Roland B.

Yalon BSN3D
Antianxiety and sleeping medication (Anxiolytics and hypnotics)
Benzodiazepines are used to treat insomnia (short-term), anxiety disorders, and as adjuncts to
antipsychotics to reduce agitation. In addition they are also used to treat alcohol withdrawal, some side
effects of antipsychotics, and are occasionally used as a muscle relaxant for those with bone and muscle
problems.
The major difference between most sleeping pills and anti-anxiety medication is simply the time it
takes for the substance to act and wear off.
Benzodiazepines are also used to get intoxicated, particularly when other substances are not
available. Other times, clients become addicted without realising it.
Sudden withdrawal can lead to agitation, anxiety, insomnia, nausea, hallucinations, delirium and
seizures.
When mixed with other depressants, particularly alcohol and heroin, they can be lethal.
It is for this reason that cognitive behavioral therapy is generally the first line of treatment in anxiety
disorders.
An alternative to benzodiazepines for the treatment of anxiety is buspirone which does not seem to
have the same addition potential.
Antidepressants
Antidepressants are not only used in the treatment of depression, they are also used to treat
anxiety disorders (particularly obsessive and panic disorders) and chronic pain.
Clients should be instructed that the full effects of antidepressants may take two to four weeks
and that they usually should continue taking antidepressants for a month after normal mood returns.
Some of the newer antidepressants have fewer side effects and are less likely to cause overdose.
However, overdose risk is increased in those who are also drug dependent and prescriptions should be
limited to one week at a time.
Antimanic drugs
Lithium is the most common substance used to treat bipolar affective disorder (manic-depression).
At therapeutic levels it may also cause a fine tremor, muscle weakness, problems with memory
and concentration, weight gain, increased thirst and increased urination.
Toxic levels can cause increased tremor, nausea and vomiting, painful joints, difficulty in walking,
and confusion. Dehydration from illness or sweating in hot weather can cause toxicity.
Carbamazepine is also use to manage mania, particularly those who do not respond to lithium.
However, this drug reacts with many substances including dextro-propoxyphene (Doloxene) which is
sometimes used by drug addicts. This drug also reduces the effects of oral contraceptives which can
result in pregnancy.
TCA
Tricyclic antidepressants (TCAs) are heterocyclic chemical compounds used primarily as
antidepressants. The TCAs were first discovered in the early 1950s and were subsequently introduced
later in the decade; since then the ability of the trycyclics to relieve depressive symptoms has been
firmly established. They are named after their chemical structure, which contains three rings of atoms.
The tetracyclic antidepressants (TeCAs), which contain four rings of atoms, are a closely related group of
antidepressant compounds.
In recent times, the TCAs have been largely replaced in clinical use in most parts of the world by
newer antidepressants such as the selective serotonin reuptake inhibitors (SSRIs) and serotonin-
norepinephrine reuptake inhibitors (SNRIs), which typically have more favourable side-effects profiles,
though they are still sometimes prescribed for certain indications.
SSRI

Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor (SSRIs)

are a class of compounds typically used as antidepressants in the treatment of depression, anxiety
disorders, and some personality disorders. They are also typically effective and used in treating some
cases of insomnia.
SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by
inhibiting its reuptake into the presynaptic cell, increasing the level of serotonin in the synaptic cleft
available to bind to the postsynaptic receptor. They have varying degrees of selectivity for the other
monoamine transporters, with pure SSRIs having only weak affinity for the noradrenaline and dopamine
transporter.
SSRIs are the most widely prescribed antidepressants in many countries.
The efficacy of SSRIs is being disputed. A 2010 meta-analysis indicated that:
"The magnitude of benefit of antidepressant medication compared with placebo ... may be minimal or
nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe
depression, the benefit of medications over placebo is substantial."
SSRIs are the first class of psychotropic drugs to be discovered using the process called "rational
drug design", a process that starts with an untested hypothesis that affecting the chemical behavior of a
specific biological target such as a hormone receptor may have therapeutic value.
The term SSRI is somewhat of a misnomer, invented by the pharmaceutical companies who
developed these drugs. Rationally, they should be referred to as SRIs, as dopamine reuptake inhibitors
and norepinephrine reuptake inhibitors are referred to as DRIs and NRIs respectively, regardless of their
selectivity.
MAOI

Monoamine oxidase inhibitors (MAOIs) are a class of antidepressant drugs prescribed for the
treatment of depression. They are particularly effective in treating atypical depression.
Because of potentially lethal dietary and drug interactions, monoamine oxidase inhibitors have
historically been reserved as a last line of treatment, used only when other classes of antidepressant
drugs (for example selective serotonin reuptake inhibitors and tricyclic antidepressants) have failed.[1]
However, a transdermal patch form of the MAOI selegiline, called Emsam, was approved for use by the
Food and Drug Administration in the United States on February 28, 2006.[2] When applied transdermally,
the drug does not enter the gastrointestinal system, thereby decreasing the dangers of dietary
interactions associated with oral administration of MAOIs.