anxiety is a nervous disorder characterized by a state of excessive uneasiness and apprehension. it is related to low levels of neurotransmitters GABA and serotonin which are both inhibitory meaning they block or prevent the chemical message from being passed along any farther. insomnia is also caused by these two neurotransmitters, it's a sleep disorder which makes it difficult falling asleep or staying asleep.
anxiolytics (calm), sedatives (drowsy) and hypnotics (asleep). increasing the dose of sedative-hypnotics it first causes sedation then hypnosis, general anesthesia, respiratory depression and coma then death. anxiolytic agents are benzodiazepines also called "benzos", it slows brain activity by producing a calming effect,they are given at low doses, they are commonly divided into 3 groups based on half-life. short acting is under 12 hours, intermediate acting is 12-24 hours and long acting is over 24 hours. benzodiazepines have 2 drug name stem; "-azepam" like diazepam for antianxiety. and "-azolam" like triazolam and "-azam" like clobazam. they are administered orally to treat anxiety and sleep disorders but some are administered parenterally (diazepam, midazolam and lorazepam). there is only one short-acting benzo called midazolam (Versed) and it is primarly used as a pre-anesthetic and is used in palliative care. for intermediate-acting there are alprazolam (Xanax), oxazepam (Serax) and lorazepam (Ativan) which are used to treat anxiety, ativan is also used for seziures alongside clonazepam (Rivotril). it is also used for insomnia besides temazepam (Restoril). now for long-acting benzos there is diazepam (Valium) used for anxiety, withdrawal from ethanol and used IV for seizures. last there is flurazepam (Dalmane) used for insomnia. they all cause daytime drowsiness, sedation and respiratory depression. for sedatives/hypnotics there are 3 groups benzodiazepines, barbiturates and z-hypnotics. we have already gone over the benzos so lets go on to barbiturates! the drug name stem is barb which stands for barbituric acid derivatives. they have a lower margin of safety than benzos. hypnotics are given at high doses. although barbiturates are no longer recommened for use as a sedative-hypnotic there is phenobarbital (Phenobarb)! it is used as an anti-convulsant, it has strong sedation and rapid tolerance, abuse and lethal overdose potential. it is located in schedule 4 of CDSA. there are non-benzodiazepines/hypnotic drugs called Z-drugs. these are indicated for short-term treatment of insomnia (&-14 days). there is zopiclone (Imovane) and zolpidem (Sublinox ODT), these drugs have side effects such as confusion, daytime anxiery, restless dry mouth and zopiclone has an unpleasant metallic taste. there is also caution for tolerance, abuse and physical dependence.
anti-depressant drugs. the cause of depression is actually unknown but we think that it's possible there is a imbalance/low levels of neurotransmitters such as dopamine, serotonin and norepinephrine. anti-depressants that affect serotonin are called selective serotonin reuptake inhibitors (SSRI) and drugs that affect serotonin and norepinephrine are called selective serotonin norepinephrine reuptake inhibitors (SSNRI/SNRI) and tricyclic antidepressants (TCA). these increase neurotransmitter levels of serotonin and norepinephrine at receptor sites, serotonin improves mood, emotions and disgestion while norepinephrine improves attention, alertness and decreases stress. for SSRIs there is: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram/s-enantiomer of citalopram (Cipralex) and fluvoxamine (Luvox), these are taken once daily and takes 4-8 weeks for full effect. SNRIs have venlafaxine (Effexor XR), desvenlafaxine/metabolite of venlafaxine (Pristiq ER) and duloxetine (Cymbalta DR) these also are only taken once daily and take 4-8 weeks for full effect. for TCA there is amitriptyline (Elavil), nortriptyline (Aventyl), imipramine and doxepin. same as above. serotonin syndrome can occur while taking these medications, this happens due to increased levels of serotonin in the brain, agitation, muscle twitching, sweating, diarrhea and confusion are the symptoms.