Why are there so few new anxiety meds?

Over the last decades we had a lot of new antidepressants, antipsychotics and a few mood stabilizers. When it comes to antidepressants there really has been an explosion. Not very many new sleep meds have come. How many new anxiety meds? Even Buspar that people think is fairly new, was patented in the 70s.

Isn't there a market for anxiety meds? Is there too little money in medication used PRN and not daily? Is anxiety always seen as part of another mental illness so it always needs to be treated with depression or psychosis meds?

What IS the deal really? Sure, some antidepressants can deal with certain aspects of anxiety, but they cannot be used PRN and also IMO they are quite useless for certain types of anxiety where they don't help at all.

There are old types anxiety meds that do indeed help, work PRN and act stronger towards anxiety compared with antidepressants. Those are all... well old.... There are no newer ones. They make all kinds of meds these days, is it that impossible to have a next generation anxiety med with lesser dependence factor? Take ativan as an example. It came 1977. That is many many many years ago.

Even in pre op anxiety they use really old stuff, going back to neuroleptics like thorazine. To me this is quite weird.

Aside from some relief with AD's there is only buspar which has a 20% success rate verses the placebo's 10% success rate I kid you not. Benzo's remain the best for anxiety. They replaced barbiturates in the 60's and were welcome with open arms from doctors all over the world because compared to barbiturates benzo's are 100% safer and less addicting. Also it is almost impossible to OD on just benzos while you could easily accidentally OD on barbs. Granted benzos are not as fast or effective as barbs but if you never had barbs you wouldn't know that. These days you can only get barbs as inpatient. You hear all these horror stories about benzo withdrawal. I been around the block a few times, it's all in the head and they call it withdrawal. Real withdrawal comes from opiates, barbs and amphetamines. Equal to cocaine and heroin withdrawal. Benzo withdrawal is a walk in the park. The only withdrawal I get from benzos is I get pissed off for a few days when my doc stops my scripts before I wanted to. I've stopped cold turkey more times then I can count with zero withdrawal. So the best we have these days available for out patient is benzos and we are facing severe benzo phobia in part from all the horror stories. </rant>

They try antihistamines like benadryl and hydroxyzine, but those don't do a thing for me.
The benzos work so good. At least Klonopin has worked great for me. Don't know whether I will get a refill or not. My mental health center has a big anti benzo policy. Addictive and withdrawal I guess or maybe afraid of law suits I dunno.

Antihistamines just make me feel physically ill and sluggish, and when I do I feel bad mentally. Some antihistamines others can take, would probably be really bad for me. One I tried knocked me out for 24 hours on a kiddie dosage.

I agree benzos have a place, still weird that anxiety meds have been on a standstill for decades and no new ones. When other types of meds have been so developed. Antihistamines are old too.

I agree, it is odd, especially since there are people like me who are extremely resistant to benzos and basically can't use them because I need a dangerously high dose for them to do anything at all.

Bromazepam Camazepam Carburazepam Chlordiazepoxide Cinazepam Cinolazepam Clonazepam Clorazepate Cyprazepam Delorazepam Demoxepam Devazepide * Diazepam Diclazepam Doxefazepam Elfazepam Ethyl carfluzepate Ethyl dirazepate Ethyl loflazepate Flubromazepam Fletazepam Fludiazepam Flunitrazepam Flurazepam Flutemazepam Flutoprazepam Fosazepam Gidazepam Halazepam Iclazepam Ketazolam Lorazepam Lormetazepam Lufuradom * Meclonazepam Medazepam Menitrazepam Metaclazepam Motrazepam Nimetazepam Nitrazepam Nitrazepate Nordazepam Nortetrazepam Oxazepam Phenazepam Pinazepam Pivoxazepam Prazepam Proflazepam Quazepam QH-II-66 Reclazepam RO4491533 * Ro5-2904 Ro5-4864 * Sulazepam Temazepam Tetrazepam Tifluadom * Tolufazepam Tuclazepam Uldazepam Arfendazam Clobazam CP-1414S Lofendazam Triflubazam Girisopam GYKI-52466 GYKI-52895 Nerisopam Talampanel Tofisopam Adinazolam Alprazolam Estazolam Flubromazolam Pyrazolam Triazolam Bretazenil Climazolam FG-8205 Flumazenil Imidazenil Iomazenil (123I) L-655,708 Loprazolam Midazolam PWZ-029 Remimazolam Ro15-4513 Ro48-6791 Ro48-8684 Ro4938581 Sarmazenil SH-053-R-CH3-2′F Cloxazolam Flutazolam Haloxazolam Mexazolam Oxazolam Bentazepam Brotizolam Ciclotizolam Clotiazepam Etizolam JQ1 * Olanzapine * Lopirazepam Zapizolam Razobazam * Ripazepam Zolazepam Zomebazam Clazolam Avizafone Rilmazafone

Deez iz duh boozodiazepines

Why aren't there more meds for anxiety? Good question!

As for benzo withdrawal, IndieVisible you are either really lucky or you've stopped a benzo after having been on it for a short time. Every time I've tried to w/d from k-pin I have had severe PHYSICAL and emotional w/d symptoms. 8 years ago I tried to w/d, tapered down very slowly, and I was so sick I literally could not stand on my legs and walk from the bedroom to my car. I was terrified because I felt like I was dying. I mean I physically REALLY felt like I was facing death. Benzo w/d is known to be as harsh as heroin w/d - and more life-threatening, especially if done too quickly.

Alonewithmycat, as many as they are, I doubt any of them are from the last 2 decades. Most are from the 60s and 70s.

For other issues there are newer classes of drugs, like there are several classes of antipsychotics and several of antidepressants. After benzos, most barbiturates were discontinued, so there are really just one class of anxiety med, and one that is basically not used.

The problem I see is when someone can't or doesn't want to take a benzo, or very common where I am, it will not be prescribed at all, a big cluster of symptoms that we call anxiety, will be untreated.

I do think it would be nifty if a third generation anxiety meds came along. But the industry doesn't seem to be at all interested in this, which sort of confuses me.

It would be so nice if something could be used PRN, just lowered the anxiety levels without the whole abuse/dependence risk. At least they could make something less easy to get addicted to. When the Z meds came, they were under free prescription as totally non addictive. Now we know there is chance of some addiction with Z meds as well, but much less people get addicted, most people will not develop addiction or abuse the med. So if that is possible, maybe it is possible to make a lower risk anxiety med?

Or maybe it is plain impossible?

Anti-anxiety requires medicines to calm the brain, meaning tranquilizers, benzos, etc. Some SSRIs work, if you have just the right brain chemistry. Problem is that there are so many places that no longer prescribe downers because of lawsuits, risk of addiction and illicit abuse. I think it's a liability issue, too. I'm hoping (assuming) that someone is doing some research in developing alternatives.

There is a lot of research leading up to more atypical antidepressants with anti-anxiety effects. Also other meds with said effect.

Looking at a snapshot of clinical trials (note that this one is somewhat old and several substances are now on the market) here:

Compounds in clinical development for anxiety disorders : 50 years of hurdles and hope in anxiolytic drug discovery : Nature Reviews Drug Discovery : Nature Publishing Group

we can see rather quickly (now with those already approved) that it does not seem like any of the substances are meant for anything than everyday use.

To me it is a little discouraging.

Antihistamines (atarax specifically) work great for me for 2-3 days. Then at the third or forth day they do not send me to sleep anymore. I would say they are good for once a week. Apart from that, all antihistamines first, second and third generation make me very very hungry and this is the reason that I don't use them daily, as I am highly allergic person.

I think that this issue is highly dependent on individual makeup -- both physical and psychological. I have been on and off benzos for most of my life and I have never suffered a severe withdrawal reaction -- instead, I get angry with the health care professional who takes it into his head to discontinue a regimen which works for me (I suffer from agoraphobia with panic attacks, and there is nothing like a hard, high dose of alprazolam or clonazepam to abort these attacks and make it possible for me to go outside and do whatever I have to do). Also, New York state is in the grip of a hysteria pertaining to the prescription of these and other drugs, rendering many healthcare professionals reluctant to prescribe these drugs for fear of being audited and potentially losing their licenses. Sometimes I feel like moving to a completely different state, just so as to be able to access the medications which do me the most good -- specifically the benzos.

There are many benzos which were developed in the 1970s and 1980s but never marketed, and I often wonder why this is so.

PHILIP

Do Probiotics Help Anxiety? | Psychology Today

People are thinking outside the box now...gut microflora have been implicated in a number of things and anxiety is now one of them. One strain of bacteria is being developed as an anti-anxiety agent. So these aren't even drugs, you'll be able to go up to the whole foods and get a capsule of bacteria to take. The problem is the bacteria don't colonize so you have to keep taking them just like a normal med and it's very strain specific and none of the currently available ones have been shown to have this effect...

funny side note...i took hydroxyzine for a condition called interstitial cystitis. its supposed to calm the bladder...but it never helped with anxiety...although at that time I didnt have much anxiety and smoked pot all the time for pain and was in remission for most of my problems. Now I dont smoke pot and everything is out of control. Ironic eh?

First its the gut and bacteria that cause autism, then it causes depression, now it causes anxiety. Obviously pro-biotics are the cure all for everything that could possibly be wrong with a person.

As for reality, I have taken pro-biotics just to help digestion and it did nothing for my anxiety, depression and certainly didn't make me any less autistic. Its a healthy thing, perhaps it can contribute to reducing some peoples anxious feelings...but I highly doubt its an effective treatment for people who suffer from severe anxiety.

Sorry but I am just very skeptical of this whole '(insert mental disorder) is caused by problems with gut bacteria and this and that, therefore taking pro-biotics will get rid of the symptoms.' thing. Its plausable that perhaps for some people this gut issue might contribute to their symptoms....but then I'd question if its just causing depression and anxiety 'like' symptoms but not the disorder.

Benzo. withdrawal is not something to be taken lightly. Paranoia, denationalization, seizures including grand-mal, delirium tremors and you can die from those. Basically the higher the dose on a pam=all benzos. need to be reduced gradually unless you are on a very low dose. It can take months but with a pdoc that knows a good scheduled reduction. You could have some discomfort but nothing like the above. That is why it is now basically protocol to use benzos. only as prn and very carefully! Unless the person/patient actually needs daily amounts for quality of life/ Agoraphobics are a case for that.

The antihistamines talked about will tire you and also are anti-cholnergic, which is why people will feel a hangover effect and a "dumbing" down effect. The problem is that it really has to due with excess production of glutamate. That is released by NMDA post synaptic receptors. And the N.T. GABA which is the "calming" N.T. The balance between the two. They are using gabapentin and pregabalin( voltage calcium regulators) now. Which originally was scripted for fibromyagia. That basically block the release of glutamate phasic release.
Problem being is that all of the GABAa meds that mediate a steady release of GABA will eventually lead to tolerance or addiction. The VSCC's also are inclined to basically lose their effect with regular use.
Buspar (buspirone) is a 5HT1a partial agonist that has a very questionable reputation but is used by some pdocs.. Some call it a sugar pill. Usually takes a long time for therapeutic effects because of it's downstream changes unlike the acute effects of a benzo. Take a benzo and in a half hour to 45 minutes. You will feel it.

So basically the receptor sites that are trying to be handled are in the amygdala. Where the fight or flight response comes from. Also norepinephrine and the prefrontal cortext are involved along with adrenergic receptors-adrenalin. So there is alot going on . It is complicated and complex. Dealing with so many areas of the brain.
The newer approaches med wise include d-cycloserine, SGRI's selelective glycine reuptake inhibitors. All looking to effect NMDS receptors in the amygdala and the plasticity. While using CBT and exposure therapy.

Studies:
Bringing a developmental perspective to anxiety genetics
The role of the serotonergic and GABA system in translational approaches in drug discovery for anxiety disorders
Neuroplasticity as a target for the pharmacotherapy of anxiety disorders, mood disorders, and schizophrenia

Again, if you want members to add long and informative posts. Don't boot them off. If I hadn't saved most of this. A lot of time and energy would have been wiped out. That's why I didn't throw out more studies, right now. Give people time to write!!!
Guess the answer is to use a word document before posting it but sometimes what starts as a short response expands.
Sorry about the rant, I just almost lost all of it!!!

I've actually never seen any convincing research that gut bacteria cause autism however there are a few papers that are analyzing it in mice but no mechanisms are suggested. I've also never seen any convincing research on depression. Certainly people have speculated on these things though. In any case I'm not suggesting that gut bacteria cause anxiety so much as the possibility that they might be able to stop it some people. Many of the studies on probiotics use a specific strain of bacteria and the effects are in fact highly strain specific. So let's say the anxiety study is on lactobacillus rhamnosis strain xxq12 (made up) even the closely related lactobacillus LGG that is found in common probiotics won't have the same effect. The probiotics which cause this effect are not commercially available at the moment but they will be in the future. This post was about research in the pipeline not what we already have. You wont't get this from yogurt....

While the specific mechanism was not identified this effect on anxiety works on stimulation of the vagal nerve so this is a known to help suppress anxiety...cut the nerve no effect of bacterial treatment.

The latest research in these areas are much more about prebiotics though. Use of prebiotic fiber can actually change your gut flora so you don't have to supplement with probiotics everyday. What does this mean....lots of fruits and veggies...

It seems weird to consider that the gut microbiota might have control over how we think and yet they are many more of them than us and we basically carry them around and feed them so it's to their advantage to keep us alive...

Do you have links to studies to back up your claims? I don't disagree. Actually much 5HT is found in the intestines. Of course a good diet, lifestyle and exercise are all positives for the body and mind.
But if you are going to postulate on the latest research of these claims. Please provide links to studies, as to back up your statements . Anyone can use the phrase "latest research" but show the papers and studies done!

I personally believe in the "mind body" connection. I am not backing that statement up with any research it is just my intuition or "gut" instinct. To me it stands to reason give the number of neurotransmitter receptors throughout the body that there is some connection.

The role of serotonin in the gut seems not to be understood very well.
Serotonin in the Gut: What Does It Do?

Think Twice: How the Gut's "Second Brain" Influences Mood and Well-Being - Scientific American

This article seems to support the theory of gut bacteria effecting the brain.
That gut feeling

Different neurotransmitters (monoamines) and all the receptors for them on cell membranes serve a whole bunch of different functions. Serotonin regulates blood pressure, body temp regulation, sexual things, GI intestinal things, and others. This is why we get the side effects we do from SSRI's and SSNRI's. How much all these systems have an impact on the brain, who knows. Interesting that serotonin cannot cross the blood brain barrier and what the brain uses for whatever functions has to be produced in the brain. 5-HT receptors outside the brain may have nothing to do with brain function....who knows.

Serotonin Involvement in Physiological Function and Behavior - Basic Neurochemistry - NCBI Bookshelf

Neurotransmitter Receptors - Molecular Cell Biology - NCBI Bookshelf

What is serotonin? What does serotonin do? - Medical News Today

Just my opinion but it seems logical that given how integrated the whole nervous system is between the brain and body and the common use of the same monoamines and their receptors for so many different functions, that there would be bi lateral communication between the two and that each one would have a huge influence on the other.

Also, factor in how many different cell structures there are and their unique functions and properties. I did a research paper on the brain and the effects of nutrition, herbs, other supplements and personal lifestyle. I also did a paper on inflammation in the brain and body and it's contributing not only on mental health issues but illnesses and disease in general,
They are a few yrs old and some of the links are dead. Let me see if I can pull them up!

http://forums.psychcentral.com/3522664-post1.html
http://forums.psychcentral.com/3522657-post1.html

http://forums.psychcentral.com/2699054-post1.html
http://forums.psychcentral.com/2699054-post1.html
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