Test anxiety is a kind of social anxiety that produces anxiety symptoms before or during tests and exams. Symptoms include heart palpitations, increased respiration, tremors, tensed muscles, racing thoughts, an inability to speak or think, nausea and diarrhea. The medications usually prescribed for test anxiety are the same as those prescribed for other anxiety disorders. They include selective serotonin reuptake inhibitors, benzodiazepines and beta blockers.
Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors, SSRIs, are frequently prescribed for social anxiety disorders, including test anxiety. As of August 2010, the only SSRI FDA-approved for the treatment of anxiety disorders is escitalopram, or Lexapro. But several other medications in this class reportedly have the same effects as escitalopram.
SSRIs decrease the breakdown of the "feel good" chemical serotonin, thereby increasing the brain's levels of serotonin. Serotonin in the brain regulates fear processing in the brain's fear center, also known as "the amygdala." This, in turns, down-regulates the secretion of stress chemicals, such as adrenaline and cortisol, from the adrenal gland. According to a study published in the August 2010 issue of "Genetics," SSRIs also strengthen the synaptic connections between neurons.
As noted by a research team in the September 2007 issue of "Neuron," while SSRIs have significantly fewer side-effects than benzodiazepines, they cannot be used as a treatment of acute anxiety, as it takes about six weeks for them to restore the brain's serotonin levels.
Benzodiazepines
According to "Managing Social Anxiety," benzodiazepines are frequently prescribed for social anxiety disorder, including test anxiety, because they are fast working. The most commonly prescribed benzodiazepines are alprazolam, or Xanax, and diazepam, or Valium. Alprazolam takes effect after 15 minutes, whereas the effects of diazepam set in after about an hour.
Benzodiazepines work via the GABA pathway. GABA is a naturally occurring inhibitor of neuron excitability, which prevents the brain from going into a state of hyper-excitement as is seen during local and grand mal seizures. Benzodiazepines increase the effects of GABA, thereby decreasing distractability, stress symptoms and muscle tremors. According to a study in the August 2008 issue of "Neuropsychopharmacology," benzodiazepines also bind to the brain's dopamine receptors, which can generate a pleasurable "reward" feeling and trigger addiction.
Compared to SSRIs, benzodiazepines have many disturbing short-term side-effects, including sleepiness, a slow voice, a drunken appearance, short-term memory loss and slow cognitive abilities. Long-term side-effects include tolerance and addiction.
Beta Blockers
The anti-anxiety drugs with the fewest known side-effects are heart medications known as "beta blockers." According to a study published in the March 2007 issue of "Journal of Cognitive Neuroscience," beta blockers block anxiety symptoms triggered by the stress hormone adrenaline. Adrenaline binds to receptors on the heart muscle and the smooth muscles of the blood vessels, thereby giving rise to a quickening of the heart beat, more intense contractions of the heart muscle, faster respiration and muscle tremors.
As these effects are the most disabling symptoms of test anxiety, beta blockers are very effective drugs for this type of anxiety. Because they only treat the symptoms of anxiety, however, they are less suitable for the treatment of generalized anxiety disorder, panic disorder and obsessive-compulsive disorder.
References
- "Neuron"; Serotonin4 (5-HT4) Receptor Agonists Are Putative Antidepressants with a Rapid Onset of Action; Lucas, et al.; September 2007
- "Genetics"; The Antidepressant Sertraline Targets Intracellular Vesiculogenic Membranes in Yeast; Meredith M. Rainey, et al.; August 2010
- "Managing Social Anxiety"; Debra A. Hope, et al; 2005
- "Neuropsychopharmacology"; Long-lasting Modulation of Glutamatergic Transmission in VTA Dopamine Neurons after a Single Dose of Benzodiazepine Agonists; Heikkinen, et al.; August 2008
- "Journal of Cognitive Neuroscience"; Beta-adrenergic Modulation of Cognitive Flexibility during Stress; Jessica K. Alexander, et al.; March 2007
