OTC agents that induce drowsiness

Ex: diphenhydramine

• Restoring normal NE & serotonin balance helps reduce symptoms associated w/ depression, panic, obsessive-compulsive behavior, & phobia
• SSRI's
• SNRI's (atypical antidepressants)
• TCA's
• MAOI's

• CNS depressant
• Rarely used to treat anxiety and insomnia because of:
• life threatening side effects r/t depressing CNS function on all levels- overdose produces extreme respiratory depression, hypotension, & shock
• High risk of physical and psychological dependence
• Withdrawal syndrom is extrememly severe, possibly fatal

• Some people use them b/c of sedative side effect
• Not enough research has been done to determine their safety & effectiveness in treating anxiety/insomnia

alprazolam (Xanax)

lorazepam (Ativan)

diazepam (Valium)

oxazepam (Serax)

• Benzodizepines
• Use to treat anxiety & insomnia
• MOA: intesify effect of GABA, CNS depressant
• AE: drowsiness, sedation, lethargy, ataxia, confusion
• Preferred agent for insomnia cause by anxiety
• Also used for: seizures, EtOH withdrawal, adjunct to anesthesia, nausea
• Some agents have metabolites
• Antidote: flumazenil (Romazicon)
• Schedule IV

• gamma-amniobutyric acid
• inhibitory CNS neurotransmitter

• Serotonin receptor agonist
• Used to treat anxiety & insomnia
• MOA: Uknown; exhibits high affinity for serotonin receptors & moderate affinity for dopamine receptors
• AE: nasuea, dizziness, nervousness, headache, somnolence, tachycardia, heart failure, MI, CVA
• Many drug-drug interactions
• Slow onset of action (14 days)
• Adjust does for liver or renal impairment
• Not a controlled substance

eszopiclone (Lunesta)

zaleplon (Sonata)

zolpidem (Ambien)

• Hypnotics
• Used to treat anxiety & insomnia 
• MOA: enhance effect of GABA
• AE: taste disturbance, vomiting, diarrhea, dizziness, headache, somnolence, visual disturbances, fatigue
• Rapid onset
• Zaleplon/zolpidem: short term use only (FDA)
• Several drug-drug interactions
• Adjust dose for liver impairment
• Schedule IV controlled substance 

• Melatonin receptor agonist
• Improves sleep induction
• Short onset (30 minutes)
• Ok for long-term use: does not produce tolerance or dependence

• Drugs that are sedative (relaxing) at low doses and hypnotic (sleep inducing) at high dose
• Barbituates

In order of highest to lowest cause of anxiety:

1. Phobias
2. PTSD
3. GAD
4. OCD
5. Panic disorder

Others:

• Situational anxiety
• Social anxiety disorder

• Drug having ability to relieve anxiety

• Ex: antidepressants, CNS depressants, seizure drugs, emotional and mood disorder drugs, antihypertensives, antidysrhythmics

Used to diagnose sleep disorders, seizure activity, depression, dementia

Measures brain waves (alpha, beta, delta, theta)

• 4 stages
• Go through I to IV and then in reverse
• Can be identified on EEG

• Happens at then end of a NREM cycle
• When dreaming happens
• Brain wave pattern (on EEG) similar to drowsy but awake