Insomnia treatment principles

In the treatment of children and adolescents with anxiety disorders clinicians have a wide variety of pharmacologic options beyond the antidepressants (Shader and Greenblatt, 1995 Lydiard et ah, 1996 Riddle et ah, 1999). The benzodiazepines (BZs), with their favorable safety profile and quick onset of action, are attractive alternatives for the treatment of acute anxiety. While the clinical effectiveness of buspirone has not been proven in children, buspirone is used alone or in combination with other drugs in the treatment of anxiety disorders. The antihistamines are often used to treat insomnia and may reduce acute mild agitation. Zolpidem (Ambien) is occasionally used for its sedative properties. This chapter reviews the structure, proposed mechanisms of action, pharmacodynamic principles, and pharmacokinetic principles of these drugs. 

Lichstein KL, Nau SD, McCrae CS, Stone KC (2005) Psychological and behavioral treatments for secondary insomnias. In MH Kryger, T Roth, W Dement (eds) Principles and practice of sleep medicine (4th ed). Saunders, Philadelphia, 138-148... 

Lichstein KL, McCrae CS, Wilson, NM (2003) Secondary insomnia Diagnostic issues, cognitive-behavioral treatment, and future directions. In ML Perlis, KL Lichstein (eds.) Treating sleep disorders Principles and practice of behavioral sleep medicine. Wiley, New York, 286-304... 

Clonidine, an antihypertensive drug, also has been used in the treatment of mania. Sudden withdrawal can produce a rebound hypertensive crisis. Consistent with the brain-disabling principles, it can produce a variety of psychiatric symptoms, including sedation, vivid dreams or nightmares, insomnia, restlessness, anxiety, and depression. More rarely, it can cause hallucinations. Unfortunately, this drug is too commonly used as a so-called mood stabilizer in children. When mistakenly prescribed with stimulants, it causes an elevated risk of cardiac arrhythmia and cardiac arrest in children. 

---

See also in sourсe #XX -- [ ]

---