It is repeatedly mentioned in the literature that, in addition to the anxiolytic effect itself, the drug farmapram (alprazolam) also has an antidepressant effect, which has not been detected in other tranquilizers. Its presence was discovered shortly after the active introduction of farmapram into clinical practice and was confirmed in a number of further studies. There are indications that alprazolam is effective not only for neurotic, but also for endogenous depression. Moreover, its effect is comparable to tricyclic antidepressants. Many authors indicate the preference for its use in syndromes, in the structure of which there is a combination of anxiety and depressive symptoms.
There are data indicating the effectiveness of farmapram (alprazolam) in the therapy of premenstrual syndrome. Successful use of alprazolam in the treatment of acute stress and obsessive-compulsive disorders has been described. The drug was prescribed either at the beginning of a course in addition to selective serotonin reuptake inhibitors (SSRIs) to relieve severe anxiety, or as monotherapy for resistance or intolerance to SSRIs. However, despite the assumptions made, alprazolam has proven ineffective in the treatment of post-traumatic stress disorder (PTSD).
There is evidence for the use of alprazolam as a corrector of extrapyramidal symptoms (especially acute dystonia and akathisia) caused by neuroleptic intake. However, in the presence of other highly effective remedies for neuroleptic syndrome, alprazolam cannot be considered as a first-line drug. The most frequent side effects of alprazolam therapy are sedation and somnolence, which is explained by the interaction of the drug with GABAA-receptors and during the course of treatment, the above mentioned side effects are significantly reduced.
Discontinuation of regular alprazolam should be done gradually to avoid the development of withdrawal syndrome. Over such a period, lasting from several weeks to months, the daily dosage of the drug is gradually reduced until complete withdrawal. A number of studies have noted that decreasing the dose of benzodiazepine tranquilizers may be accompanied by withdrawal symptoms and a return of the underlying clinical manifestations, especially when therapy is abruptly discontinued.
Despite the widespread perception that there is a risk of drug dependence, data from numerous studies suggest that the rate of dependence among patients receiving alprazolam is relatively low. The authors point out that dependence on benzodiazepines is a relatively rare phenomenon and occurs mostly in persons who abuse alcohol or narcotic drugs. Its main effect is anxiolytic. Alprazolam belongs to high-potency benzodiazepines, that is, a pronounced anxiolytic effect develops when using low doses of the drug. This is explained by the fact that alprazolam has a higher affinity for specific benzodiazepine receptors.