Anxiety, Insomnia and Depression.txt

  1. 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?)
  2. Available Hypnotic agents
    • Barbiturates: Amobarbital (Amytal?)
    • Benzodiazepines: Estazolam (ProSom?)
    • Non-Benzodiazepine GABA Specific Agents: Zolpidem (Ambien?), Eszopiclone (Lunesta?)
    • Melatonin Receptor Agonists: Ramelteon (Rozerem?)
  3. Available antianxiety agents
    • Benzodiazepines: Alprazolam (Xanax?), Lorazepam (Ativan?), Clonazepam (Klonopin), Diazepam (Valium?).
    • Buspirone (BuSpar?)
    • SSRI: Escitalopram (Lexapro?), Fluoxetine (Prozac?), Sertraline (Zoloft?), Paroxetine (Paxil?)
  4. 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,
  5. 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
  6. 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
  7. 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?)
  8. 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?)
  9. 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?)
  10. 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?)
  11. 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
  12. Selective Serotonin Reuptake Inhibitors (SSRI)
    • Block reuptake of only serotonin into nerve endings
    • Escitalopram (Lexapro?)
    • Fluoxetine (Prozac?)
    • Sertraline (Zoloft?)
    • Paroxetine (Paxil?)
  13. 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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Anxiety, Insomnia and Depression.txt