Benzodiazepines: A Reevaluation of Their Benefits and Dangers

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Hypnotics

TCPR: Benzodiazepines were the most commonly prescribed drug—of all drugs—in the 1970s. Are they still that popular? Dr. Salzman: I think benzodiazepines are still widely used, both appropriately and inappropriately. The SSRIs were supposed to replace the benzos for long-term treatment of anxiety, but while the use of these antidepressants has in

Benzodiazepines in Older Adults

Topics: Addiction | Anxiety | Ashton manual | Beers criteria | Benzodiazepines | Cognitive Behavioral Therapy for Insomnia | Dementia | Fall risk | Hypnotics | Insomnia | Opioids | Overdose | Silexan | taper | Withdrawal

CGPR: When do you start benzodiazepines in older adults? Dr. Aiken: The best evidence for benzodiazepines in the elderly is in panic disorder, followed by phobias, social anxiety disorder, and generalized anxiety disorder. Benzodiazepines are also the mainstay of treating catatonia, rapid eye movement sleep behavior disorder, and alcohol withdrawal. Ho

Study Ignites Controversy Over Trazodone and Suicide

Topics: Hypnotics | Research Update | Suicidality | Trazodone

Review of: Lavigne JE et al, J Gen Intern Med 2019;34(8):1554–1563 Study Type: Observational comparative safety study Trazodone is one of the most widely prescribed sleep aids in the US despite lacking FDA approval for insomnia. But what if patients taking trazodone attempted suicide at a rate over 1.5 times that of those taking zolpidem (Ambien)? L

Lemborexant and Sleep Architecture in the Elderly

Topics: Free Articles | Geriatric Psychiatry | Hypnotics | Lemborexant | Sleep | Sleep Disorders

REVIEW OF: Moline M et al, J Clin Sleep Med 2021. Epub ahead of print. TYPE OF STUDY: Randomized, double-blind, parallel-group study As we age, sleep architecture worsens in ways that reduce sleep quality, particularly after age 55. Unfortunately, most hypnotics either do not improve sleep quality (eg, the z-hypnotics) or slightly worsen it (eg, t

Mood, Cognition, and Metabolic Health

Topics: Eszopiclone | Hypnotics | PTSD | Sleep

TCPR: Your research has explored how metabolic disorders can impair mood and cognition. Can you give us an overview of that topic? Dr. Mansur: Yes. There is a direct association between metabolic health and both mood and cognitive outcomes. All of the components of the metabolic syndrome—obesity, type II diabetes, dyslipidemia, and hypertension—inc

Rest Easy: Benzos, Z-Drugs, and Dementia

Topics: Anxiety | Benzodiazepines | Dementia | Deprescribing | Generalized Anxiety Disorder | Geriatric Psychiatry | Hypnotics

Review of: Osler M and Jorgensen MB, Am J Psych 2020;177(6):497–505 Study TYPE: Epidemiologic case-control Few psychotropics stir controversy like the benzodiazepines. While they work well for anxiety and insomnia, their risks of abuse and dependence have always nagged at us. More recently, some research has suggested that long-term use increase

Is Ramelteon an Effective Hypnotic?

Topics: Belsomra | Benzodiazepines | Geriatric Psychiatry | Hypnotics | Lemborexant | Melatonin | Sleep | Suvorexant

Ramelteon (Rozerem) stands out from other hypnotics in several ways: It is not a controlled substance and has no risk of addiction or ­withdrawal. It is relatively safe in the elderly. It has a low risk of falls and complex sleep behaviors. However, ramelteon’s use has been limited by its high cost and modest efficacy. Now that it’s gone ge

Lumateperone and lemborexant

Topics: Antipsychotics | Belsomra | Caplyta | Dayvigo | Hypnotics | Lemborexant | Lumateperone | News of Note | Orexin | Pharmacology | Psychopharmacology | Suvorexant

Two new psychiatric medications were approved in the final days of 2019. One is the first of its kind, an antipsychotic with minimal dopaminergic blockade: lumateperone (Caplyta). The other is lemborexant (Dayvigo), a variation on the hypnotic suvorexant (Belsomra). Lumateperone (Caplyta)Though classified as an atypical antipsychotic, lumateperone is u

A New Contraindication for Ambien and the Z-Hypnotics

Topics: FDA Warnings | Hypnotics | Insomnia | News of Note | Practice Tools and Tips | Psychopharmacology | Psychopharmacology Tips | Sleep

“Complex sleep behavior” is a euphemism for various problems that can happen after ingesting a sleeping pill. They range from cooking and emailing to driving a car or even sexual assault, all done in an amnestic state that is not recalled upon awakening. In 2007 the FDA placed warnings about these behaviors on all medications approved for insomnia,

Another Black Eye for Prazosin in PTSD?

Topics: Hypnotics | Insomnia | Nightmares | Prazosin | PTSD | Research | Research Update | Sleep | Suicidality

Review of: McCall W et al, J Clin Psychopharmacol 2018;38(6):618–621 Study Type: Randomized single-blind controlled trial (pilot study) Prazosin has become a mainstay in the pharmacologic treatment of PTSD. A selective antagonist of the noradrenergic alpha-1 receptor, it has modest benefits in sleep and nightmares that are supported by around ha

Complementary and Alternative Medicine for Mood Disorders

Topics: Benzodiazepines | Hypnotics

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Sleeping Pills: Which Ones for Which Patients?

Topics: Antidepressants | Antipsychotics | Benzodiazepines | Hypnotics | Mood Stabilizers

Insomnia is one of the most common comorbidities you’ll see in your depressed and anxious patients (Becker PM and Sattar M, Curr Treat Options Neurol 2009;11(5):349–357). But it is often misunderstood. Over the last several years there has been a shift in how we conceptualize insomnia co-occurring with psychiatric disorders. While the common view is

The Carlat Guide to Medications Used for Insomnia

Topics: Antidepressants | Antipsychotics | Benzodiazepines | Hypnotics | Mood Stabilizers | Natural Medications

This handy table lists the medications most often used to treat insomnia. Click here to see table

Sleeping Pills, New and Old

Topics: Hypnotics

"Sleep Drugs Found Only Mildly Effective, but Wildly Popular” proclaimed the headline of a recent New York Times article (S. Saul, October 23, 2007). The Times analyzed the results of a newly published meta-analysis of chronic insomnia treatments and concluded that, on average, sleeping pills reduce the time to go to sleep (sleep latency) by only 12.8

Chloral Hydrate and Anna Nicole Smith

Topics: Hypnotics

On February 8, 2007 the model and actress Anna Nicole Smith was found dead in her hotel room at the Seminole Hard Rock Hotel in Florida. An autopsy report ruled that the primary cause of death was a toxic overdose of several prescription medications, but most coverage has centered on chloral hydrate. Smith also had traces of Klonopin, Valium, Ativan, an

Practical Sleep Hygiene Tips

Topics: Hypnotics | Practice Tools and Tips

Is Cognitive Behavior Therapy more Effective than Medication? According to a review in the New England Journal of Medicine, cognitive behavioral therapy (CBT) is at least as effective as hypnotics for chronic insomnia, and probably provides more sustained benefit (Silber MH, NEJM 2005;353:803-810). For example, in one study, young and middle-aged pat