Relapse sleep

Diseases which will probably be subject to control by insecticides but have not yet been adequately tested include sandfly fever, dengue, urban yellow fever, bartonellosis, cutaneous leishmaniasis, Chagas disease, filariasis, trench fever, and louse-born relapsing fever. Some of the virus encephalitides. sleeping sickness, and visceral leishmaniasis may also be susceptible of control. 

The reason for this warning is that abrupt cessation of SSRIs produces withdrawal symptoms in about 20 per cent of patients. Symptoms of withdrawal from antidepressant medication include gastrointestinal disturbances (abdominal cramping and pain, diarrhoea, nausea and vomiting), flu-like symptoms, headaches, sleep disturbances, dizziness, blurred vision, numbness, electric-shock sensations, twitches and tremors. Abrupt withdrawal can also produce symptoms of depression and anxiety, which can occur within hours of the first missed dose of the drug.11 Withdrawal symptoms are sometimes mistaken for a relapse, leading patients to resume antidepressant medication and to conclude that they need it in order to remain free of depression. Technically, this is not considered addiction , but it does seem awfully close. 

It is now widely recognized that a number of sleep manipulations improve the symptoms of depression (Gillin 1983 Leibenluft and Wehr 1992). These include total and partial sleep deprivation, selective deprivation of REM sleep, and phase shifting of the sleep-wake cycle. Total and partial sleep deprivation induce an immediate improvement in about 60% of depressed subjects, but this effect is typically reversed by subsequent sleep. If total sleep deprivation is combined with antidepressant medication, starting on the day prior to the sleep deprivation, this sometimes prevents relapse after the recovery sleep (Elsenga and van... 

Acetarsol An organic arsenic compound, being therapeutically active when administered orally, that might be of value in the treatment of spirochaetal or protozoal diseases, for instance syphilis, yaws, relapsing fever, sleeping sickness and amoebic dysentiy. 

Whichever sedative-hypnotic agent is selected, the following guidelines can help ensure a safe and effective treatment. Use the minimal therapeutic dose at first to decrease possible hangover effects. Consider using the medication on an as-needed basis if the insomnia is intermittent, and after 2-4 weeks attempt a trial off medication to see if it is still required. Many individuals with chronic insomnia will relapse after a 14-28 day trial of treatment, but this time frame also affords an opportunity to implement sleep hygiene improvements. 

In addition to their proven efficacy in the treatment of all types of depression, the SSRIs have been shown to be the drugs of choice in the treatment of panic disorder, obsessive-compulsive disorder, bulimia nervosa, and as an adjunct to the treatment of alcohol withdrawal and relapse prevention, premenstrual dysphoric disorder and post-traumatic stress disorder. The usefulness of these drugs in treating such a diverse group of disorders reflects the primary role of serotonin in the regulation of sleep, mood, impulsivity and food intake. 

If at the end of the continuation phase it is decided that the antidepressants should be discontinued, this should be done gradually (e.g., over 6 weeks) to avoid withdrawal effects such as sleep disturbance, irritability, or gastrointestinal symptoms, which may lead the clinician to misinterpret the need for continued medication treatment. Clinical practice has suggested that rapid discontinuation of antidepressants may precipitate a relapse or recurrence of depression. In children and adolescents, it is recommended that treatment be discontinued while they are on extended vacations, rather than during the school year. 

Klein E, Bental E, Lerer B, et al Carbamazepine and halopeiidol vs. placebo and haloperidol in excited psychoses. Arch Gen Psychiatry 41 165-170, 1984a Klein E, Hefez A, Lavie P Effects of clomipramine infusion on sleep in depressed patients. Neuropsychobiology 1 85-88, 1984b Klein E, Lavie P, Meiraz R, et al Increased motor activity and recurrent manic episodes risk factors that predict rapid relapse in remitted bipolar disorder patients after lithium discontinuation—a double blind study. Biol Psychiatry 31 279-284, 1992... 

Tolerance to inhalants can develop with frequent use, and withdrawal symptoms include sleep disturbance, irritability, jitteriness, sweating, nausea and vomiting, fast heart rate, and hallucinations or delusions. Withdrawal can last one month or longer, and the relapse rate is high. 

For example, in a bipolar patient, reduction of the amplitude of mood swings may be the focus of acute therapy. During the maintenance phase, however, the most sensitive predictor of an impending relapse might be a decreased need for sleep. Careful attention to the onset of such a symptom might lead to early treatment, preventing a full-blown recurrence. 

Nicotine withdrawal is mild compared with opioid withdrawal and involves irritability and sleep problems. However, nicotine is among the most addictive drugs (relative risk = 4), and relapse after attempted cessation is very common. 

Wu JC, Bunney WE (1990) The biological basis of an antidepressant response to sleep deprivation and relapse review and hypothesis. Am J Psychiatry 147 14-21... 

Methods of assessing rebound and withdrawal in more clinically relevant terms have been available for many years (e.g., [8]). In the past decade, regulatory authorities have insisted on discontinuation studies after short-term use as well as long-term maintenance or relapse prevention. This applies to hypnotics in equal force despite most product licences now restricting hypnotic use to short-term (2 1 weeks) use. An adequate number of subjects, normal and insomniac, must be studied. Rebound needs assessment over more than one night, with a variety of techniques including PSG, activity meters, and subjective reports. Standard sleep questionnaires can be used for the subjective assessments. 

Regulation of mood, sleep, and aggression have all been shown to involve the serotoninergic system (17-19), and most antidepressant drugs currently being used inhibit 5-HT reuptake and/or act on 5-HT receptors (of which there are several subtypes). 5-HT is produced centrally from the amino acid tryptophan, and depressed mood can be induced experimentally by acute tryptophan depletion in healthy individuals. This effect is accentuated in those with a family history of depression (18-21). Similarly, depressive relapse can be initiated in individuals treated with MAO inhibitors or selective serotonin reuptake (SSRI) inhibitors by depleting tryptophan (22, 23). 

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