Introduction
A human organism is a complicated natural phenomenon, which is subjected to various influences of the environment, natural and human-made effects of certain activities. The whole set of these influences causes various diseases, mental or physical, and leads to several psychological disorders. Depression, anxiety disorder, feelings of sadness, and fear are all the phenomena that make human life hard and make people look for the means of fighting these disorders. The recent advances in pharmacology have allowed humanity to create a group of drugs based on benzodiazepines that are allegedly able of calming people’s nervousness and easing their depression recovery. These drugs include Lorazepam, or Ativan according to its brand name, Clonazepam (Klonopin), Diazepam (Valium), and Tempazepam (Restoril). However, it is Alprazolam or Xanax, that is considered to be the most effective drug among the whole variety mentioned above. This research paper considers the history of Xanax’s invention, its psychopharmacodynamics, psychopharmacokinetics, and pharmacotherapy, and proposes alternative drugs and therapy methods for treating illnesses treated with Xanax.
Historical Background of Xanax
Thus, Xanax is the brand name of the alprazolam drug used mainly in the treatment of anxiety and mood disorders. The beginnings of alprazolam use date back to the 1960s, when the drug was first synthesized by scholars from the Upjohn Company in Kalamazoo, Michigan. Dr. David Sheenan is considered to be one of the pioneers of the study of Xanax’s effects on panic and fear disorders (Preston, O’Neal & Talaga, 2008). After its invention, Xanax was patented by the Upjohn Company in 1976, was launched to the United States market for the first time in 1981. The controversy over Xanax was first raised when the US Food and Drug Administration (FDA) refused to register it as an antidepressant and only allowed it to be marketed as an antianxiety medicine that does not cause depression as a result of its usage (Xanax XR, 2008). Since that time, Xanax has been in use as one of the most effective anti-depression drugs on the market.
Psychopharmacodynamics or mode of action
Actions
The pharmacodynamics, or the mode of action according to which Xanax operates, is rather complex and not studied enough to describe it in detail. The scholarly proven data on Xanax operation include the statement of its action in the central nervous system and ability to treat depression, anxiety, and panic:
Their exact mechanism of action is unknown. Clinically, all benzodiazepines cause a dose-related central nervous system depressant activity varying from mild impairment of task performance to hypnosis (Xanax, 2006, p. 1).
Thus, the complete mechanism of Xanax’s action in the human organism is unknown but researchers have managed to find out that the so-called CNS agents contained in the benzodiazepines of the 1,4 class bind to each other at certain receptors that are located at stereo specific areas of the central nervous system of the human organism (Xanax, 2006). Drawing from this, the central nervous system is viewed as the center of Xanax actions.
Impact on Central Nervous System
Accordingly, the impact of Xanax on the central nervous system is major as only after impacting this system does Xanax manifest its effects on mental activities and even muscles relaxation in some cases. The point is that Xanax is based on the triazole benzodiazepines that, after getting into the central nervous system, create the active compounds able of changing the processes in the system and varying its activities (Xanax, 2006). According to the official website of Xanax XR (2008), the chemicals contained in the medicine react with the natural chemicals found in the human organism and have calming effects on the central nervous system. Thus, being an antidepressant, Xanax works through causing depression to the central nervous system centers to protect the person from anxiety or panic attacks as well as from falling into depression caused by external factors (Medicine Net, 2009).
Psychopharmacokinetics of Xanax
Absorption of Xanax
The psychopharmacokinetics of alprazolam and Xanax are explained by their chemical composition, the interactions that the chemical elements of Xanax, benzodiazepines, have with the natural chemicals observed in the human body, and by the way of taking Xanax pills (Xanax XR, 2008). Thus, as far as Xanax is usually taken orally, the process of its absorption is rather simple and fast. After Xanax is orally administered, alprazolam is absorbed in blood and plasma, and during the first two hours after the administration, the highest levels of concentration of alprazolam in blood and plasma are observed (Xanax, 2006). At the same time, during the process of absorption, the levels of plasma are directly proportionate to the levels of alprazolam administered. According to the data by Xanax (2006), given the 0.5 to 3.0 mg of alprazolam dose, the levels of plasma amount to 8 – 37 ng/mL in average healthy adults (Xanax, 2006).
Distribution of Xanax
The process of distribution of Xanax and its constituent elements in the human body is more complicated. It has not yet been studied enough to provide the exact data on how the distribution occurs and what it results in; therefore, scholars like Preston, O’Neal & Talaga (2008) and Peters (2004) base their consideration on experimentally researched distribution processes of Xanax. According to these scholars, if placed in the artificially created conditions, i. e. in vitro, the prevalent majority of the alprazolam (on average over 80%) from Xanax becomes bound to the human serum protein elements. Moreover, Xanax (2006) reports that the bindings of the alprazolam form the serum albumin elements if allowed to react with the human serum proteins. However, the reported distribution processes and chemical reactions Xanax and alprazolam participate in are proven by experiments in vitro only, and their actual performance in the human organisms demands further study.
Metabolism of Xanax
The process of metabolism of the alprazolam contained in Xanax is studied much better which allows scholars and the official sources connected to the Xanax manufacturers to describe the metabolism in detail (Preston, O’Neal & Talaga, 2008). Thus, according to Xanax (2006) and Xanax XR (2008), the major elements which serve for the metabolism of alprazolam include the cytochromes P450 3A4 and CYP3A4. After the work of the cytochromes that facilitate metabolism, the two major metabolites, i. e. metabolism results, emerge in the human blood and plasma; these metabolites include “4-hydroxyalprazolam and α-hydroxyalprazolam” (Xanax, 2006, p. 2). The plasma concentration of the above elements is research-proven to always be lower than the 4% level. The metabolites also create benzophenone, which is however proven to be passive in its influence upon the central nervous system, although the half-lives of the bindings the benzophenone forms in plasma are similar to the bindings of elements produced from alprazolam.
Elimination of Xanax
According to the above considerations concerning the metabolism of alprazolam in the human blood and plasma, it becomes evident that the elimination of Xanax from a human body is easily carried out due to the low (under 4%) concentrations of alprazolam and the bindings it forms in the human organism. The period needed for the complete elimination of the alprazolam from blood and plasma is on average 11.2 hours, while the very process of excretion is natural: “Alprazolam and its metabolites are excreted primarily in the urine” (Xanax, 2006, p. 2). Although seemingly simple, the elimination process is complicated in people with various impairments or addictions like alcoholism or impaired renal function. Medicine Net (2009) and Xanax (2006) report the increase in time needed for geriatric adults to eliminate alprazolam from the plasma. If healthy adults need 11.2 hours to excrete the alprazolam, the impaired people need from 16.3 to 65.3 hours for the same purpose.
Pharmacotherapy
Indications
The indications to the usage of Xanax include the treatment of anxiety disorders and for the short-term relief of their symptoms, the panic disorders, and anxiety associated with depression. The anxiety disorder is defined as “unrealistic or excessive anxiety and worry (apprehensive expectation) about two or more life circumstances, for 6 months or longer, during which the person has been bothered more days than not by these concerns” (Xanax, 2006, p. 2). To be subjected to Xanax treatment the anxiety disorders must be characterized by motor tension, autonomic hyperactivity, vigilance, and scanning. These and other minor issues like trembling, inability to focus, etc. should not be consequences or secondary effects of other disorders for the treatment with Xanax to be effective. Panic disorders, either characterized by agoraphobia or not, are also treated by Xanax. The effectiveness of Xanax treatment ranges from 2 weeks to 2 months without relapsing of either anxiety or panic disorders (Medicine Net, 2009; Xanax, 2006).
Contraindications
The first, and the most important, contraindication for the use of Xanax in the treatment of a patient is the fact, or assumption, that this patient has, or might have, the increased sensitivity or allergy to the components of Xanax or the medicine as the whole (Xanax XR, 2008). People are reacting rather negatively to the benzodiazepines, and the treatment of this person with Xanax is not recommended as it might lead to unpredicted consequences. The use of Xanax is also contraindicated for people with acute angle glaucoma and for pregnant women who might suffer fetal harm from Xanax constituents. Finally, the research has not yet been carried out to experimentally prove the safety of Xanax for people under the age of 18 and senior citizens as well (Xanax, 2006).
Reasons for Prescription
Therefore, the reasons for prescribing Xanax treatment to a person include complaints about anxiety or panic disorder and the proven diagnosis of these disorders. In other words, even if the prior symptoms of an anxiety disorder are observed, a therapist cannot prescribe such a strong antidepressant as Xanax because those primary symptoms might turn out to be the manifestations of other, simpler problems, and treatment by Xanax might harm the physical health of the patient. Thus, Xanax is prescribed to people with anxiety and panic disorders with a dose of 0.25 to 0.5 mg taken three times every day for the anxiety disorder and 1 to 10 mg daily with the proportionate distribution of doses throughout the day. The increase of the dose is prohibited to avoid unpredicted harm to health, while the decrease in the dose should amount to not more than 0.25 mg, and only in case if the treatment proves to be effective.
Alternatives
Therapy
Needless to say, Xanax is not the only way to treat psychological disorders, anxiety and panic disorders, etc. Scholars have long been trying to find the best alternative to drugs in this area of health care, and the reasons for looking for the alternatives are numerous. First of all, the use of Xanax is limited by a group of people who do not display any of the above-mentioned contraindications to Xanax or any of its elements. Secondly, Xanax and its effects on such groups of people as the youth and elderly people have not yet been studied enough to allow for Xanax’s overall use in health care.
Finally, the side effects of Xanax might be rather dangerous, especially for pregnant women and children. Drawing from this, Peters (2004) offers massage and acupuncture therapy as the alternative treatment for patients with contraindications for Xanax or for other people who prefer more natural treatment methods. Peters (2004) claims that message and acupuncture therapy combined with deep sleep and enough time spent for rest daily can replace Xanax treatment or eliminate the very need for the latter.
Drugs
However, there are also drug alternatives to Xanax. All the alternative drugs also belong to the benzodiazepine-based medicines that are used to treat anxiety and panic disorders, depression, etc. One of them is lorazepam, branded also as Ativan, which is used to treat anxiety and is considered a better alternative than Xanax due to the less time needed to eliminate lorazepam from the human blood and plasma (Medicine Net, 2009). Clonazepam, branded as Klonopin, is also based on benzodiazepine and is used specifically to prevent seizures and other physical issues that might result from anxiety or panic disorders. Diazepam, or Valium, is also used to treat anxiety but its effects are mostly observed in the nervous system and muscle relaxation; due to this Valium is used to relieve pains and spasms, and enable the patient to sleep in case of insomnia proves to be one of the sings of anxiety or panic disorder (Medicine Net, 2009). Thus, drug alternatives to Xanax have their pros and cons being more effective in one respect and more harmful in another one; so, it depends on a patient and a therapist which type of drug treatment or the alternative therapy will be used in each particular case.
Conclusions
As the result of this research paper, it is evident that Alprazolam, or Xanax, is considered to be the most effective drug among the whole variety of medicines aimed at treating anxiety and panic disorders, depression, etc. At the same time, scholars stress the possibility of finding alternatives to Xanax in both the variety of other antidepressants and the alternative therapies that might include massage, acupuncture, deep sleep, etc. The choice of the most fitting method of treatment should be carried out jointly by the patient and the therapist and should be based on the details of each particular case and personal characteristics of an individual who might be either allergic to Xanax or other drugs or consider alternative therapies as unnecessary and not reliable.
References
Medicine Net. (2009). We Bring Doctor’s Knowledge to You. Retrieved August 10, 2009, from Generic Name: Alprazolam.
Peters, T. (2004). Fibromyalgia and Natural Therapies: An Interview with Michael Hooker.
Preston, J. D., O’Neal, J., & Talaga, M. (2008). Handbook of Clinical psychopharmacology for Therapists. New Harbinger Publications; 5th edition.
Xanax. (2006). CIV Description. Web.
Xanax XR. (2008). Alprazolam Extended-Release Tablets.