Anxiety suppression from Efavirenz

Anxiety suppression, also known as anxiolysis, is medically recognized as a partial to complete suppression of a person's ability to feel anxiety, general unease, and negative feelings of both psychological and physiological tension. The experience may decrease anxiety-related behaviors such as restlessness, muscular tension, rumination, and panic attacks. At its fullest expression, complete anxiety suppression can produce feelings of extreme calmness, relaxation, and emotional security that allow a person to engage with situations that would normally produce significant distress.

The subjective quality of anxiety suppression varies notably depending on the class of substance producing it. GABAergic depressants such as benzodiazepines, alcohol, and GHB tend to produce a heavy, sedating form of anxiolysis that feels like a warm blanket being draped over one's worries. The relief is broad and non-specific, suppressing anxiety regardless of its source. Opioids produce anxiolysis as a secondary effect of their euphoric and analgesic properties, where pain relief and contentment make worry seem irrelevant. Psychedelics and entactogens can produce a more nuanced form of anxiety suppression that feels like genuine resolution rather than mere suppression, as if the underlying causes of anxiety have been understood and accepted.

Anxiety suppression is most commonly induced under the influence of moderate dosages of anxiolytic compounds which primarily include GABAergic depressants such as benzodiazepines (alprazolam, diazepam, clonazepam), alcohol, GHB, and gabapentinoids (pregabalin, gabapentin). It is also produced by opioids, certain serotonergic compounds, cannabinoids at low to moderate doses, and entactogens such as MDMA. Some psychedelics can produce anxiety suppression during certain phases of the experience, particularly during the afterglow period.

While anxiety suppression is generally experienced as a desirable and therapeutic effect, it carries important considerations when combined with other effects. When accompanied by disinhibition, the loss of normal caution and social restraint can lead to risky decision-making, excessive honesty, or behaviors that the person would normally avoid. When combined with sedation at higher dosages, the relaxation can progress into impaired coordination and consciousness. The therapeutic window between beneficial anxiolysis and problematic disinhibition varies by substance and individual.

Subjective reports frequently describe the onset of anxiety suppression as a wave of relief washing through the mind and body. Chronic worriers often describe the experience as revelatory, noting that they had forgotten what it felt like to be free from the constant background hum of anxiety. Social situations that normally provoke dread may suddenly feel comfortable and enjoyable. Physical tension in the shoulders, jaw, and stomach that had gone unnoticed may suddenly release.

Regular reliance on substance-induced anxiety suppression carries a significant risk of psychological and physical dependence, as the contrast between the anxiolytic state and one's baseline anxiety can create a powerful motivation to redose. This is particularly true of benzodiazepines and alcohol, where tolerance develops rapidly and withdrawal can produce rebound anxiety that exceeds the original baseline. The therapeutic use of anxiety suppression is most beneficial when used sparingly and in conjunction with other coping strategies.