Insomnia pharmacotherapy

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

If symptoms (e.g., hyperarousal, avoidance, dissociation, insomnia, depression) persist for 3 to 4 weeks and there is social or occupational impairment, patients should receive pharmacotherapy or psychotherapy, or both. 

Management includes identifying the cause of insomnia, education on sleep hygiene, stress management, monitoring for mood symptoms, and elimination of unnecessary pharmacotherapy. 

The use of benzodiazepines should be avoided. There are other safer pharmacological alternatives. Benzodiazepine withdrawal may play a role in the occurrence of delirium in the elderly. Other withdrawal symptoms include tremor, agitation, insomnia and seizures (Turnheim 2003). Thus, when there is long-term use of benzodiazepines abrupt discontinuation might be difficult. Discontinuation should however not be withheld but done slowly and step-wise. If benzodiazepines are used in the elderly, short-acting benzodiazepines such as oxazepam are preferred, because they do not accumulate in the elderly to the same extent (Kompoliti and Goetz 1998). If short-acting benzodiazepines are used they should be prescribed with caution, at low doses, and for short periods. As with all pharmacotherapy the effects should be evaluated. Benzodiazepines are sometimes used as a behavioural control. One should always ask if this use is for the benefit of staff or the benefit of the patient. The presence of staff may be sufficient for behavioural control. 

Smith MT, Perlis ML, Park A, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 2002 159(1) 5-10. 

Although benzodiazepines, zolpidem, zaleplon, and eszopiclone are the mainstay of pharmacotherapy for insomnia, other sedating drugs, such as trazodone, diphenhydramine, or chloral hydrate, also may be used. Insomnia should first be addressed diagnostically, and in most cases, nonpharmacological interventions should be attempted before treatment with a hypnotic is instituted. Hypnotic agents should be administered in the lowest effective dose. Medications commonly prescribed for insomnia, along with their recom-... 

Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW (2004) Cognitive behavior therapy and pharmacotherapy for insomnia a randomized controlled trial and direct comparison. Arch Intern Med 164 1888-1896... 

Owens JA, Babcock D, Blumer J, Chervin R, Ferber R, Goetting M, Glaze D, Ivanenko A, Mindell J, Rappley M, Rosen C, Sheldon S (2005) The use of pharmacotherapy in the treatment of pediatric insomnia in primary care Rational Approaches. A Consensus Meeting Summary. J Clin Sleep Med 1 49-59... 

Buysse DJ (2000) Rational pharmacotherapy for insomnia time for a new paradigm. Sleep Med Rev 4 521-527... 

If symptoms (e.g., hyperarousal, avoidance, dissociation, insomnia, depression) persist for 3 to 4 weeks and there is social or occupational impairment, patients should receive pharmacotherapy or psychotherapy, or both. Psychotherapies for PTSD include anxiety management (e.g., stress-inoculation training, relaxation training, hiofeedback, distraction techniques), CBT, group therapy, hypnosis, psychodynamic therapies, and psychoeducation. Psychotherapy may he used in patients with mild symptoms, those who prefer not to use medications, or in conjunction with drugs in those with severe symptoms to improve response. 

Systemic effects of methamphetamine are similar to those of cocaine. Inhalation or IV injection results in an intense rush that lasts a few minutes. Methamphetamine has a longer duration of effect than cocaine. Pharmacologic effects include increased wakefulness, increased physical activity, decreased appetite, increased respiration, hyperthermia, euphoria, irritability, insomnia, confusion, tremors, anxiety, paranoia, aggressiveness, convulsions, increased heart rate and blood pressure, stroke, and death. Methamphetamine intoxication is an acute condition that may result in death pharmacotherapy may be indicated for seizures. 

Timely treatment of short-term insomnia is valuable, as it may prevent progression to a chronic condition, which is much harder to alleviate. Psychological treatments are effective and pharmacotherapy may be either unnecessary or used as a short-term adjunct. The approaches are to ... 

Sandler, 2005) and illustrates once again the necessity of placebo-controlled study designs for evaluating ASD pharmacotherapies. Notably, the results from this study are at variance with previous open-label studies that reported benefits for citalo-pram in ASD (reviewed by Posey et ah, 2006). In addition, adverse events were significantly more frequent overall with citalopram than with placebo, with significant increases in energy level, impulsiveness, impaired attention and concentration, hyperactivity, stereotypy, and insomnia. 

The pharmacotherapy of insomnia has improved dramatically, and the recent development of novel agents has continued to grow thanks to the drug discovery process. 

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