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Psychotropic Drug Categories

-sedative-hypnotic; antianxiety drugs
-treatment of dementia

Goal of sedative-hypnotic; antianxiety drugs

Primary Goal: relax pt; promote "normal" sleep
-decrease anxiety
Primary Agent- benzodiazapines, many others

Benzodiazapines (sedative/hypnotic AND anti-anxiety)

-increase effects of GABA
-GABA- inhibitory NT- decreases excitation throught CNS
-increase inhibition= increase Cl- entry= decrease excitability= better sleep/relax
*drug and GABA bind to specific receptor in SC

Newer Sedative/Hypnotics- 'Z' Drugs

-not benzodiazapines
-still bind to GABA receptors in the brain (alpha subunit)
-may produce fewer problems when discontinued (less rebound insomnia)

Newer Sedative/Hypnotics- Lunesta

-also binds GABA to receptors at/near bzd site

Newer Sedative/Hypnotics- Ramelteon

-melatonin receptor agonist (like seratonin)

Newer Anti-Anxiety Drugs- Azapirones (BuSpar)

-stimulates seratonin receptors in CNS
-NOT GABA- acts like seratonin
-may decrease anxiety w less sedation, less dependence
-drawbacks: slow onset, moderate efficacy (will still help w maintenance/low-grade anxiety)

Use of antidepressants vs anxiolytics

-anxiety often occurs w depression- pts may need both
-antidepressants can have anxiolytic effeccts
-may also have fewer side-effects; less chance of addiction

Side Effects of Anti-Anxiety/sedative-hypnotic drugs

-residual hangover effects (still drug in system when wake up- disoriented/confused/nautious)
-anterograde amnesia-forget things that happened earluier in day prior to taking pill (dec short term memory)
-tolerance and dependence (treat a symptom! not the cause.. should combine w non-drug therapy)

Rehab Concerns

-treat symptoms, not cause of anxiety/insomnia
-trade-offs: benefits of sleep vs too much sedation
-trend now is more toward non-benzodiazapines

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