A lot has been written and researched about physical disorders. But in case of mental disorders, awareness regarding their impact on our lives is just beginning to take effect. Mental disorders are conditions that affect your thinking, feelings, mood and through it affect your health, social and professional lives and entire state of existence. Of the various mental disorders, anxiety, depression and stress are the most prevalent of the lot. Regarded as the most common illness in the U.S and U.K, they are said to affect 18.1% of the population yearly. Though they can be managed through early detection and therapy, medications play a very important role as an ideal control mechanism.
A word about Etizolam and Xanax
Etizolam and Xanax are both extremely popular anxiolytic medications used today for treatment of anxiety and sleep disorders. Both of them belong to a group of drugs called benzodiazepines or psychoactive drugs that work on the nervous system to alter mood, cognition, consciousness and behaviour. Apart from these, Benzos treat a wide range of psychiatric disorders based on the neurotransmitter they bind themselves to. Etizolam is a potent anxiolytic with a benzodiazepine analog. Xanax, the brand name of Alprazolam, is a Triazolobenzodiazepine or a benzodiazepine fused with an additional triazole ring.
How do they work?
Etizolam and Xanax have similar modes of bringing out their anxiolytic properties. Etizolam binds to the benzodiazepine binding site located at the interface between alpha and gamma subunits. It has strong affinity to the alpha 1, beta 2 and gamma 2S subunits of the GABA inhibitory neurotransmitter and through its selective binding properties opens the GABA-induced chloride channels for improved GABA transmission. Through alpha 1 receptors, it brings out its sedative effects and through the alpha 2 and 3 receptors, it brings out its sedative effects.
Like Etizolam, Xanax also binds to the GABA receptors for its anxiolytic and muscle relaxant effects. Because of the additional triazole ring attached to its structure, it exhibits properties similar to that of Tricyclic antidepressants and has additional antidepressant properties. Apart from GABA, it binds to the dopamine receptors as well for its psychoactive properties.
What are they used for?
Etizolam is an effective anti-anxiety medication and used for short term treatment of the condition. Animal studies have proved its efficacy as a sedative and muscle relaxant with drawing attention to its antidepressant properties. It has been proved to be 6 times more effective than Diazepam. Researchers have observed that it is more potent than Valium with fewer side effects. In a human study conducted to test the efficacy of Etizolam against Diazepam, it was found that Etizolam at a recommended dose has small effects on sleep time and amount of REM sleep. Clinical studies have observed its efficiency in attenuating the recurrence of chronic hematoma after a neurosurgery.
Alprazolam or Xanax is mainly used for anxiety and panic attacks. It is FDA-approved in the US for treatment of panic attacks with or without agoraphobia. Additionally, it is recommended by the WFSBP for treatment resistant cases of panic disorder without any history of tolerance or dependence. It is also used on a short term basis for depression. In the US, it is used for short term treatment of symptoms of anxiety while in the UK it is used for short term treatment of severe acute anxiety. Off-label, it is used concomitantly with other medications in cancer patients for treating chemo induced nausea and vomiting.
Which one is better?
For understanding which is a better option, it is important to take a look at the pharmacodynamics of the two drugs. Etizolam has a half-life of 3.5 hours. But the active metabolite of Etizolam, alpha- Hydroxyetizolam has a half-life of above 8 hours. Etizolam achieves peak effects in 3-4 hours and lasts between 6-8 hours after which it is metabolized and excreted by the body. Etizolam is said to be 10 times stronger than Xanax. But it is available in less stronger doses of 0.25-1 mg.
Xanax, in comparison, has a longer half-life of 6.3- 26.9 hours depending on the age, weight and sometimes even the race of the person amongst other factors. It is even available in doses as high as 3mg along with its extended release version lasting for an even longer period. It takes almost 2.3 days for Xanax to be completely metabolized and eliminated by the body through the liver and kidneys. In some people using the released version, it sometimes takes 5.6 days to completely eliminate the effects of Xanax from the body.
Xanax has a longer duration of action because of which for some, it proves the required anxiolytic effects. But its longer lasting qualities also make the patient drowsy and affect his daily activities while it lasts. Etizolam, in comparison, does not last for such a long period and subsequently its effects start waning within 6 hours of use. But it has comparatively less sedative effects and thus does not interfere in the use of diurnal activities as much as Xanax.
What about the legal aspect?
Etizolam, despite its effectiveness, is not for use in the United States. It cannot be obtained or sold there or be used for any person apart from research purposes. Countries like Japan, India, and Italy have declared it legal where it is available under a variety of brand and generic versions. But in the USA, it continues to remain a controlled substance despite not being controlled on a federal level. Xanax, on the other hand, has been actually FDA-approved and till date is the most sought-after medication for people with anxiety. It has been declared a controlled substance and is a Schedule IV medication but is recognized and available in a prevalent manner, unlike Etizolam.
What is the abuse potential?
Unfortunately, both Etizolam and Xanax are drugs with abuse potential. In fact, the rate of their misuse is a matter of growing concern worldwide. It was precisely the growing rate of casualties due to its misuse and increased addiction rates that led the US to list it as a drug of concern. From 2012-2018, around 2400 Etizolam related drug reports were reported from 44 states of the US. Xanax, though not a primary drug of abuse, is gradually inching towards the abuse potential. Around 4.3 individuals reported in a survey of 2016 of having misused it at least once. An intense and extremely uncomfortable tolerance develops rapidly during the withdrawal phase of both Etizolam and Xanax. Similarly, the scope of overdose is equal in either of the drugs with overdose symptoms ranging from loss of consciousness to motor and speech impairment and even coma.
Take home factor
Both Etizolam and Xanax are potent drugs and suitable for effective remedy against anxiety and panic disorders, if used in a judicious manner. Etizolam, despite its wide spectrum of effectiveness, has safety issues because of comparatively less research conducted in its uses and safety parameters. Xanax, though of less abuse potential, needs urgent regulation to control the growing cases of addiction related to its misuse. More attention needs to be provided in making either of the medications safe and effective with improved tolerance and decreased misuse potential.