Anxiety and psychological stress can make bipolar patients more susceptible to an episode of their mood disorder - as can sleep deprivation. Benzodiazepines decrease activity in brain arousal systems and can diminish anxiety, activity, agitation, and promote normal sleep.

Benzodiazepines appear to work by enhancing the actions of the neurotransmitter gamma-aminobutyric acid, which reduces nerve impulse transmissions and slows down certain brain activity. In the 1980's, researchers discovered that some brain cells have receptors that benzodiazepine molecules fit into as perfectly as a hand into a glove. This breakthrough led to the assumption that these manmade drugs somehow imitate chemicals made by the body that have a naturally tranquilizing effect.

Benzodiazepines are most often used along with mood stabilizers and/or antipsychotic medications in the treatment of acute mania. It is important to be aware, however, that benzodiazepines can be abused, and it is possible to become psychologically and physically addicted to them. The sedating effects decrease over time, and after several weeks of use their effectiveness as tranquilizers decreases. For these reasons benzodiazepines are used most commonly as a temporary measure.

Most often used Benzodiazepines:

- Ativan (lorazepam)
- Centrax (prazepam)
- Dalmane (flurazepam)
- Halcion (triazolam)
- Klonopin (clonazepam)
- Librium (chlordiazepoxide)
- ProSom (estazolam)
- Restoril (temazepam)
- Serax (oxazepam)
- Tranxene (clorazepate)
- Valium (diazepam)
- Xanax (alprazolam)

The most common side effects of the benzodiazepines are sedation, drowsiness, and decreased mental acuity. Combining alcohol with these medications can produce unconsciousness, coma, and even brain death. Persons taking benzodiazepines should drink with caution or not at all.

Buspar:

BuSpar is a newer anxiolytic prescribed mainly for the treatment of generalized anxiety disorder. It is preferred by many over the benzodiazepines as it is less sedating and nonaddictive. However, it can take weeks to become effective and usually requires several doses each day for maximum benefit.

Although it works well when taken with the SSRI antidepressants, it should not be taken within two weeks of treatment with MAOI medications.

Side effects can include dizziness, mild headache, nausea, nervousness and insomnia.

Natural Treatments for Anxiety:

* Valerian:
Valerian is a sedative obtained from a plant found in Europe and temperate regions in Asia. It can act as a minor tranquilizer for restlessness, anxiety and sleep disturbance. Dubbed "God's Valium" in the popular press, valerian also acts as a muscle relaxant. It inhibits an enzyme that breaks down the neurotransmitter GABA. By stimulating GABA, it dampens the brain's arousal system.

Significant side effects are not common. The PDR for Herbal Medicines (Fleming, 1998) cautions that gastrointestinal complaints can occur in rare instances and that contact allergies can occur in very rare cases. With long-term administration, restlessness, sleeplessness, mydriasis, headaches and cardiac dysfunction can occasionally appear.

* Kava-Kava:
Kava-kava, a green leafy member of the pepper family, may be a safe, efficacious, low-cost herbal alternative to conventional antianxiety medications, without the potential for physical addiction, major side effects or loss of alertness. Its name means "intoxicating pepper" in Latin. It is well known to the natives of the South Pacific Islands for its tranquilizing properties and its ability to increase sociability.

The herb can reduce anxiety and tension, and it can promote restful sleep. It is probably the most potent anxiolytic available without a prescription. It is nonaddictive, and people rarely seem to develop tolerance. It does not alter mental clarity, nor does it interfere with reaction times, alertness or other cognitive abilities. Its ability to promote relaxation without loss of mental sharpness makes it particularly useful for the daytime management of anxiety.

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