Sleep disturbance dysfunction

Other potential adverse effects from P-blockers include fatigue, sleep disturbances, malaise, depression, and sexual dysfunction. Abrupt P-blocker withdrawal may increase the frequency and severity of angina, possibly because of increased receptor sensitivity to catecholamines after longterm P-blockade. If the decision is made to stop P-blocker therapy, the dose should be tapered over several days to weeks to avoid exacerbating angina. 

Treatment with imipramine, the most studied TCA, leaves 45% to 70% of patients panic free. Both desipramine and clomipramine have demonstrated effectiveness in PD as well. Despite their efficacy, TCAs are considered second- or third-line pharmacotherapy due to poorer tolerability and toxicity on overdose.48,49 TCAs are associated with a greater rate of discontinuation from treatment than SSRIs.53 PD patients taking TCAs may experience anticholinergic effects, orthostatic hypotension, sweating, sleep disturbances, dizziness, fatigue, sexual dysfunction, and weight gain. Stimulant-like side effects occur in up to 40% of patients.49... 

Other symptoms include vaginal dryness, dyspareunia, urogenital atrophy, sleep disturbances, sexual dysfunction, and impaired concentration and memory. 

Side effects include drowsiness, fatigue, sleep disturbances, vivid dreams, memory disturbance, depression, G1 intolerance, sexual dysfunction, bradycardia, and hypotension. 

Side effects, mainly due to serotonin reuptake inhibition include G1 upset, nervousness, and sexual dysfunction. SSRls are associated with an increased risk of falls. Hyponatraemia due to SIADH is an uncommon, but important side effect in elderly patients. Selective serotonin and norepinephrine reuptake inhibitors (S SNRls) such as venlafaxine and duloxetine are also useful in older patients. Other heterocyclic antidepressants of importance in older patients because of relative safety include bupro-prion and mirtazepine. They are reserved for patients with resistance to or intolerance of SSRls. Currently, trazodone is used mostly for sleep disturbance in depression in doses of 50-100 mg at bedtime. The monoamine oxidase inhibitors phenelzine. 

Yeung, C.K., Chiu, H.N., and Sit, F.K. (1999) Sleep disturbance and bladder dysfunction in enuretic children with treatment failure fact or fiction Scand J Urol Nephrol Suppl 202 20-23. 

Mirtazapine has been shown to reduce anxiety symptoms and sleep disturbances associated with depression, as early as 1 week after the start of treatment. Other advantages are minimal sexual dysfunction, minimal nausea, and once-daily dosing. In addition, mirtazapine is unlikely to be associated with cytochrome P450-mediated drug interactions. The disadvantages of mirtazapine are weight gain and prominent early sedation. 

In eight patients with major depressive disorder without psychotic features, who did not respond to serotonin re-uptake inhibitors therapy when risperidone was added, all improved within 1 week. Furthermore, risperidone also seemed to have beneficial effects on sleep disturbance and sexual dysfunction (47). In an open study in 30 healthy subjects who took risperidone 1 mg orally... 

In eight patients with major depressive disorder without psychotic features, who did not respond to serotonin reuptake inhibitors therapy when risperidone was added, all improved within 1 week. Furthermore, risperidone also seemed to have beneficial effects on sleep disturbance and sexual dysfunction (272). In an open study in 30 healthy subjects who took risperidone 1 mg orally before and after venlafaxine dosing to steady state, the oral clearance of risperidone fell by 38% and the volume of distribution by 17%, resulting in a 32% increase in AUC renal clearance of 9-hydroxyrisperidone also fell by 20% (273). The authors concluded that these small effects were consistent with the fact that venlafaxine is unlikely to alter the clearance of risperidone, which is mainly by CYP2D6. 

Adverse Effects. Typical antidepressant doses of SSRIs can cause side effects of insomnia, jitteriness, restlessness, and agitation, and lead to drug discontinuation in patients with panic disorder. Transient gastrointestinal disturbances occur more frequently with SSRIs than with TCAs. Thus low initial SSRI doses should be prescribed. Sleep disturbances, headaches, and sexual dysfunction often are problematic. ... 

Secondary amenorrhea Vasomotor symptoms (hot flushes and night sweats), sleep disturbances, mood changes, sexual dysfunction, problems with concentration and memory, vaginal dryness, and dyspareunia... 

Low level chronic exposme to mercury vapour can also affect the peripheral nervous system, leading to pol)meuropathy (reduced sensory and motor nerve function) and neuropsychological symptoms of stress and behaviour problems. Longer exposures, around 15 years, have been shown in several studies to lead to alterations in pulse rate, blood pressure, memory, sleep disturbance and EEGs, probably as a result of kidney and CNS (central nervous system) dysfunction. 

Sleep disturbances (insomnia, nightmares) Prolongation of hypoglycemia Sexual dysfunction in men... 

Beta-blockers Minimal Sleep disturbances, sedation, sexual dysfunction, cardiac disturbances, asthma... 

Many industrial accidents involving malfunctioning reaction vessels used to manufacture chlorinated phenols or phenoxy herbicides have exposed more than 1300 workers to shortterm, high-level doses of the dioxins that occur as contaminants of these substances. Exposures have frequently been associated with acne-like skin lesions, dermatitis, altered liver enzyme concentrations, pulmonary deficiency, numbness, nausea, headache, hearing loss, sleep disturbance, tiredness, sexual dysfunction, depression, and appetite loss. Populations exposed to dioxin-contaminated materials through non-occupational sources - including (hoxin-contaminated soils in Missouri, a trichlorophenol reactor explosion in Italy, dioxin-containing herbicide in Viemam, and assorted laboratory accidents - have all experienced similar effects. 

Psychological disorders related to working conditions include sleep disturbances, mood disturbances, reduced motivation to work or recreate, somatic and psychosomatic compleiints, neuroses, psychoses, and dysfunctional coping behavior. The effects of stress on an individual are influenced by the nature of the exposures and the individual s physical and psychological characteristics and coping behaviors that may accentuate or mitigate the exposure. 

Deterioration of vision Suicidal behavior Sexual dysfunction Sleep disturbances Pruritis Psychosis... 

Other consequences were less serious, in that they did not present immediate threats to life, but were certainly serious for the patient. For instance, one patient suffered prolonged sexual dysfunction after his doctor failed to stop a selective serotonin uptake inhibitor another had continued sleep disturbance due to taking an anti-depressant that his doctor was not aware of. Such reactions represent prolonged, avoidable suffering over many months, to say nothing of the waste of time and resources. If these findings were replicated across the United States, the cost implications would be staggering. 

The most commonly used therapies for anxiety and depression are selective serotonin reuptake inhibitors (SSRIs) and the more recently developed serotonin noradrenaline reuptake inhibitors (SNRIs). SSRIs, which constitute 60% of the worldwide antidepressant and antianxiety market, are frequently associated with sexual dysfunction, appetite disturbances and sleep disorders. Because SSRIs and SNRIs increase 5-HT levels in the brain, they can indirectly stimulate all 14 serotonergic receptor subtypes [2,3], some of which are believed to lead to adverse side effects associated with these drugs. Common drugs for short-term relief of GAD are benzodiazepines. These sedating agents are controlled substances with addictive properties and can be lethal when used in combination with alcohol. The use of benzodiazepines is associated with addiction, dependency and cognitive impairment. 

Significant adverse reactions include edema vaginitis nervousness emotional lability hepatic dysfunction elevated blood pressure pelvic pain carpal tunnel syndrome sleep disorders fatigue tremor visual disturbances anxiety depression gastroenteritis. 

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