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At one time or another, almost every teen may appear to be depressed. Usually, the depression is slight and goes away with time. But some kinds of depression need medical intervention. With such an intervention, writing a prescription for Prozac (fluoxetine) or some other antidepressant drug (Figure 1.1) has become the first order of business. Yet, less than twenty years ago, adolescents were rarely diagnosed as depressed, much less given antidepressants. Today, however, teenagers are now receiving medications almost routinely for symptoms that can hardly be termed “depressive” — attention deficit disorder, social anxiety, or drug addiction, for example. Read the rest of this entry »

Since 1987 when zopiclone (somnosan, ximovan) was introduced into clinical practice, extensive evaluations have shown that some rebound changes can be detected in healthy individuals. In patients with insomnia more than 20 studies have assessed rebound. Rebound can be found in such patients, but is usuallymore frequent and present in greater intensity in comparison groups given triazolam.

Studies in the elderly have been carefully reviewed by Soldatos and his colleagues. Some deterioration in the soundness of sleep has been detected but the amount of rebound insomnia following zopiclone (somnosan, ximovan) discontinuation is relatively weak. Although one would certainly expect rebound in a hypnotic with a half-life of around 5 h, the frequency and severity of such rebound seems definitely less than those observed with comparative benzodiazepines such as triazolam and temazepam. Read the rest of this entry »

Pronunciation: lor-A-ze-pam
Chemical Abstracts Service Registry Number: 846-49-1
Formal Names: Ativan, Temesta
Type: Depressant (benzodiazepine class).
Federal Schedule Listing: Schedule IV (DEA no. 2885)
USA Availability: Prescription
Pregnancy Category: D

Lorazepam [Ativan, Temesta] Uses. This antianxiety drug is also known for its sedative properties and is used to promote sleep and to fight convulsions. The substance is given to treat status epilepticus, a dangerous condition in which people have one epileptic seizure after another, back-to-back. It can reduce and sometimes even eliminate vomiting from cancer chemotherapy.  Lorazepam has been used to treat LSD and methamphetamine overdose and has been a standard medicine to help alcoholics through the alcohol withdrawal syndrome. Recreational sedative users report euphoria from lorazepam. When given experimentally in combination with other drugs, it has helped reduce depression. In contrast, experimentation using motion picture excerpts to evoke particular emotions found that lorazepam may reduce happy feelings and increase unhappy ones. One study found that lorazepam worked as well as alprazolam for treating panic attacks, and a case report tells of success in treating mania. Lorazepam has been used to cure both catatonia (in which people are frozen in place) and akathisia (compulsive moving around). Patients being prepared for surgery receive the drug to calm them and to cloud their memory of the event. Read the rest of this entry »

Pronunciation: feen-oh-BAR-bi-tall
Chemical Abstracts Service Registry Number: 50-06-6
Formal Names: Arco-Lase Plus, Donnatal, Gardenal, Luminal, Phenobarb, Phenobarbitone, Solfoton, Somnosan
Informal Names: Phennies, Phenos
Type: Depressant (barbiturate class).
Federal Schedule Listing: Schedule IV (DEA no. 2285)
USA Availability: Prescription
Pregnancy Category: D

Phenobarbital (Somnosan, Donnatal, Phenobarb, Luminal) Uses. This is one of the more familiar pharmaceuticals. For about a century it has been used as an anticonvulsant and was prescribed as a tranquilizer and as a migraine remedy, although all those functions are being superseded by more modern drugs. Phenobarbital is also given to treat cyclic vomiting in children and hyperbilirubinemia (a type of jaundice) in infants. The drug is used against epilepsy and against seizures with other causes, such as fever. The substance has cross-tolerance with alcohol and is given temporarily to help relieve withdrawal symptoms from opiates or alcohol. Despite acceptance of phenobarbital for that purpose, scientific proof is lacking for its usefulness in alcohol withdrawal. Read the rest of this entry »

Benzodiazepines became widely available for medical purposes in the 1960s and replaced barbiturates in treatments of many conditions. Benzodiazepines proved themselves less prone to abuse than barbiturates, in addition to being safer—accidental overdose is unlikely because the amount needed for a medical effect is so much smaller than a poisonous amount. In addition to reducing anxiety, benzodiazepines may improve quality of sleep—from fighting insomnia to eliminating sleepwalking. This class of drugs is also used to calm people and to treat convulsions. Some users experience mild euphoria. Read the rest of this entry »

Generic Name: Tramadol

Brand name: Ultram, Ultram ER, Amadol, Tramadolor

Class of drug: Narcotic (opioid) analgesic.

Mechanism of action: Most likely produces analgesia by binding to opioid receptors. Also inhibits reuptake of norepinephrine and serotonin.

Indications/dosage/route: Oral only.

• Moderate to moderately severe pain

Adults: 50-100 mg q4-6h prn. Maximum: 400 mg/d.

Adjustment of dosage

• Kidney disease: Creatinine clearance <30 mL/min: 50-100 mg q12h. Maximum: 200 mg/d.
• Liver disease (cirrhosis): 50 mg q12h.
• Elderly: Maximum daily dose of 300 mg in patients >75 years.
• Pediatric: Safety and efficacy of tramadol have not been estab-
• lished in children <16 years. Read the rest of this entry »

Anti-anxiety drugs, or “anxiolytics,” are powerful central nervous system (CNS) depressants that can slow normal  brain function. They are often prescribed to reduce feelings of tension and anxiety, and/or to bring about sleep. Anti-anxiety medications are among the most abused drugs in the United States, obtained both legally, via prescription, and illegally, through the black market. These drugs are also known as sedatives.

The drugs associated with this class of substance-related disorders are the benzodiazepines [such as diazepam (Valium),  chlordiazepoxide (Librium), alprazolam (Xanax), triazolam (Halcion), and estazolam (ProSom)], the barbiturates [such as Seconal and pentobarbital (Nembutal)], and barbiturate - like substances including Quaalude, Equanil, and Doriden. Any of these drugs is capable of producing wakeful relief from tension, or sleep, depending upon dosage. Some non-psychiatric uses of anti-anxiety medications include treatment and prevention of seizures, muscle relaxants, anesthetics, and drugs to make other anesthetics work more effectively (known as “adjuvants”). Read the rest of this entry »