Give me a list of non sedating anxiety medications
Ramelteon may also be a safer choice for older patients (Srinivasan V et al, 2010;27(11):796–813).
Ramelteon doesn’t deliver the expected “kick” of a sleeping pill, and some patients do not feel it is as effective as a benzodiazepine or non-benzodiazepine hypnotic.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are medications that alter the balance of chemical messengers in the brain.
These drugs were first used to treat depression, but are currently recommended as first-choice medications for treating certain anxiety disorders, according to the World Federation of Biological Psychiatry.
” Often this information will be supplied without prompting: “I can’t sleep at all. So if your patient is a candidate for a sleeping pill, which one should you use? These medications can be effective, but they are often slow to act, can be associated with next-day “hangover” effects, and your patients may develop tolerance to them.
Since these drugs are also muscarinic receptor blockers, you need to watch out for anticholinergic effects (eg, blurred vision, constipation), particularly in your older patients (Neubauer DN and Flaherty KN, 2009;29(4):340–353).
Other sedating antidepressants have also long been used off label to treat insomnia, such as trazodone (Desyrel) and mirtazapine (Remeron).
Trazodone’s long half-life (mean of seven to eight hours) is helpful for keeping patients asleep all night, but can lead to next day sleepiness.
With the exception of temazepam, these medications are no longer commonly prescribed.
While the common view is that insomnia is caused by a primary psychiatric or medical condition, it is more accurate to simply say that patients have insomnia and depression at the same time. In the 2002 National Health Interview Survey (an in-person structured health interview conducted by the CDC with 35,849 participants with insomnia), only 4.1% of respondents with insomnia reported having no comorbid condition.
Over the last several years there has been a shift in how we conceptualize insomnia co-occurring with psychiatric disorders.
SSRIs are particularly effective for obsessive-compulsive disorder and post-traumatic stress disorder.
SNRIs are generally recommended for anxiety disorders.