Sedative-hypnotics evaluation

Cantopher T, Olivieri S, Cleave N, et al Chronic benzodiazepine dependence a comparative smdy of abrupt withdrawal under propranolol cover versus gradual withdrawal. Br J Psychiatry 156 406-411, 1990 Caplan RD, Andrews FM, Conway TL, et al Social effects of diazepam use a longitudinal field study. Soc Sci Med 21 887—898, 1985 Charney DA, Paraherakis AM, Gill KJ The treatment of sedative-hypnotic dependence evaluating clinical predictors of outcome. J Clin Psychiatry 61 190—195, 2000... 

Insomnia is a common comorbid condition with depression, and frequently is made worse by antidepressants, particularly the SSRIs. When insomnia persists despite adequate evaluation and attempts to reduce it by other approaches, it is often necessary to use a concomitant sedative-hypnotic, especially a short-acting nonbenzodiazepine with rapid onset such as zaleplon or zolpidem. At times a benzodiazepine sedative hypnotic such as triazolam or temazepam may be necessary. If anxiety persists during the day and cannot be otherwise managed, it may be necessary to add an anxiolytic benzodiazepine such as alprazolam or clonazepam. Use of sedative-hypnotics and anxiolytics should be short-term whenever possible. 

Medications for treatment of RLS are available based on the level of distress and frequency of symptoms. Dopamine agonists, sedative-hypnotic medications, opiates, or anticonvulsants have been used for treatment. Nonetheless, it is suspected that RLS remains a disorder that is unrecognized and therefore untreated. Although recent literature has began to report the social impact of RLS, its economic impact remains to be evaluated. 

Kava is most often used as a sedative-hypnotic to treat anxiety. The substance has been evaluated in Europe and in the USA for the treatment of anxiety in several placebo-controlled studies. Most of these trials have shown significant improvements in anxiety symptoms in patients with moderate to severe anxiety within 8 weeks after starting treatment. In one study, kava was compared with oxazepam, a benzodiazepine. Similar reductions in anxiolytic effects and fewer adverse effects were reported for the kava group. Kava appears to have a slow onset of action for the treatment of anxiety symptoms, most patients responding only after 4-8 weeks. Kava should not be used to treat acute symptoms of anxiety or panic attacks. 

What characteristics should be evaluated in choosing a sedative-hypnotic agent for a patient ... 

Pandeya, S. N. Aggarwal, N. Jain, J. S. Evaluation of semicarbazones for anticonvulsant and sedative-hypnotic properties. Pharmazie 1999, 54, 300-302. 

Central Muscle Relaxants - There appeared during the year an excellent re-view oi the synthetic centrally acting skeletal muscle relaxants which covers the literature through most of 1966 ". As the authors, Donahoe and Kimura, point out, there continues to be a need for effective chemical compounds which relieve painful skeletal muscle spasms without producing muscular weakness or incapacitating sedative or hypnotic effects. Since most of the clinically useful compounds fall within a few structural classes there is a need for more basic studies involving molecular alteration for evaluation as central muscle relaxants. 

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