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Available antidepressants agents
- Tricyclic Antidepressants: Amitriptyline (Elavil?)
- SSRI: Citalopram (Celexa?), Escitalopram (Lexapro?), Fluoxetine (Prozac?), Sertraline (Zoloft?), Paroxetine (Paxil?)
- Bupropion (Wellbutrin?, Budepiron XL?)
- SSNRI: Trazadone (Desyrel?), Venlafaxine (Effexor?), Duloxetine (Cymbalta?)
- Mirtazapine (Remeron?)
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Available Hypnotic agents
- Barbiturates: Amobarbital (Amytal?)
- Benzodiazepines: Estazolam (ProSom?)
- Non-Benzodiazepine GABA Specific Agents: Zolpidem (Ambien?), Eszopiclone (Lunesta?)
- Melatonin Receptor Agonists: Ramelteon (Rozerem?)
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Available antianxiety agents
- Benzodiazepines: Alprazolam (Xanax?), Lorazepam (Ativan?), Clonazepam (Klonopin), Diazepam (Valium?).
- Buspirone (BuSpar?)
- SSRI: Escitalopram (Lexapro?), Fluoxetine (Prozac?), Sertraline (Zoloft?), Paroxetine (Paxil?)
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Benzodiazepines
- enhance the effect of GABA on its receptors which further decreases the excitability of the CNS.
- Anxiety
- Tension, irritability, agitation in older patients
- Alcoholic withdrawal
- Pre-anesthesia
- Muscle relaxation
- Status epilepticus
- Insomnia
- Alprazolam (Xanax?) - half life of 12 -15 hrs
- Lorazepam (Ativan?) ? half life of 10 ? 20 hrs
- Clonazepam (Klonopin?) ? half life of 18 to 39 hrs,
- Diazepam (Valium?) ? half life of 20 ? 80 hrs,
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What advantages does buspirone have over benzodiazepines?
- Treatment of anxiety when immediate action is not required
- Good in patients who do not need CNS depression
- Good in elderly patients who are more prone to CNS effects of benzodiazepines
- Beneficial in treatment of anxiety in alcoholics
- No potential for abuse
- Apparently no chance for physical dependency
- Fewer effects on cognitive function
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The Ideal Hypnotic
- Rapid onset of action
- Duration of action allows for 6 to 8 hrs of sleep
- Effects mimic normal sleep patterns
- Patient functions well if awakened at night
- No hangover symptoms in the morning
- No development of drug tolerance
- No potential for abuse or addiction
- No withdrawal symptoms
- No other CNS side effects
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Barbiturates
- Non specific depression of the CNS
- Use in OR setting
- Use caution when driving or operating equipment
- Avoid use with alcohol or other CNS depressants
- May lead to dependence
- Amobarbital (Amytal?)
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Benzodiazepines
- Enhance the effect of GABA on its receptors which further decrease the excitability of CNS
- Do not interfere with REM sleep
- Less potential for dependence than barbiturates
- Fewer side effects than barbiturates
- Estazolam (ProSom?)
- Flurazepam (Dalmane?)
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Non-Benzodiazepine GABA Specific Agents
- Specific for GABA receptors in the CNS
- Little if any antianxiety, antiepileptic or muscle relaxant effects
- Help to stay in sleep
- Be careful about the
- Zolpidem (Ambien?)
- Eszopiclone (Lunesta?)
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Melatonin Receptor Agonists
- MT1 and MT2 receptor agonsist
- Not a controlled substance
- No evidence of abuse or addiction
- No hangover effects
- Help to stay in sleep
- Ramelteon (Rozerem?)
- Do not use with fluvoxamine (Luvox?)
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How do tricyclic antidepressants work?
- Block reuptake of norepinephrine, serotonin and dopamine into nerve endings
- Amitriptyline (Elavil?);
- Take 4 to 6 weeks to show improvement
- Must be taken multiple times a day
- Dose adjustment Potentially fatal if overdoses
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Selective Serotonin Reuptake Inhibitors (SSRI)
- Block reuptake of only serotonin into nerve endings
- Escitalopram (Lexapro?)
- Fluoxetine (Prozac?)
- Sertraline (Zoloft?)
- Paroxetine (Paxil?)
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What advantage do SSRI?s offer over other antidepressant drugs?
- Response seen in 1 to 2 weeks
- Once daily dosing in most patients
- Few side effects
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