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Abstract
This paper intends to elucidate anxiety disorders main treatments, one being
psychopharmacological treatment and the other cognitive behavioral treatment, in order for the
reader to comprehend its main differences and how using them individually or combined can
change the course of the disorders course of action. This essay will also introduce the
benzodiazepine course in the GABA receptor system for it to understand how is that
neurochemicals act in behaviors related to anxiety. Finally, aspects of substance abuse will be
commented briefly for the reader to understand some side-effects of pharmacological treatment.
Keywords: anxiety disorder, medication, CBT, benzodiazepines, GABA, substanceabuse.
threatening or extremely disturbing because they seem unpredictable, incontrollable, and may
potentially damage the patients most vital interests (Beck & Clark, 2010)
Neurochemical basis of anxiety
Neuroanatomic circuits that trigger fear and anxiety behaviors are modulated by a range
of chemical neurotransmitter systems which include the peptidergic neurotransmitters, the
monoaminergic transmitters, serotonin (5-hydroxytryptamine or 5-HT) and dopamine (DA), and
the amino acid transmitters GABA and glutamate which will be commented shortly. These
chemical systems are important in regulating the adaptive functions of preparing an organism for
a response to threat or stress, this behaviors or actions can be in the form of increased vigilance,
modulating memory, storing energy and elevating the cardiovascular system. However, these
responses can become pathological if they are activated inappropriately.
Gamma-aminobutyric acid, or GABA is one of the most abundant neurotransmitters of
the central nervous system and act as a neve transmission inhibitory calming the nervous activity
(Denver Naturopathic Clinic, n.d.). This can be related to anxiety disorder and their high physical
activation, people with a neuropsychological originated anxiety disorder can be found in a
decrease in the GABA receptor system, this means that medication related to this neurochemical
channels are essential in order to reduce the anxiety symptomatic picture. This is where
benzodiazepines show up as the neurochemical that reduces anxiety which is also called
anxiolytic. Benzodiazepines are prescribed often through the name of Valium, Xanax and
Klonopin. These are often used as tranquilizers or anxiolytics for people to cope with major life
stress events.
through synaptic pore that hyperpolarizes the receptor making it hard for it to propagate an
action potential effectively inhibiting or decreasing the neurons firing rate affecting directly the
patients behavior.
The GABA
receptors have binding sites for other chemicals other than GABA, one
site is special for barbiturates which are prescribed as a sleeping medication but is used mainly
for anesthesia before surgery. And another site is special for benzodiazepines. An activation of
each site promotes the influx of chlorine ions, but in different ways. Activating the
benzodiazepine site promotes the natural action of GABA by increasing the frequency that the
ion pore opens in response to the GABA chemical (Kolb & Whishaw, 2014). This is extremely
important to notice because having this two sites that can be triggered with external elements like
alcohol (barbiturate) and anxiolytics (benzodiazepines) we must educate the patient not just with
the right dosage but also with the right use of the medication, this is why is strictly prohibited to
drink alcohol or take sleeping pills during a benzodiazepine treatment and vice-versa; this can
react as a hyper sedative effect that can lead to a coma or even death.
Treatment: BZD vs CBT
Benzodiazepines abuse
This treatment can be subjected to an abuse for people that arent using them for
legitimate reasons, and can produce a physical addiction for patients that have been using
tranquilizers all their lives and are beginning to generate tolerance to the medication, needing
more dosage every time to fulfill the therapeutic objectives. The wide availability of these
tranquilizing medications can become very alarming due to the increasing overdose deaths
consumers have reached.
The National Institute on Drug Abuse (2015) had gather data regarding overdose deaths
from benzodiazepines.
This graph elucidates the number of deaths from benzodiazepines, the chart shows the
total number of overdose deaths from 2001 to 2014. The chart is overlayed by a line graph that
differentiates the deaths by females and males (NIDA, 2015).
Also, benzodiazepines withdrawal has similar effects of those from the alcohol
withdrawal syndrome that has to be medically supervised because of the extremely painful
effects this can have. Benzodiazepine withdrawal must be managed by administrating long acting
benzodiazepines at a dose high enough to abort the symptoms with gradual suspension when the
patient has regained control of the cravings (Marin & Escobar, 2013).
Mental health facilitator often think that medication is necessary in order to reduce
anxiety disorders, and this can be accurate, some anxiety disorders can be effectively treated with
benzodiazepines, however some studies have concluded that exposure based CBT plus BZD is
Denver Naturopathic Clinic. (n.d.). GABA: Gamma-Amino Butyric Acid. Retrieved from:
http://www.denvernaturopathic.com/news/GABA.html
Marin, H., Escbar, J. (2013). Clinical Psychopharmacology: A Practical Approach.
Singapore: World Scientific Publishing Company.
National Institute on Drug Abuse. (2015). Overdose Death Rates. Retrieved from:
https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Kolb B., Whishaw I. (2014) An introduction to Brain and behavior. Worth Publishers:
New York
Last Name, F. M. (Year). Article Title. Journal Title, Pages From - To.
Last Name, F. M. (Year). Book Title. City Name: Publisher Name.
Wrz, A., & Sungur, M. Z. (2009). Combining Cognitive Behavioural Therapy and
Pharmacotherapy in the Treatment of Anxiety Disorders: True Gains or False Hopes?. Klinik
Psikofarmakoloji Bulteni, 19(4), 436-446.