Sticking it to Anxiety: The Science Behind Anti-Anxiety Patches

Understanding anxiety and stress
Anti-anxiety patches: how they work
Evidence and effectiveness
Benefits for wellbeing
Conclusion
References
Further reading

Anxiety and depression are two of the most disabling mental disorders, ranked within the top 25 leading causes of global health-related burden in 2019. This health-related burden was reported to be high across entire lifespans of individuals for both sexes. There has not been a reduction in this global prevalence for either disorder since 1990, regardless of health-related interventions.

This article will provide insight into the efficacy of anti-anxiety patches as a novel approach to managing anxiety and stress and the potential role they may play in treating anxiety disorders and promoting overall wellbeing.

Understanding anxiety and stress

Anxiety can be defined as an emotion that is characterized by feelings of tension and thoughts riddled with worry, as well as physical indicators such as increased blood pressure. Anxiety, which can be confused with fear, is rooted in worry about the future, with long-lasting responses focusing on a diffuse threat. However, fear is considered an appropriate response to present, identifiable, and specific short-lived threats.

Stress, which is similar to anxiety, is a natural response, including mental tension or worry as a result of a difficult situation that prompts humans to address obstacles and challenges. However, the way an individual responds to stress can make a significant difference in their overall wellbeing and anxiety levels.

The pathophysiology of anxiety includes important mediators of anxiety within the central nervous system, such as norepinephrine, dopamine, and gamma-aminobutyric acid (GABA). Most anxiety-related symptoms are mediated by the autonomic nervous system, especially the sympathetic nervous system.

The amygdala, a part of the brain, also holds a significant role in responding to fear and anxiety, with patients with anxiety disorders being found to have an increased amygdala response to anxiety.

Both the amygdala and the limbic system structures are connected to the brain's pre-frontal cortex region, and psychological or pharmacologic interventions may reverse pre-frontal-limbic activation abnormalities.   

Managing anxiety disorders is significant in providing individuals with a calmer state of mind, enabling them to carry out daily tasks with ease and without constant mental tension and stress.

Overall, this can provide patients with anxiety disorders with a better quality of life, aiding their mental and physical wellbeing without psychosocial or physical symptoms.

Anti-anxiety patches: how they work

Non-invasive drug routes have become a desirable administration alternative to needle injections and even oral administration. A transdermal drug delivery system (TDDS) is an attractive drug administration method due to having a low rejection rate, being easily applied, and overall offering patients a more convenient lifestyle when requiring medication such as for anxiety.

TDDS involves the non-invasive delivery of drugs into the body through the skin, unlike direct administration that utilizes needles, a route that is less desirable for patients, especially the elderly, children, and those who fear needles, which results in a high rejection rate.

As TDDS does not involve passing through the gastrointestinal tract, there is no drug availability or concentration loss due to first-pass metabolism. Drugs using the transdermal route can also avoid disruption due to pH, enzymes, and intestinal bacteria.

A transdermal patch containing a drug works by being applied to the skin, resulting in drug release through the skin at a controlled rate and seeping into the capillary bed. The drug is then transported into the bloodstream and the whole body.

However, while this route of drug administration seems simple, there are some challenges, including the skin barrier with the stratum corneum, the outermost layer of the epidermis, preventing the entry of external substances, especially those with a large molecular weight. TDDS aims to deliver small molecular weighted substances to utilize the intracellular pathway into the body.

The use of anti-anxiety patches may be a more desirable form of treatment compared to other forms of anxiety management, with acute anxiety being managed by medication such as benzodiazepine or buspirone hydrochloride.

Chronic anxiety, defined as lasting longer than four weeks, is managed by health professionals with the use of an antidepressant. The use of selective serotonin reuptake inhibitors (SSRIs) is usually the first line of treatment, with beta-blockers also being used to treat anxiety disorders.

When treating anxiety over a period of time, it may be difficult for patients to be consistent with medication, which may work against the user, preventing them from reducing their anxious feelings.

The use of a transdermal anti-anxiety patch may be an easier form of treatment, allowing patients to feel the effects of the drug through sustained drug release, leading to a longer-lasting impact. A transdermal patch may be worn for 24 hours, potentially lasting even longer.

Evidence and effectiveness

The EMSAM patch is the only antidepressant that utilizes a monoamine oxidase inhibitor (MAOI) within a TDDS route and has been FDA (Food and Drug Administration) approved for several years.

This TDDS development was initially a welcomed therapy for clinicians with the hope that it would be tolerated better than the oral version of the antidepressant, as well as non-MAOI antidepressants. However, while this patch has been deemed effective, it has been underutilized in clinical practice, with possible fear of side effects.

MAOIs can be used to treat social anxiety and panic disorders when other medications are unsuccessful, with this drug being used to prevent the enzyme monoamine oxidase from removing significant neurotransmitters such as serotonin, dopamine, tyramine, and norepinephrine from the brain. 

Interestingly, the EMSAM patch was highly effective in double-blind placebo-controlled studies with reduced risks for many adverse effects seen in oral MAOIs, including the "cheese reaction."

Benefits for wellbeing

The potential for using anti-anxiety patches seems significant for patients suffering from anxiety disorders, with TDDS being more effective for avoiding side effects and ensuring drug availability. The use of anti-anxiety medication through patches can aid in the daily functioning of users, enabling improvement in sleep quality and mood, as well as improving overall wellbeing and quality of life.

However, it seems this route for anxiety medication is not widely researched, and with EMSAM being FDA-approved several years ago, there does not seem to be much advancement in this field.

Conclusion

The use of anti-anxiety patches and the delivery of anti-anxiety medication through a transdermal route may have value. However, it seems to have little progression, with many anti-anxiety patches being for more commercial use with a psychological and mindfulness component without scientific backing. 

References

• Antidepressant drugs. NICE. Accessed October 27, 2023. https://bnf.nice.org.uk/treatment-summaries/antidepressant-drugs/#:~:text=Management%20of%20acute%20anxiety%20generally%20involves%20the%20use,may%20be%20required%20until%20the%20antidepressant%20takes%20effect.
• Asnis G, Henderson M. Emsam (deprenyl patch): How a promising antidepressant was underutilized. Neuropsychiatric Disease and Treatment. Published online 2014:1911. doi:10.2147/ndt.s59107
• Bandelow B, Michaelis S. Epidemiology of Anxiety Disorders in the 21st Century. Dialogues in Clinical Neuroscience. 2015;17(3):327-335. doi:10.31887/dcns.2015.17.3/bbandelow
• Chand SP, Marwaha R. Anxiety. StatPearls [Internet]. StatPearls.2023. Accessed: October 27, 2023. https://www.ncbi.nlm.nih.gov/books/NBK470361/
• Jeong WY, Kwon M, Choi HE, Kim KS. Recent advances in Transdermal Drug Delivery Systems: A Review. Biomaterials Research. 2021;25(1). doi:10.1186/s40824-021-00226-6
• Leppert W, Malec–Milewska M, Zajaczkowska R, Wordliczek J. Transdermal and topical drug administration in the treatment of pain. Molecules. 2018;23(3):681. doi:10.3390/molecules23030681
• Santomauro DF, Mantilla Herrera AM, Shadid J, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet. 2021;398(10312):1700-1712. doi:10.1016/s0140-6736(21)02143-7
• Selegiline transdermal patch. MedlinePlus. Accessed October 27, 2023. https://medlineplus.gov/druginfo/meds/a607003.html.
• Sub Laban T, Saadabadi A. Monoamine Oxidase Inhibitors (MAOI) [Updated 2023 Jul 17]. In: StatPearls [Internet]. StatPearls. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539848/
• WIlson J. Do anti-anxiety patches work or are they total B.S.? . September 15, 2023. Accessed October 27, 2023. https://www.huffingtonpost.co.uk/entry/do-anti-anxiety-patches-work-or-are-they-total-bs_uk_650459a5e4b0b10a3ff96d64.

Further Reading

• All Anxiety Content
• What is Anxiety?
• Anxiety Causes
• Anxiety Symptoms
• Anxiety Diagnosis

Written by

Marzia Khan

Marzia Khan is a lover of scientific research and innovation. She immerses herself in literature and novel therapeutics which she does through her position on the Royal Free Ethical Review Board. Marzia has a MSc in Nanotechnology and Regenerative Medicine as well as a BSc in Biomedical Sciences. She is currently working in the NHS and is engaging in a scientific innovation program.