Postconcussive syndrome
Brian Sindelar, Julian E. Bailes in Sports-Related Concussion, 2017
Conservative measures can be instituted acutely and continued with chronically symptomatic athletes, but persistent symptoms warrant escalation to pharmacological agents. Due to the limited research on pharmaceutical interventions specifically for concussive injury, these are only recommendations based on the limited data from concussion and moderate to severe TBI literature. Medications that have been suggested for use in cognition and arousal following a concussion/TBI are neurostimulants (i.e. amantadine, dextroamphetamine, modafinal, methylphenidate, atomoxetine), selective serotonin reuptake inhibitors (i.e sertraline, fluoxetine), and acetylcholinesterase inhibitors (i.e donepezil, rivastigmine, galantamine)175,184,186,215,217–227 (refer to Table 5.3).175 In patients whose complaints appear to be more sleep-related, the use of both nonbenzodiazepine sedatives and herbal remedies are advocated (Table 5.4).175 Benzodiazepines, such as lorazepam, clonazepam, and diazepam, are highly addictive and alter the normal sleep architecture and therefore are not recommended for routine use.184,186,228 Nonbenzodiazepine derivatives, such as zolpidem, are good short-term, first line agents to aid those with sleep difficulties because they decrease sleep latency and nocturnal awakenings.11,175,184,228 Caution should be exercised when used in the elderly due to potential side effects of confusion and altered mental status.228
Special Issues in Patients with Comorbid Psychiatric and Chemical Dependency Disorders
John Brick in Handbook of the Medical Consequences of Alcohol and Drug Abuse, 2012
The anxiolytic or antianxiety medications are used to reduce and remove symptoms associated with any of the anxiety spectrum disorders such as generalized anxiety disorder, post-traumatic stress disorder (PTSD), panic disorder, the phobias, obsessive-compulsive disorder and substance induced anxiety. Medications used to treat the anxiety spectrum disorders include the benzodiazepines, the nonbenzodiazepine anxiolytics, and the SSRIs. When treating patients suffering from anxiety, it is most important to screen for substance use as the benzodiazepines are cross-tolerant with alcohol, are abusable, and have a high market value as street drugs. Patients with dual diagnoses for whom benzodiazepines were prescribed were more than twice as likely to develop benzodiazepine abuse as those who were not prescribed benzodiazepines (Brunette et al., 2003). Consequently, these medications should only be used as stabilization agents in monitored circumstances, such as alcohol withdrawal or as sedatives in acutely psychoticor manic patients. Examples of benzodiazepines include alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), Lorazepam (Ativan), and oxazepam (Serax).
Medical Conditions and Diseases
Clete A. Kushida in Sleep Deprivation, 2004
Treatment of Sleep Disturbance Associated with Parkinson’s Disease. In a study of 220 Parkinson’s patients, 215 reported sleep difficulties, with 29% of these patients using hypnotic or sedative drugs to assist their sleep (102). While administration of benzodiazepines or other nonbenzodiazepine drugs may assist with sleep initiation and maintenance, these drugs are typically recommended as only a short-term solution for insomnia, as with non-Parkinsonian patients. REM sleep behavior disorder is successfully treated with clonazepam (104,129), and in some cases nocturnal administration of l-dopa (138). An alternative therapy for sleep initiation difficulties is the use of tricyclic antidepressants with sedative properties. In addition to their sedating properties, these drugs exert anticholinergic effects, which may improve waking symptoms also. In Parkinson’s patients with comorbid neurobehavioral impairment, however, these drugs are contraindicated, as they may produce nocturnal delirium.
Sleep disorders, sleep medication use, and predictors of sleep disturbance in children with persistent tic disorders
Published in Children's Health Care, 2023
Valerie S. Swisher, Maya S. Tooker, Christine Qu, Helen J. Burgess, Meredith E. Coles, Shannon M. Bennett, John Piacentini, Christopher S. Colwell, Emily J. Ricketts
Per parent report of youth, melatonin has been associated with improved sleep, and motor and vocal tics in children with PTDs (Smith & Ludlow, 2023). In light of its widespread use and aforementioned benefits and limitations, the present findings highlight the need for establishing the efficacy and side effect potential of melatonin use in children with PTDs through controlled trials. Antihistamine use was endorsed at a much lower rate of 8%. Antihistamine is among the most frequently recommended over-the-counter medications for pediatric insomnia (Owens, Rosen, & Mindell, 2003); however, there are not yet studies examining its efficacy for sleep problems. Notably, a number of prescription sleep medications were endorsed, each at low rates. There are presently no FDA-approved medications to treat sleep problems in children. Benzodiazepines and nonbenzodiazepine hypnotics, each endorsed at low rates, are less often prescribed by physicians to treat pediatric sleep problems than antihistamines, alpha-2-adrenergic agonists, melatonin, and antidepressants due to adverse side effects (Owens, Rosen, & Mindell, 2003).
Sleep-promoting activity of lotus (Nelumbo nucifera) rhizome water extract via GABAA receptors
Published in Pharmaceutical Biology, 2022
Yejin Ahn, Singeun Kim, Chunwoong Park, Jung Eun Kim, Hyung Joo Suh, Kyungae Jo
Humans spend one third of their lives sleeping. Sleep is crucial in human life; during sleep, the brain relieves mental and physical fatigue acquired during work and processes information to strengthen cognitive functions such as memory (Berkley 2021). However, 30%–35% of the world’s population has temporary sleep disorders, and the ratio is particularly high among women and older adults (Ohayon 2011). Sleep disorders are caused by various factors, such as stress, tension, fear and anxiety, and among these, people in modern society tend to experience stress-induced sleep disorders. In fact, 78% of insomnia patients reported that the insomnia was caused by stress (Bastien et al. 2004). Benzodiazepine-based drugs, nonbenzodiazepine-based drugs, benzodiazepine receptor agonists and antidepressants with sedative action have been used as therapeutic drugs (Madari et al. 2021). However, prolonged use of these drugs has side effects, which include resistance and dependence. Therefore, use of alternative drugs that can treat anxiety and insomnia and have fewer side effects is warranted.
“Sign Me Up, I’m Ready!”: Helping Patients Prescribed Sleeping Medication Engage with Cognitive Behavioral Therapy for Insomnia (CBT-I)
Published in Behavioral Sleep Medicine, 2021
Erin Koffel, Mariah Branson, Erin Amundson, Jennifer P. Wisdom
Participants were 29 Veterans (59% female) with insomnia who had been prescribed sleeping medication in the last year and had no history of CBT-I treatment. A pool of potential participants was first identified by searching the electronic medical record for insomnia diagnoses and prescriptions, including nonbenzodiazepines (e.g., z-drugs) and benzodiazepines, antidepressants and melatonin agonists. The study coordinator sent invitation letters to potentially eligible patients and if patients were interested, screened for eligibility over the phone. All participants met criteria for insomnia as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) using the insomnia module from a validated semi-structured interview, the Structured Clinical Interview for DSM-5 Sleep Disorders (SCISD) (Taylor et al., 2018). Participants were also asked to confirm that they had been given a sleeping medication in the last year and had no history of CBT-I treatments. The most common medications prescribed for sleep were zolpidem and trazodone.
Related Knowledge Centers
- Anxiety
- Chemical Structure
- Gabaa Receptor
- Insomnia
- Pharmacodynamics
- Psychoactive Drug
- Benzodiazepine
- Mechanism of Action
- Gabaa Receptor Positive Allosteric Modulator
- Gabaa Receptor
- Imidazopyridine