Anxiety and insomnia

These are the newer drugs used to treat schizophrenia. Atypical anti-psychotic drugs are recommended for newly diagnosed schizophrenics and those who cannot tolerate other drugs or who are not getting adequate control from other drugs. 

All are thought to improve negative as well as positive symptoms of schizophrenia in addition to causing fewer motor side effects and are less likely to affect prolactin secretion. 

Examples of atypical anti-psychotic drugs are clozapine, risperidone, olanzapine and quetiapine. 

Clozapine can cause agranulocytosis and should only be used if other drugs are not effective. 

Other adverse effects of most anti-psychotic drugs are anti-cholinergic effects such as dry mouth, constipation and urinary retention and a-adrenergic blocking effects, primarily vasodilation leading to a fall in blood pressure especially in the elderly. 

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Pharmacological Profiles of Anxiolytics and Sedative—Hypnotics. Historically, chemotherapy of anxiety and sleep disorders rehed on a wide variety of natural products such as opiates, alcohol, cannabis, and kawa pyrones. Use of various bromides and chloral derivatives ia these medical iadications enjoyed considerable popularity early ia the twentieth century. Upon the discovery of barbiturates, numerous synthetic compounds rapidly became available for the treatment of anxiety and insomnia. As of this writing barbiturates are ia use primarily as iajectable general anesthetics (qv) and as antiepileptics. These agents have been largely replaced as treatment for anxiety and sleep disorders. 

The term pasaon flower is used to denote many of the approximately 400 species of the herb. F saon flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinsonism. F saon flower is often used in combination with other herbs , such a valerian, chamomile, and hops, for promoting relaxation, rest and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patientstaking the monoamine oxidase inhibitors (MAOIs). Fission flower contains coumarin, and the risk of bleeding may be increased when used in patientstaking warfarin and pasaon flower. 

Mischoulon, D. (2002). The herbal anxiolytics kava and valerian for anxiety and insomnia. Psychiatric Annals, 32, 55-60. 

Asthenic syndrome with headaches, irritability, anxiety, and insomnia were observed in 62 of 130 people working with OPPs for more than five years... 

Because Rohypnol is banned in the United States, there is an emerging trend for young people to start abusing two other Rohypnol-like drugs that are still legal in the United States clonazepam (Klonopin ) and alprazolam (Xanax). Both Klonopin and Xanax are benzodiazepines that are used for the treatment of anxiety and insomnia. Although they are less potent than Rohypnol, they can produce similar effects when mixed with alcohol and also have been reported to enhance the effects of heroin. 

Functioning in a compiex and dangerous environment requires one to possess effective mechanisms of arousai, both arousai to consciousness and emotionai arousai, in order to meet the demands on behavior. For exampie, an organism needs to be abie to arouse behavioraiiy in order to deai with predators and other environmentai threats. As is often the case with disorders of the mind and brain, normai and adaptive mechanisms can be overactivated and thus become maiadaptive. A common outcome of this overactivation is anxiety and insomnia. 

No health hazards are known with the proper use of kava (Gruenwald et al. 1998). Kava has been approved by the German Commission E for treatment of anxiety and insomnia. In clinical studies of kava for anxiety, adverse effects were uncommon and did not differ across placebo and kava groups. There do not appear to be any studies published on the effects of acute overdosage with kava. Given its CNS depressant effects, it should not be taken with other similar drugs, including benzodiazepines, barbiturates. 

Barbiturates. The first barbiturate, barbital, was introduced at the turn of the 20th century. Hundreds of others, including phenobarbital and pentobarbital, were later developed. The barbiturates were a highly successful class of medications as it became clear that they treated not only alcohol withdrawal but seizure disorders, anxiety, and insomnia as well. By the 1960s, however, the barbiturates were largely surpassed by the benzodiazepines. The newer benzodiazepines act in a similar fashion and provide much the same therapeutic benefit but are significantly safer and easier to tolerate. 

Of the non-benzodiazepines that have been introduced recently for the treatment of anxiety and insomnia, buspirone and zopiclone have been the most extensively investigated so far. The pharmacokinetic characteristics of... 

Lorazepam is a short-acting benzodiazepine indicated for use in relieving anxiety and insomnia. Lorazepam may also be administered perioperatively to alleviate pain and in status epilepticus. Imipramine is a tricyclic antidepressant, paroxetine is a selective serotonin re-uptake inhibitor, venlafaxine is a serotonin and adrenaline re-uptake inhibitor and moclobemide is a reversible monoamine oxidase inhibitor. Imipramine, paroxetine, venlafaxine and moclobemide are all classified as antidepressants. 

Benzodiazepines have similar pharmacological properties and are used in anxiety and insomnia. The choice of which benzodiazepine to use usually lies with the pharmacodynamic and pharmacokinetic properties, which vary across the class. For example, diazepam, flurazepam and nitrazepam have a prolonged duration of action whereas lorazepam and temazepam have a shorter duration of action. 

CNS symptoms. A substantial proportion of patients experience some degree of increased restlessness, agitation, anxiety, and insomnia, especially shortly after initiation of treatment. 

Anxiety and Insomnia Anx ety, nervousness, and insomnia were reported for venlafaxine-treated patients, and led to drug discontinuation. 

Amphetamine and methamphetamine are metabolites of selegiline and may cause anxiety and insomnia. 

A significant advantage of the benzodiazepines over other central nervous system depressants (e.g., the barbiturates) is that they possess a much greater separation between the dose that produces sleep and the dose that produces death. This increased margin of safety has been one of the major reasons benzodiazepines have largely replaced the barbiturates and other types of sedative-hypnotics in the treatment of anxiety and insomnia. In addition, benzodiazepine aclministration is associated with few side effects. 

Before the introduction of the benzodiazepines, a number of drugs from different chemical and pharmacological classes were used in the treatment of anxiety and insomnia. However, these drugs are more toxic and produce more serious side effects than do the benzodiazepines. Many also have signihcant abuse potential. Consequently, most of these compounds are no longer widely used. These drugs include the barbiturates (e.g., pentobarbital, amobarbital), carbamates (e.g., meprobamate), piperidinediones (e.g., glutethimide), and alcohols (e.g., ethchlorvynol). 

Use of the extended-release (XL) preparation is recommended because of increased tolerability, decreased seizure risk, and the increased ease of use associated with a once-a-day preparation. Treatment with the sustained-release (SR) or XL preparation is initiated at a dose of 150 mg, preferably taken in the morning. After 4 days, the dosage may be increased to 150 mg twice a day (SR) or 300 mg once daily in the morning (XL). Gradual dose titration helps to minimize initial anxiety and insomnia. Temporary use of anxiolytic or hypnotic agents is reasonable in some patients but generally should be limited to the first few weeks of treatment. 

Anxiety and insomnia are prevalent symptoms with multiple etiologies. Effective treatments are available, but they vary by diagnosis. In most instances, the best course of action is to treat the underlying disorder rather than reflexively to institute treatment with a nonspecific anxiolytic. 

Schatzberg and Cole (204) reviewed 20 controlled studies of BZDs used in the treatment of a mixed profile of depressions and also concluded that, although anxiety and insomnia may be significantly relieved, core depressive symptoms (e.g., psychomotor retardation and diurnal variation) remain essentially unchanged. Some positive resolutions were seen in depressions associated with a high level of anxiety, but there was little evidence for efficacy in more severe depressions without prominent anxiety. 

Lader MH. Limitations on the use of benzodiazepines in anxiety and insomnia are they justified Eur Neuropsychopharmacoi 1999 9(suppl 6) S399-S405. 

Abrupt alcohol withdrawal leads to a characteristic syndrome of motor agitation, anxiety, insomnia, and reduction of seizure threshold. The severity of the syndrome is usually proportionate to the degree and duration of alcohol abuse. However, this can be greatly modified by the use of other sedatives as well as by associated factors (eg, diabetes, injury). In its mildest form, the alcohol withdrawal syndrome of tremor, anxiety, and insomnia occurs 6-8 hours after alcohol consumption is stopped (Figure 23-2). These effects usually abate in 1-2 days. In some patients, more severe withdrawal reactions occur, with patients at risk of hallucinations or generalized seizures during the first 1-3 days of withdrawal. Alcohol withdrawal is one of the most common causes of seizures in adults. Several days later, individuals can develop the syndrome of delirium tremens, which is characterized by total disorientation, hallucinations, and marked abnormalities of vital signs. 

Time course of events during the alcohol withdrawal syndrome. The signs and symptoms that manifest earliest are tremor, anxiety, and insomnia as well as (in severe syndromes) hallucinations and seizures. Delirium tremens—with its associated delirium, hallucinations, and autonomic instability—develops 48-72 hours after alcohol discontinuation. 

Adverse effects have been reported with a frequency comparable to that of placebo. These include nausea, headache, stomach upset, diarrhea, allergy, anxiety, and insomnia. A few case reports noted bleeding complications in patients using ginkgo. In a few of these cases, the patients were also using either aspirin or warfarin. 

Wyeth ( 16 billion in sales). Formerly known as American Home Products, this company headquartered in Madison, New Jersey, makes many well-known OTC drugs such as Robitussin and Advil. The company first used machines to mass-produce tablet pills in 1872 and supplied the polio vaccine for early trials in the 1950s. It produced a diet drug called fenfluramine that when combined with other drugs into a form known as fen-phen caused health problems and was withdrawn from the market. It makes Premarin and Prem-pro for estrogen replacement, Effexor for depression and anxiety disorders, Ativan for anxiety and insomnia, and Enbrel for arthritis. 

The company, acquired by Pfizer in October 2009 produced fenfluramine, the diet drug that was removed from the market for causing health problems, and makes Premarin and Prempro for estrogen replacement, Effexor for depression and anxiety disorders, Ativan for anxiety and insomnia, and Enbrel for arthritis. 

If patients are on dmgs for hypertension, tachycardia, anxiety and insomnia, herbs that strongly sedate Heart-shen and descend the... 

Long Yan Rou is sweet and neutral, and enters the Heart and Spleen meridians. It can gently tonify the Spleen-Qi, Heart-Qi and the blood. At the same time, it can calm the mind and treat restlessness, anxiety and insomnia. As this sweet fruit has neither cloying nor drying properties, it is often used in a formula for a chronic condition or in the diet for long-term use. 

These herbs can be used as assistants in formulas that spread the Liver-Qi when the Qi disturbs the mind and influences sleep. Bai He is sweet and slightly cold, and enters the Lung and Heart meridians. It can calm the mind and treat depression, anxiety and insomnia. Suan Zao Ren is able to nourish the blood of the Liver and improve sleep. 

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