From a psychological point of view, the emergence of anxiety in everyday life is a universal mental reaction of a person to a threat to comfort, well-being, self-respect, health, etc. From this position, some authors highlight the positive anxiety. It helps to mobilize a person to overcome discomfort, to prevent the very possibility of any threat, i.e. performs an adaptive function. Anxiety that is excessive in strength and / or duration is defined as negative; it acquires an independent clinical significance in the form of various health disorders in the field of internal medicine and psychiatry. Anxiety in the mental sphere in this case performs a function similar to pain in the field of somatic health. Anxiety disorders are multifaceted. They can be presented in the form of mental disorders of any severity. In practice, neuroses are more common; clinically, these are emotional disorders (anxiety, fear, depression) and signs of autonomic imbalance. Anxiety can be presented in the structure of any somatic diseases, influencing their course or the very occurrence. In the practice of internists, anxiety disorders with a predominance of various somatovegetative, minor organ disorders are more common, and anxiety, as a clinical symptom, is not always recognized by patients, remains “disguised”, secondary. Most diseases, in the onset and course of which anxiety plays a significant role, are located “on the border” of psychiatry, neurology and therapy. Such diseases include, in particular, neurotic and somatoform disorders, latent depression, psychosomatic diseases. A common feature of patients with the above symptoms is a reluctance to communicate with a psychiatrist, even when it is necessary. However, with the right treatment, such a need often does not arise. To one degree or another, any substance with a component of action that inhibits the nervous system has an anxiolytic (anti-anxiety) effect, for example, hypnotic barbiturates, antipsychotics, anticonvulsants, some nootropics, etc., up to alcohol and opium drugs. Conversely, many anxiolytics have the above effects.
Several classes of drugs are most commonly used to treat anxiety disorders: anxiolytics (tranquilizers) – mainly benzodiazepines; beta blockers; antipsychotics; antidepressants; other drugs. The latter include, for example, combined, metabolic agents, phytopreparations.
For the treatment of acute anxiety disorders, including so-called “somatic anxiety”, benzodiazepines and beta-blockers are indispensable. Anxiolytic (against anxiety and fear) treatment is effective as well as the correction of autonomic disorders inextricably linked with anxiety. For example, when tachycardia is eliminated with a vegetative stabilizing agent, the patient’s mental state improves. For this purpose, combined preparations of ergot alkaloids with barbiturates have been used for a very long time. However, the peculiarities of the action do not make it possible to use all of the above drugs for a long time. Tranquilizers and barbiturates can form addiction with addiction and withdrawal, beta-blockers can negatively affect cardiovascular activity. There are many contraindications to such treatment, for example, pregnancy and lactation, severe pathology of the kidneys, liver, etc. In general, the listed drugs successfully solve the problem of treating acute anxiety disorders within two to three weeks. Then, if the anxiety disorder is not completely controlled, the therapy must be changed. Anxiolytics are replaced by antidepressants, “small antipsychotics” and other substances with less anti-anxiety effect, but safer when taken for a long time.
The caution of internists with regard to the prescription of psychotropic drugs to the physically ill is quite understandable. When prescribing psychotropic drugs, unwanted interactions with the main treatment may occur.
Among the side effects of psychotropic drugs, there is “behavioral toxicity” (in the form of unwanted drowsiness, lethargy, impaired coordination, deterioration of attention), the effect on body weight, sexual dysfunction, cardiovascular activity, digestion, etc. In recent years, in psychopharmacology there is an increased interest in metabolic drugs. This interest can be attributed to several reasons. Drugs targeting certain neurotransmitter systems have a powerful effect on the central nervous system, the consequences of which are not fully clear (since the neurochemical mechanisms of various mental states themselves are not fully known) and cannot be accurately predicted. Metabolic drugs are often themselves natural metabolites, such as amino acids, or are of exogenous origin, but are a necessary part of the metabolism, such as trace elements. Metabolic agents are safe, act “softly”, use mainly the possibilities of self-regulation without depleting the resources of the sick organism.
The role of magnesium in metabolism is diverse. The intracellular concentration of magnesium ions is second only to the concentration of potassium, sodium and calcium. The role of insufficiency of this element in the genesis of disorders of the cardiovascular, digestive systems, endocrine and mental disorders has been proven.
The original drug, which is a combination of the trace element magnesium and pyridoxine, attracts attention. The daily requirement for magnesium is up to 300 mg in women and 400 mg in men. A decrease in the required amount of magnesium can occur with an excessive intake of its natural calcium antagonist, an increase in the volume of circulating blood, the use of diuretics, nutritional disorders, malabsorption in the small intestine, chronic stress, fatigue, alcohol abuse, pregnancy and lactation, diabetes mellitus.
The nature of the diet of a modern person is of great importance for the formation of magnesium deficiency in the body.
The widespread use of mineral fertilizers reduces the content of this trace element in the soil, and then in plants. Modern vegetable processing technologies, in turn, also reduce the intake of magnesium from food. Obviously, the indications for the correction of the magnesium content in the body include not only therapeutic goals, but also prophylactic ones.
An indirect indicator of the most important role of magnesium is the breadth of indications of one of the most popular drugs in the history of medicine – magnesia sulfate: from constipation to hypertensive crises.
In psychiatry and neurology, magnesium is used to correct metabolic disorders and as a sedative, including for the treatment of anxiety. It is known that magnesium ions in the extracellular fluid inhibit the release of neurotransmitters (acetylcholine and catecholamines). Due to this, magnesium has an inhibitory effect on the central nervous system, relaxes muscle fibers, thus being a natural anti-stress factor.
A limitation to the use of magnesium salts is the need to prescribe them mainly parenterally due to insufficient absorption in the gastrointestinal tract. Opportunities for oral magnesium supplementation have expanded with the advent of combination products containing magnesium and pyridoxine (vitamin B6). Vitamin B6 and magnesium potentiate each other’s action. In addition, pyridoxine significantly improves the absorption of magnesium in the intestine and increases its intracellular concentration and fixation in the cell. The complex use of magnesium preparations and such a “neurotropic” vitamin as pyridoxine has led to their widespread use in the field of neurology, psychiatry and narcology, as well as in the treatment of any conditions accompanied by psychoemotional stress. The combination of pyridoxine and magnesium (Magne-B6) has a prophylactic effect in chronic mental and physical fatigue, is indicated for headaches, sleep disturbances, and premenstrual tension syndrome.
Confirmation of the safety of complex preparations of magnesium and pyridoxine is the extensive experience of their use in obstetric and gynecological practice with the threat of miscarriage.
Magnesium and pyridoxine preparations successfully eliminate anxiety and its somatovegetative manifestations. These drugs are combined with other psychotropic drugs and do not alter their metabolism. In addition, they correct the side extrapyramidal and somatovegetative effects of antipsychotics. The combination of magnesium and pyridoxine can be used as an anxiolytic as monotherapy or in combination with antidepressants, neuroleptics, tranquilizers, hypnotics. Magnesium preparations, unlike tranquilizers, do not interact with alcohol, therefore, violation of the sobriety regimen for outpatients will not cause dangerous complications. In addition, in narcology, the role of magnesium compounds is extremely important in the treatment of alcohol hangover, these drugs effectively stop vegetative manifestations of withdrawal in the form of sweating, tremor, hypertension, and also improve mental state – reduce irritability, anxiety, reduce pathological craving for alcohol, improve sleep.
If necessary, it is possible to simultaneously or gradually replace benzodiazepine tranquilizers with a combination of magnesium and pyridoxine. This anti-anxiety therapy can be continued for many months without the risk of habituation or withdrawal.