function of the body and brain, both of which are essentially chemically driven systems, a wide variety of medications can be used to aid in the process of stress relief and prevention. There is no one specific family of medicines that is used to decrease stress. Instead, physicians may prescribe a range of medications to address specific stress-related symptoms. For instance, sedatives (also referred to as tranquilizers, hypnotics, and/or anxiolytics), antidepressants, and beta-blockers have all been used to help people cope with stress.

A note of caution is appropriate with regard to using medicines for stress relief. Many of the medications that are useful for stress relief are also addictive. Serious behavioral and health problems are possible and even likely to occur as a result of using such substances unless care is exercised. All of the medicines described below (addictive or not) have the potential for side effects and health risks and should only be used as prescribed by a responsible and licensed physician.

Sedative (CNS depressant) medications

Sedative medications depress (slow down or inhibit) the activity of the central nervous system (CNS: comprising the brain and spinal cord), causing a sense of relaxation, reduced anxiety and tension, sleepiness, and slowed breathing. In higher doses, these medications can cause slurred speech, an impaired ability to walk around, poor judgment, and slowed reflexes. It is possible to overdose on such medications, with potentially lethal effects (although some types of sedatives achieve lethal doses more easily than others).

One of the most commonly prescribed group of sedatives is the Benzodiazepines which include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), triazolam (Halcion), temazepam (Restoril), and chlordiazepoxide (Librium). As CNS depressant drugs go, benzodiazepines are relatively safe substances with a relatively low lethality potential. An older class of CNS depressant drugs, the barbiturates, are less safe to use (as a rule) than are benzodiazepines. As a result, barbiturates are less commonly prescribed today. Alcohol (the active ingredient in liquor, beer and wine) is also a sedative.

Benzodiazepines, barbiturates and alcohol produce their calming effects by activating (or 'agonizing') a naturally occurring neurotransmitter substance commonly found in the brain called GABA. GABA is an inhibitory neurotransmitter whose function is to slow down brain activity. By activating GABA, benzodiazepines, barbiturates and alcohol all function to inhibit brain activity and thus slow and calm down the body.

Other commonly prescribed drugs with sedating effects include antihistamines (medications typically used to decrease allergic reactions such as Atarax or Vistaril), and sleeping medications (e.g., glutethimide (Doriden), methyprylon (Noludar), and ethchlorvynol (Placidyl). Most sedative medications have the potential to cause physiological and psychological dependence (addiction) when taken regularly. Users of such substances who become dependent may experience withdrawal symptoms, including potentially severe restlessness and insomnia and even death if they do not continue to take their medication. Combining multiple sedatives (or taking sedatives together with alcohol) can lead to coma or death.

Buproprion (BuSpar)

BuSpar is an anti-anxiety medication that is not chemically related to the benzodiazepines, barbiturates, or other sedative/anxiolytic drugs. BuSpar is used to treat the physical symptoms of anxiety, such as bodily tension, dizziness, racing heartbeat, etc. This medication is typically prescribed as a short-term remedy for anxiety (i.e., patients use it for no more than 4 weeks at a time). Therefore, it is not a good option as a long-term stress reducing strategy.

BuSpar does not exert anti-convulsant (anti-seizure) or muscle relaxant effects, and is non-sedating. Although it's not entirely clear how this drug works, some research suggests that BuSpar affects Serotonin and Dopamine (other chemical messengers in the brain and nervous system that impact mood) receptors. BuSpar is not addictive, and people do not develop a tolerance (i.e, require increasing amounts of the medication to achieve the same effects) to this medication.

The main disadvantage of BuSpar is that it takes about 1 to 3 weeks before people experience relief of their anxiety symptoms. Also, many people report that BuSpar does not work as well as benzodiazepines for controlling their symptoms.

Serious, life-threatening side effects can occur if people take BuSpar within 14 days after using an MAO inhibitor (e.g., phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate), which is an older medication that is sometimes prescribed to treat depressive symptoms. Grapefruit and grapefruit juice may also interact with BuSpar and lead to potentially dangerous side effects.

Antidepressant medications

Antidepressant medications derive their family name from their function. They are used primarily to treat Major Depression and related conditions. However, these medications also have anti-anxiety properties, and in many cases, can also be used to treat symptoms of stress. These days, a particular family of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which includes Paxil, Prozac and Lexapro, are the most commonly prescribed antidepressant medications for this anti-anxiety, anti-stress purpose.

The SSRI medicines are named for their work at the neuronal level of the brain. Neurons (the primary cells comprising the brain and spinal cord) talk with one another through the use of chemical messagers known as neurotransmitters. One of these neurotransmitters, Serotonin, is thought to play an important role in creating susceptibility to depression and anxiety conditions.

During the process of neuronal communication, a sending neuron releases a neurotransmitter chemical into a space between neurons known as the synapse, where it makes contact with a receiving neuron and stimulates that neuron into action. Having completed its communication job, the Serotonin gets sucked back up by the sending neuron in a process called reuptake. When reuptake happens too quickly or efficiently (as seems to be the case in depression and anxiety), the net effect is that not enough Serotonin is present to properly do it's job, and mood regulation problems can result. SSRIs and similar drugs slow down the process of reuptake so that Serotonin stays in the synapse longer. Increased Serotonin levels can, in part, improve a person's mood and decrease anxious feelings.

SSRI medications are not addictive in the classical sense, but there are negative side effects associated with their use, such as nausea, dizziness, dry mouth, sleep disturbances and a wide range of sexual arousal and climax problems. For more information about SSRI medications, please consult this article in our Major Depression topic center.

Beta Blockers

Beta blockers are medications that are typically used to control high blood pressure and treat certain heart problems. For some people, these medications can decrease stress symptoms. Beta-blockers such as Inderal (propranolol) and Tenormin (atenolol) block the action of the neurotransmitter and hormone norepinepherine in the arteries and the heart muscle, causing arteries to widen, slowing the action of the heart, and decreasing the force of contraction. The most common negative side effects of beta-blockers are cold hands and feet, tiredness and sleep disturbance (i.e., nightmares). Less common side effects of beta blocker use include impotence, dizziness, wheezing, digestive tract problems, skin rashes and dry eyes.

Nutritional Supplements

Various nutritional supplements, including Kava, Passion flower, Valerian, 5-HTP; and the herbs Skullcap (Scutellaria lateriflora), Chamomile (Anthemis nobilis), Hops (Humulus Lupulus), Motherwort (Leonurus cardiaca), and Oats (oat straw) (Avena sativa) are in common use as stress and anxiety remedies.

Though most of these substances occur naturally (e.g., are harvested from plants rather than created in a laboratory) this does not mean that these substances are harmless! In certain doses and certain combinations, such supplements can exacerbate medical conditions and/or interfere with the effectiveness of prescription medications. It is always advisable to consult with a physician trained in complementary and alternative medicine before using any of these herbal or nutritional substances. For more information on how these various substances work, as well as their potential side effects, please consult the Anxiety Chapter of our Complementary and Alternative Mental Health Medicine Topic Center.