Download Drugs for Anxiety and Insomnia Expanded Key

Drugs for Anxiety and Insomnia
Expanded Key Concepts
14.1 Generalized anxiety disorder is the most common type of anxiety, although there are several
other important categories.
Situational anxiety occurs when experiencing daily events in the environment and often does not
require pharmacotherapy. Drug therapy is indicated in at least five types of anxiety disorders:
generalized anxiety disorder (GAD), panic disorder, phobias, obsessive-compulsive disorder, and
post-traumatic stress disorder.
14.2 The limbic system and the reticular activating system are specific regions of the brain
responsible for anxiety and wakefulness.
Two important brain regions underlie anxiety and restlessness: the limbic system and the reticular
activating system. Neural impulses transferred between these two areas of the brain are
responsible for anxiety, fear, restlessness, and an interrupted sleeping pattern.
14.3 Anxiety can be managed through pharmacologic and nonpharmacologic strategies.
Complementary therapies such as behavioral therapy, biofeedback techniques, massage and
meditation have been used successfully to treat anxiety in some patients. When anxiety becomes
severe enough to significantly interfere with daily activities of life, drug therapy is indicated.
14.4 Insomnia is a sleep disorder that may be caused by anxiety.
There are many causes of sleeplessness. Stress is one factor in short-term insomnia. Others
include: caffeine, nicotine, room temperature, light, snoring, and sleep apnea. In long-term
insomnia, psychological and physiological factors may be involved.
14.5 The electroencephalogram records brain waves and is used to diagnose sleep and seizure
disorders.
The EEG is a diagnostic procedure used to examine brain wave patterns in patients with
disorders such as insomnia and seizure activity. With this procedure, two types of sleep may be
identified: non-REM and REM sleep.
14.6 CNS depressants including anxiolytics, sedatives, and hypnotics are used to treat anxiety
and insomnia.
The three classes of drugs used to treat most anxiety and sleep disorders are the
benzodiazepines, barbiturates, and non-barbiturate/ non-benzodiazepine CNS depressants.
These agents suppress impulses traveling through the limbic and reticular activating systems.
They reduce symptoms of stress, produce drowsiness, and promote sleep.
14.7 Benzodiazepines are the drugs of choice for generalized anxiety and insomnia.
Benzodiazepines are preferred over any other drug class to treat anxiety and certain sleep
disorders due to their high margin for safety. These agents produce their effects by binding with
the GABA receptor-chloride channel molecule, which is a natural receptor, found throughout the
entire brain.
14.8 Because of their side effects and high potential for dependency, barbiturates are rarely used
to treat insomnia.
Traditionally, barbiturates have been the primary class of CNS depressants used to treat
insomnia. Serious side effects such as respiratory depression, physical and psychological
dependence, and induction of hepatic microsomal enzymes have been noted. Coupled with a risk
for severe withdrawal symptoms and fatal overdoses has resulted in barbiturates rarely, if ever,
being prescribed to treat insomnia.
14.9 Some commonly prescribed CNS depressants used for anxiety and sleep disorders are not
related to either benzodiazepines or barbiturates.
A small group of CNS depressants are chemically unrelated to benzodiazepines or barbiturates.
Two such depressants (buspirone and zolpidem) are commonly prescribed for anxiety and sleep
disorders.