Insomnia Free Forever

Outsmart Insomnia

Researchers at the University of Oxford have discovered the true cause of insomnia, and are here to give you the cure in this simple eBook that contains the research AND ways to beat insomnia, backed up by the recent scientific discoveries about insomnia. This guide can teach you to fall asleep in 15 minutes or less, by training your brain to allow your body to rest. This book contains only practical information, from all-new studies that have changed the way that doctors are thinking about insomnia. You don't have to wait hour after hour to fall asleep All you have to do is follow the directions in this eBook to retrain your brain to fall asleep when your body is actually tired. This cure for insomnia is permanent, and does not require you to take all manner of mystery drugs just to feel normal. You can get a real, all-natural, good night's sleep! Read more here...

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Sleep disorders with dopamine receptor agonists

The whole field of sleep disorders in Parkinson's disease has been reviewed in a consecutive series of 320 patients from Houston, with analysable data from 303 (sex distribution unknown) (37C). The mean age was 67 years and the mean duration of the disease was 9.1 years. All the patients completed the Epworth Sleepiness Scale and answered specific questions about falling asleep while driving and about the restless legs syndrome. The mean sleepiness score was 11.1, values greater than 10 being regarded as abnormal. As one would expect, just over half the patients had scores at that level. Higher scores correlated with longer duration and greater severity of the disease, with male sex, and with the use of dopamine receptor agonists. There was no apparent difference in this regard between the three most commonly prescribed drugs in these patients (pergolide, ropinirole, and pramipexole, the last being the most frequent). Among those currently driving, 23 reported falling asleep in the...

Treatment Options for Insomnia

Improve Your Sleep Habits If you experience insomnia for more than a few days, do everything you can to get the most out of the time you are in bed. Avoid foods high in sugar, like ice cream and cookies, especially in the evening. After the two or three hours your body takes to metabolize the sugar, it increases its adrenaline output. This will worsen insomnia. Avoid naps during the day. Although you may catch up on your sleep, it disrupts the normal rhythms of your brain and makes it harder to fall asleep in the evening. You will probably not feel tired at bedtime if you just awoke from a nap several hours before. Minimize Stress Insomnia can be a signal from your body that you are under too much stress. Perhaps you need to cut down on the amount of work you are doing. You may need to work on resolving conflicts in relationships with people who are close to you. Obtain an Evaluation There are three possible parts to a formal evaluation if your insomnia doesn't respond to improving...

Treatment of Insomnia in Medical and Psychiatric Conditions

No matter what the cause of your insomnia, it is worth making the changes described in the previous section to improve your sleep, enhance your quality of life, and avoid taking medication with all its attendant difficulties. Further treatment of insomnia depends on its etiology and its duration. For prolonged stress that contributes to insomnia, antidepressants may make the most sense. Trazodone has fewer side effects than amitriptyline and is generally well tolerated. Many people don't find it effective, however. Primary Sleep Disorders Medical evaluation is indicated if you believe that you have a primary sleep disorder. This evaluation may include overnight evaluation at a sleep laboratory. Psychiatric Syndromes Insomnia is an unfortunate component of many psychiatric syndromes. Treatment varies depending on what the problem is. Anxiety Insomnia often accompanies acute anxiety about an issue in your life. Hypnotics and benzodiazepines are reasonable aids in acute anxiety. Both can...

TABLE 51 Sleep Hygiene Techniques

If you do not fall asleep within a half-hour or so, get up and read a book or watch television. When you stay in the bed and don't sleep for long periods of time, the bed becomes associated with not sleeping. other sedating antihistamine such as doxylamine. They tend to have a prolonged duration of action leading to sedation and slowed reaction times the day after their use. Their side effects are substantial, including urinary retention, blurred vision, orthostatic hypotension, elevated liver enzymes etc. Tachyphylaxis often develops within several days to 1-2 weeks, limiting their utility to short-term insomnia problems. Unless pain is a significant complaint, the common practice of combining an analgesic such as aspirin or acetaminophen and an antihis-tamine (e.g., Tylenol PM) is no more effective than the use of an antihistamine alone. Melatonin is a naturally occurring pineal gland peptide hormone available in OTC formulations. The FDA classifies it as a nutritive or dietary...

Effects on Anxiety and Insomnia

Cannabis smoking produces a relaxant effect which most users value and it has been suggested that the beneficial effects of cannabis and THC observed in neurological disorders such as motor tics, dystonias and Huntingdon's chorea are due to sedative and anxiolytic actions. In addition, sedation is by far the most common side effect of cannabis, and in particular THC, observed in clinical trials against a range of disorders. This has lead to the suggestion that cannabis and some cannabinoids may be useful in disorders accompanied by anxiety and or insomnia. Initial studies in man showed THC to be not much different from conventional hypnotics. Single doses decreased REM sleep and increased stage 4 sleep some REM rebound was observed on discontinuation of the drug (Pivik et al., 1972). When THC was given to healthy insomniacs in doses of 10, 20 or 30 mg sleep latency was reduced but subjects experienced dose-related dysphoria prior to falling asleep and similar symptoms the following...

Health Supplement Alert Melatonin

Melatonin is a hormone produced by the pineal gland in the brain. The use of melatonin obtained from animal pineal tissue is not recommended because of the risk of contamination. The synthetic form of melatonin does not carry this risk. However, melatonin is an over-the-counter dietary supplement and has not been evaluated for safety, effectiveness, and purity by the FDA. All of the potential risks and benefits may not be known. Supplements should be purchased from a reliable source to minimize the risk of contamination. Melatonin has been used in treating insomnia, overcoming jet lag, improving the effectiveness of the immune system, and as an antioxidant. The most significant use is for the short-term treatment of insomnia at low doses. Individuals wishing to use melatonin should consult with their primary health care provider or a pharmacist before using the supplement. Possible adverse reactions include headache and depression. Drowsiness may occur within 30 minutes after taking...


It's unpleasant to toss and turn at night, especially if your frustration gets the better of you. You may feel tired during the day. You may find that your thinking is muddled and that it is harder to function effectively. When prolonged for weeks or months, insomnia can worsen your mood and impair your ability to enjoy your life during the day. Sleep is divided into non-REM and REM periods. Non-REM sleep consists of four stages characterized by different types of EEG activity. Stage 1 occurs when sleep starts. It is the lightest stage of sleep, in which the EEG shows theta waves of 3.5-7.5 Hz. Stage 2 shows sleep spindles of 12-14 Hz, which are short bursts of waves, and k complexes, which are sudden sharp wave forms. Stage 3 shows 20-50 percent delta waves of less than 3.5 Hz. Stage 4 is the deepest sleep and contains more than 50 percent delta waves. A person goes through these stages in the first ninety minutes of sleep. After the first cycle...

Causes of Insomnia

Poor Sleep Habits Many people have difficulty sleeping, primarily because they have poor sleep habits. Irregular hours, frequent naps, poor nutrition, and a lack of exercise can all contribute to insomnia. Drugs Caffeine, alcohol, and other recreational drugs can cause insomnia. Even a cup or two of coffee in the morning can worsen insomnia. Alcohol may make you drowsy as you begin to sleep, but you will awaken later in the night when the effects wear off. Recreational drugs like marijuana, cocaine, amphetamines, and narcotics can also disrupt sleep during the period of intoxication and during the period of withdrawal. Primary Sleep Disorders Primary sleep disorders are disturbances in sleep itself. Night terrors, most common in children, are episodes, lasting a few minutes, of intense fearfulness, sweating, screaming, elevated pulse, and rapid breathing. They typically occur during the early part of sleeping in non-REM sleep Stages 1-4. In...


A master hormone secreted by the pineal gland that regulates a number of the body's functions and life cycles, including the onset of puberty it is stimulated by darkness and suppressed by light. Production decreases with age when the pineal gland becomes worn out and calcified, which may explain why older people have insomnia. Some elderly people lose their ability to produce it altogether. Food sources Oats, sweet corn, rice, ginger, tomatoes, bananas, barley, Japanese radish. Tryptophan, which can be converted by the body into melatonin, is found principally in spirulina, soy products, cottage cheese, chicken liver, pumpkin seeds, turkey, and chicken. Effects Regulates the body's clock, so it can be effectively used to treat insomnia, jet lag, and depression. Unlike sleeping pills, it doesn't interfere with REM sleep (the dream state), and leave the individual feeling groggy upon wakening, and it resets the body's clock rather than just knocking the person out. It is known to...

General Information

The adverse effects of aldesleukin include fever, chills, malaise, skin rash, nausea, vomiting (often resistant to antiemetics), diarrhea, fluid retention, myalgia, insomnia, disorientation, life-threatening hypotension, and the capillary leak syndrome (which can be preceded by weight gain) (SEDA-15, 491) (2).

General adverse effects

The frequencies and the profile of adverse effects of five major classes of antihypertensive agents have been assessed in an unselected group of 2586 chronically drug-treated hypertensive patients (19). This was accompanied by a questionnaire-based survey among patients visiting a general practitioner. The percentages of patients who reported adverse effects spontaneously, on general inquiry, and on specific questioning were 16,24, and 62 respectively. With ACE inhibitors the figures were 15, 22, and 55 . The percentage of patients in whom discontinuation was due to adverse effects was 8.1 with ACE inhibitors (significantly higher than diuretics). Compared with beta-blockers, ACE inhibitors were associated with less fatigue (RR 0.57 95 CI 0.38, 0.85), cold extremities (RR 0.11 CI 0.07, 0.18), sexual urge (RR 0.52 CI 0.33, 0.82), insomnia (RR 0.10 CI 0.04, 0.26), dyspnea (RR 0.38 CI 0.17, 0.85), and more coughing (RR 13 CI 5.6, 30). The authors did not find a significant effect of age...

Other Pathways to Alternate States

Nor do I mean to imply that psychoactive plants or animal secretions have always and everywhere been the only, or even the principal, means of achieving altered states of consciousness. On the contrary, over vast areas of North America many aboriginal peoples achieved the same ends by nonchemical means fasting, thirsting, self-mutilation, torture, exposure to the elements, sleeplessness, incessant dancing and other means of total exhaustion, bleeding, plunging into ice-cold pools, near-drowning, laceration with thorns and animal teeth, and other painful ordeals, as well as a variety of nonhurtful triggers, such as different kinds of rhythmic activity, self-hypnosis, meditation, chanting, drumming, and music. Some shamans may also have used mirrors of pyrite, obsidian, and other materials to place themselves into trances, as some Indian shamans in Mexico still do. Most dramatic of known techniques were surely the spirit-quest ordeals of certain Plains Indian tribes, such as the Oglala...

Functional Consequences of MDMA Neurotoxicity

The repeated administration of MDMA also disrupts cycles of sleep wakefulness in the rat. According to Jones (95), 5-HT facilitates the transition from slow-wave sleep to REM sleep and inhibits wakefulness. Therefore, it follows that a depletion of 5-HT may increase wakefulness. Consistent with this hypothesis, Fig. 1 shows that rats pretreated with neurotoxic doses of MDMA exhibit increased bout lengths of wakefulness and increased overall time spent in wakefulness but do not exhibit any significant changes in REM or slow wave sleep (Fig. 2). Fig. 2. Treatment of rats and recordings are the same as described in the legend for Fig. 1. The duration of time spent in wakefulness, slow-wave sleep (SWS), and REM sleep (REM) is plotted as a percentage of values obtained prior to drug treatment. Fig. 2. Treatment of rats and recordings are the same as described in the legend for Fig. 1. The duration of time spent in wakefulness, slow-wave sleep (SWS), and REM sleep (REM) is plotted as a...

Benzodiazepines Misuse patterns

The use of benzodiazepines are still controversial in many countires. Self help groups and mass-media often point out the misuse of ben-zodiazepines as a very widespread and hidden problem. They also often point out that pre-sciption of benzodiazepines often are performed routinely, symptom-oriented and that the important REM-sleep are disturbed and crises are contained rather than penetrated. The advocates of extensive use of benzodi-azepines in the medical profession as well as in the pharmaceutical industry points out that the majority of the millions of benzodiazepine users do not have any problems with them and that the critics not take in to account the massive suffering of, anxiety, depressions, tensions and sleeping-problems that the benzodi-azepines at least partly counteract. The relative safety of the drugs are also udnerlined. Several national concensus conference on benzodiazepines has been arranged. But the differing opinions on benzodiazepines seems to depend on basic...

Typical Tasks Your Brain Performs When You Drive

First of all, you can't drive if you are asleep. Therefore, your brain must control all the different parts of your body that keep you awake and alive. At the same time, your brain must prevent your bodily needs from interfering with your driving. It cannot, for example, let you fall asleep at the wheel or let you run out of oxygen because you stopped breathing. So your brain must keep track of these important, but uninteresting, housekeeping chores.

Herbal Alert Passion Flower

The term passion flower is used to denote many of the approximately 400 species of the herb. Passion flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinson-ism. Passion flower is often used in combination with other herbs, such a valerian, chamomile, and hops, for promoting relaxation, rest, and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patients taking the monoamine oxidase inhibitors (MAOIs). Passion flower contains coumarin, and the risk of bleeding may be increased when used in patients taking warfarin and passion flower.

Syndromes of Anxiety and Their Treatment

Benzodiazepines can be quite helpful in crises like these. They start working within thirty minutes, and the side effects of impaired memory and muscle coordination are usually negligible. They can also help you get to sleep. They are habit-forming if taken longer than four weeks, though, so try to limit your use. Posttraumatic Stress Disorder (PTSD) PTSD occurs after a traumatic experience that is potentially life-threatening. Symptoms include reexperiencing the event through intrusive recollections, nightmares, flashbacks, avoidance of people and situations similar to the events of the trauma, and persistent symptoms of increased arousal such as insomnia, hypervigilance, and an exaggerated startle response. Generalized Anxiety Disorder The major feature of this syndrome is excessive anxiety and worry about a number of activities and events in your life. You may find it difficult to control the worry and may notice chronic restlessness, easy fatiguability, difficulty concentrating,...

Adverse Reactions

The adverse reactions associated with the administration of adrenergic drugs depend on the drug used, the dose administered, and individualized patient response. Some of the more common adverse reactions include cardiac arrhythmias, such as bradycardia and tachycardia, headache, insomnia, nervousness, anorexia, and an increase in blood pressure (which may reach dangerously high levels). Additional adverse reactions for specific adrenergic drugs are listed in the Summary Drug Table Adrenergic Drugs.

Symptoms And RiSk Factors

When sad feelings persist and begin to affect one's ability to function normally, then a serious condition called depression may be setting in. Depression is characterized by a wide range of feelings that may include dejection, focus on negative thoughts, guilt, low self-esteem, hopelessness, inability to concentrate, loss of appetite, withdrawal from friends, insomnia, and lack of interest in favorite activities. Depression often develops into a cycle in which feelings of worthlessness, helplessness, and loss of control are continually reinforced. A particularly cruel aspect of depression is that it can return unexpectedly when a person is exposed to stressful or difficult situations.

Psychological psychiatric

In one center, toxic psychosis was reported in four children over a period of 18 months (SEDA-16, 302). The children presented with acute delirium, marked restlessness, outbursts of increased motor activity, mental inaccessibility, and insomnia. One child seemed to have visual hallucinations. In each case, chloroquine had been administered intramuscularly because of fever. The dosages were not recorded. The children returned to normal within 2 weeks.

Initiation of Treatment

The usual treatment plan with SSRIs is to start a patient at the lowest effective dose and increase as indicated by clinical response. An increased response in usually seen with increased dose, however the dropout rate due to side effects also increases. For children, adolescents, the elderly, and patients who find medications generally difficult to tolerate, 50 reductions in the starting doses shown in Table 2-3 are acceptable. During titration, SSRIs may temporarily increase anxiety, insomnia, or both. These side effects can be alleviated by dose reduction, short-term use of benzodiazepines for anxiety, and the addition of either hypnotics or trazodone for sleep.

Monitoring and Managing Adverse Drug Reactions

The adverse drug reactions that may occur with the use of an amphetamine, such as insomnia and a significant increase in blood pressure and pulse rate, may be serious enough to require discontinuation of the drug. In some instances, the adverse drug effects are mild and may even disappear during therapy. The nurse informs the primary care provider of all adverse reactions. When use of the CNS stimulants causes insomnia, the nurse administers the drug early in the day (when possible) to diminish sleep disturbances. The patient is encouraged not to nap during the day. Other stimulants, such as coffee, tea, or cola drinks, are avoided. In some patients, nervousness, restlessness, and palpitations may occur. The vital signs are checked every 6 to 8 hours or more often if tachycardia, hypertension, or palpitations occur. Many times these adverse reactions will diminish with continued use as tolerance develops. If tolerance develops, the dosage is not increased.

Gerontologic Alert

I stimulants and may exhibit excessive anxiety, nervousness, insomnia, and mental confusion. Cardiovascular disorders, common in the older adult, may be worsened by the CNS stimulants. Careful monitoring is important because the presence of these reactions may result in the need to discontinue use of the drug.

Treatment Options for Depression

Monamine Oxidase Inhibitors (MAOIs) Named for their action in the brain, MAOIs are also very effective. They too must be taken every day and take weeks to become effective. Common side effects include weight gain, dry mouth, insomnia, impaired sexual response, and low blood pressure. Their most troubling side effect is the potential to cause a stroke if you ingest adrenaline or adrenaline-like substances. MAOIs can be used only with a fairly strict diet that avoids foods or medicines that contain adrenaline or adrenaline-like substances. (A full list of the dietary restrictions is found in part IV.) As a result, MAOIs need to be used with extra caution. At low doses, many people are able to use selegiline without rigorous adherence to the diet. Low doses are often ineffective for depression, however.

Pharmacological Profile Of Cannabinoid Receptor Antagonists

Additional intrinsic effects of SR141716A when administered alone, include enhanced arousal (at the expense of REM sleep and slow-wave-sleep, Santucci et al., 1996), increased pain sensitivity (hyperalgesia, Richardson et al., 1997), improved memory (Terranova et al., 1996) and rewarding properties in the conditioned place preference test for incentive motivational effects (Sanudo-Pena et al., 1997). When antagonist-induced effects in vivo are opposite to those seen after agonist administration, they can be interpreted as an inverse agonist effect, or alternatively, as an inhibition of an endogenous tone of endocannabinoid release.

Pregnancy Category C

Some undesired effects are similar to those of amphetamine abuse peevishness, nervousness, combativeness, paranoia, insomnia, and (after a dose wears off) depression. Typical afflictions include repetitions in movement or speech. Males may engage in sexual intercourse far longer than usual. Abusers may cut themselves off from other persons and become suspicious of them. Assorted hallucinations may occur, the classic one being coke bugs crawling under the skin. Psychological problems produced by unwise use of cocaine are so similar to those from other stimulants that some scientists believe similar mechanisms must cause the problems. Psychosis can be induced by cocaine but, as with other stimulants, generally does not continue after the drug use stops. Smoking cocaine can produce respiratory difficulties reminiscent of tobacco smoking difficulties that develop faster than with tobacco because lungs must deal not only with the air pollution but with powerful drug effects as well....

Syndromes of Depression and Their Treatment

How to Start Several antidepressants are first-line treatments, that is, they are the most likely to help you with the fewest side effects. I usually recommend a trial of an SSRI because these medications are the most frequently effective and the most easily tolerated. Unfortunately, they frequently inhibit sexual desire and impair sexual responsiveness, effects that intensify at higher doses. You may not care about this when you first start medication if you are focused mostly on the relief you hope to derive, but as you improve, this may become more important to you. After a couple of weeks paroxetine tends to make people tired after a dose, so this may be a useful one to try first if you experience insomnia. Some people try venlafaxine first, but blood pressure can rise and needs to be closely monitored. Bupropion is a reasonable drug to start with, although it can cause anxiety and insomnia. Additionally, the dose needs to be carefully monitored in order to prevent seizures. TCAs...

What Are the Risks in Numerical Terms

Another method of gaining perspective on the general importance of MDMA-induced mental disorder is to tour emergency rooms and the wards of psychiatric hospitals. This pragmatic investigation will produce at least one clear conclusion the drug that is principally associated with suicidal depression, homicide, cognitive deficits, schizophrenic relapse, and psychosis in this society is alcohol, by an enormous margin. It is often several weeks before a single case associated with consumption of toxicologically proven MDMA is seen in these institutions, and even longer before a case is seen that does not involve other drugs and a personal or family history of preexisting psychiatric disorder. Nevertheless, one study of self-reported immediate and long-term effects (months or years after ingestion) in five hundred people cited high levels of reported adverse psychological effects (Cohen 1995). The immediate effects reported included paranoia in 20 percent, anxiety in 16 percent, and...

Discontinuation Of Treatment

For TCAs, the usual strategy is to taper the dose at a rate of 25 to 50 mg day every 2 to 3 days. Too rapid a decrease in dose may produce symptoms of cholinergic 'rebound' or supersensitivity (nausea, vomiting, cramps), other signs of autonomic hyperactivity (diaphoresis, anxiety, agitation, headache), and insomnia as early as 48 hours or as late as 2 weeks after discontinuation. These early symptoms may be mistaken for relapse of depression. Recommendations for discontinuing SSRIs depend on the particular drug. Fluoxetine has a long half-life and abrupt withdrawal should be permissible. Shorter half-life drugs, such as sertraline, citalopram, escitalopram, and paroxetine, may require a 7-10-day taper. The withdrawal syndrome with shorter-acting agents includes symptoms of fatigue, insomnia, abdominal distress, and influenza-like symptoms. The same may be true for venlafaxine and duloxetine.

Treatment Options for Psychotic Disorders

There are significant differences among the six atypical antipsychotics. Arip-iprazole appears to be the least likely to cause weight gain, high cholesterol, and diabetes. However, approximately 25 percent of people who take it experience agitation, insomnia, and a worsening of their psychotic symptoms. Ziprasidone is the most likely of the atypical antipsychotics to cause an abnormal heart condition called QTc prolongation (see chapter 19). This condition is infrequent, even with ziprasidone (less than 1 ), but is potentially serious. Ziprasidone must be taken twice a day because the body metabolizes it quickly. This is a problem if you have difficulty taking medication regularly. It should be taken with meals to enhance absorption by the intestines taken without food causes roughly 50 percent less absorption. Risperidone tends to cause stiffness and restlessness at dosages above 6 mg a day. Although many people improve on doses lower than 6 mg a day, many people need more....

Syndromes of Psychosis and Their Treatment

Consider Medication Most people find that medication significantly improves the ability to function. Of the medications listed above, I recommend starting with an atypical antipsychotic because they are generally more effective. Each drug has its pluses and minuses. Aripiprazole makes a good first choice because it is the least likely to cause weight gain, diabetes, or elevations in cholesterol or triglycerides. However, about 25 percent of people experience anxiety, insomnia, and a worsening of their psychotic symptoms within days of starting aripiprazole. This choice may be unwise if psychotic symptoms are already quite pronounced or your ability to function and stay safe is significantly compromised. For people without heart problems, ziprasidone may make a good first choice as it appears to be less likely to cause weight gain, diabetes, or elevations in cholesterol. Quetiapine generally makes people tired, and can be a good choice if you have significant agitation or insomnia....

Comparative studies

Of the spontaneously reported adverse effects, nausea, vomiting, headache, insomnia, and diarrhea occurred in 6-10 of patients treated with domperidone and in up to 4 of patients treated with metoclopramide. The incidence of prolactin-related adverse effects was similar in the two groups (6 ).

Experimental Studies on Human Aggression

Earlier experimental studies on amphetamine and human behavior focused on performance measures as well as on eating and sleep disorders. None of these studies identified an increase in aggressive behavior as a problematic side effect (Leventhal and Brodie 1981 Laties and Weiss 1981). As a matter of fact, controlled studies on amphetamine and human social behavior, acute doses of -amphetamine (5 to 30 mg) were found to increase socializing and speaking with no indications of aggressive acts (Griffiths et al. 1977). However, antifatigue and endurance-enhancing effects of amphetamines may contribute to the effects of these substances on aggressive behavior.

Order Primulales Lindley 1833

The order Primulales consists of 3 families and about 1900 species of shrubs and herbs close to Ericalesand Ebenales, with which it shares the ability to use benzoquinones, triterpenoid saponins and flavonoids as chemical repellents (Appendix I). The largest family of this order is the Myrsinaceae with a thousand species. Besides the Myrsinaceae is the family Primulaceae, the family of Primula veris (cowslip, primrose), the flowers and the roots of which have been used to treat insomnia, stress, cough, and skin diseases in Western medicine. The therapeutic potential of Primulales is yet to be fully investigated.

Oxidative Stress A Possible Cause of METHInduced Neurotoxicity

The exact mechanisms responsible for METH-induced neurotoxicity have not been fully defined. As mentioned previously, however, a large body of work implicates oxidative stress inflicted by reactive oxygen species in damaging neurons. Although GLU plays a significant role in the destructive effects of METH,268 it is clear that excess DA is required for neurotoxicity to occur. Reactive species can form from oxidation of DA, DA auto-oxidation, and disruption of mitochon-dria.77 Pretreatment with DA-synthesis inhibitors prevents METH-induced damage in both DA and 5-HT systems and L-dopa reverses this effect.82269-271 METH administration also induces the formation of an endogenous neurotoxin 6-hydroxydopamine (6-OHDA), used experimentally to induce DA-specific lesions.272273 Further, studies in genetically modified mice have shown that the degree of damage is mediated, in part, by a number of enzymes. Mice over-expressing the reducing enzyme superoxide dismutase (SOD) show reduced...

Gewurzkalmus Calamus GF 21 Alphaprodine

Seizures can occur following abuse of GHB and, when combined with methamphetamine, there appears to be an increased risk of seizure. Combining use with other drugs such as alcohol can result in nausea and difficulty breathing. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating. Because of concern about Ro-hypnol, GHB, and other similarly abused sedative-hypnotics, the United States Congress passed the Drug-Induced Rape Prevention and Punishment Act of 1996 in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault. GHB can be produced in clear liquid, white powder, tablet, and capsule forms, and it is often used in combination with alcohol. GHB has been increasingly involved in poisonings, overdoses, date rapes, and fatalities. The drug is used predominantly by adolescents and young adults, often when they attend nightclubs and raves. GHB is often manufactured in homes with recipes...

State schedules USA Availability Prescription where legal

This quick-acting and long-lasting drug is widely used around the world for legitimate medical purposes. Flunitrazepam is prescribed to treat insomnia and anxiety, to relax muscles, to stop convulsions, and to calm people. In the 1990s it was Western Europe's most commonly prescribed calming and sleep-inducing medicine. The drug is administered to treat alcohol withdrawal syndrome, and experimental use in treating depression has found flu-nitrazepam promising. Some unauthorized use of the drug is believed to be for self-medication of depression and low self-esteem. The drug has specialized usefulness in surgery as a medication given prior to administration of anesthesia, and its tendency to reduce pressure inside the eyeball can avert the rise caused by the anesthetic succinylcholine (important if patients are at risk for glaucoma). In hospice care where doses can be higher and more frequent than normal, flunitrazepam has reduced nausea and vomiting from cancer chemotherapy....

Effects on later development

Adolescents who use methamphetamine expose themselves to the risk of developing severe behavioral and physical problems into adulthood. According to NIDA, chronic methamphetamine use can lead to violent behavior, anxiety, confusion, insomnia, paranoia, hallucinations, delusions, and mood disturbances. Paranoia caused by chronic methamphetamine use can result in homicidal and suicidal thoughts. Long-term use can cause increased blood pressure and significantly increase the chances of suffering a stroke. Other long-term physical effects include respiratory problems, irregular heartbeat, and extreme anorexia.

Benefit to harm balance

An open trial with 3-year follow up has been conducted in 36 patients with catastrophic childhood onset epilepsy (2). The overall responder rate (more than a 50 reduction in seizure frequency) fell with time 69 at 3 months, 66 at 6 months, 47 at 1 year, and 41 at the end of the study. The most frequent adverse effects were anorexia, weight loss, urinary retention, somnolence, nervousness, and insomnia. Other reported adverse effects include skin reactions (including Stevens-Johnson syndrome), various blood dyscrasias, hepatotoxicity, and systemic lupus erythematosus (3).

General Adverse Effects Dexfenfluramine

During both short-term and long-term therapy the adverse effects of dexfenfluramine seen with greater frequency than with placebo were tiredness, nausea, diarrhea, and dry mouth (1,2). Mydriasis, depression, withdrawal depression, insomnia, nervousness, headache, and increased urinary frequency have also been reported. So far, published clinical experience suggests that the greater selectivity of the dextrorotatory isomer leads to better tolerability. There has been only one long-term, that is longer than 6 months, trial on which to base this opinion (2). Since weight increase is common after withdrawal of treatment, long-term treatment is likely to be sought and given. Because studies on laboratory animals, including squirrel monkeys, suggest that there is a dose-dependent depletion of serotonin and metabolites along with a persistently reduced number of uptake sites, there has always been concern about a neuro-toxic response with both isomers. However, it has also been pointed out...

Pregnancy Category None

Have potential for reducing damage from bleeding. Animal experiments also suggest the drug may have potential in treating heart attack. Although GHB is a depressant that has been used successfully to treat insomnia, it has also been used to treat narcolepsy, a condition in which people have difficulty staying awake. Drawbacks. Tests using medical-size doses (which may be smaller than ones taken by illicit users) reveal no impairment of mental or physical abilities the researchers concluded that GHB does not hurt job performance or ability to drive a car. Nevertheless, GHB is suspected of causing an automobile driver to pass out, and the drug's sleep-inducing properties make it inadvisable to use while operating dangerous machinery. Supposedly the drug causes amnesia about events that occur while a person is intoxicated with the substance, although experiments using medical-size doses find no effect on short-term memory. A large-enough dose can slow heart rate and interfere with a...

Serotonin And Suicide

One side effect that may interfere with daily life is insomnia, which occurs in up to 14 percent of people who Agitation insomnia Figure 3.2 Like TCAs, SSRIs have a high probability of causing sexual dysfunction. Other side effects, listed here, include agitation, insomnia, and sedation, although they occur less frequently.

Antidiabetic Activity

The prevention of diabetes is an urgent worldwide public health concern. Obesity and insulin resistance induced by overeating and physical inactivity typically characterizes the period preceding onset of type 2 diabetes. Shigeta et al. 62 have shown that caloric restriction and physical exercise have obvious importance. They stress that actively promoting healthy eating and sleeping habits should be considered for the prevention of obesity and insulin resistance.

Observational studies

A Japanese study of the use of estriol 2 mg day for 12 months in 68 postmenopausal women with climacteric symptoms showed a significant effect in relieving hot flushes, night sweats, and insomnia (8,9). There were significant falls in serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) concentrations, but no effect on lipids, bone demineralization, or blood pressure. There was slight vaginal bleeding in 14 of women treated during a natural menopause, but histological and ultrasound evaluation showed no changes in the endometrium or breasts. It is evident, however, that higher doses might be needed when treating women of other races with a higher body weight. Other workers have found that when given with a progestogen over long periods, estriol 2.0 mg day seems much less likely to cause undesirable lipid changes than are equine conjugated estrogens, which can cause increased HDL cholesterol and triglyceride concentrations (10).

Herbal Alert Green

Green tea and black teas come from the same plant. The difference is in the processing. Green tea is simply dried tea leaves, whereas black tea is fermented, giving it the dark color, the stronger flavor, and the lowest amount of tannins and polyphenols. The beneficial effects of green tea lie in the polyphenols, or flavonoids, that have antioxidant properties. Antioxidants are thought to play a major role in preventing disease (eg, colon cancer) and reducing the effects of aging. Green tea polyphenols are powerful antioxidants. The polyphenols are thought to act by inhibiting the reactions of free radicals within the body that are thought to play a role in aging. The benefits of green tea include an overall sense of well-being, cancer prevention, dental health, and maintenance of heart and liver health. Green tea taken as directed is safe and well tolerated. It contains as much as 50 mg of caffeine per cup. Decaffeinated green tea retains all of the polyphenol content. The...

History And Legal Status

Rohypnol is the trade name for flunitrazepam (pronounced floo-nigh-trays-eh-pam), a drug that belongs to a class of drugs called benzodiazepines (pronounced ben-zoh-di-ayz-eh-peens). Other well-known benzodiazepines include Valium and Xanax. Benzodiazepines are primarily prescribed by doctors to treat anxiety, panic attacks, and insomnia. Rohypnol was first manufactured and patented by the pharmaceutical company Hoffman-La Roche in 1963 as a way to treat insomnia and anxiety. Rohypnol was intended to be an analogue of Valium and other benzodiazepine drugs. In 1984, Rohypnol became classified as a Schedule IV controlled substance by the DEA. However, due to increasing reports of Rohypnol abuse and misuse, it was reclassified as a Schedule III drug in 1995, requiring more thorough record keeping by manufacturers, pharmacies, and doctors. Further increases in illegal use of the drug in the United States during the late 1990s has prompted the DEA to consider classifying it as a Schedule I...

See also Myeloid colony stimulating factors General Information

Glycosylated mammalian-derived recombinant human M-CSF (rhM-CSF) has been used in several trials. Constitutional symptoms (malaise, fatigue, insomnia, headache, nausea, fever, and chills) sometimes occurred. There was no evidence of long-term toxicity during follow-up of patients who received rhM-CSF after allogeneic bone marrow transplantation (4).

Reproductive system

Melatonin affects reproduction in seasonally breeding animals. In humans, findings of increased endogenous melatonin in hypogonadism and low concentrations in precocious puberty imply an interaction between melato-nin and gonadotropins however, data on the effects of exogenous melatonin are limited (1). In a randomized study in 16 women, melatonin enhanced LH and FSH responses to submaximal GnRH stimuli in the follicular but not the luteal phase of the menstrual cycle (20). A very high dose of melatonin (300 mg) partially inhibited ovulation in healthy young women norethisterone enhanced the effect (21).

Long Term Effects Drug withdrawal

There was suppression of endogenous melatonin secretion in two of five patients with bipolar disorder after 12 weeks of treatment with high-dose melatonin (10 mg day) (15). One woman developed an unentrained sleep-wake cycle after melatonin was withdrawn (not previously a feature of her illness), which persisted for several months. Involuntary movements of the lip and tongue, restlessness, and insomnia developed twice when chronic melatonin therapy was abruptly withdrawn in a young woman with cerebral palsy these symptoms resolved when melatonin was restarted, but did not recur with gradual withdrawal over 2 months (12). This again suggests that endogenous melatonin secretion is suppressed after chronic use.

Drug Administration Drug contamination

The reliability and consistency of commercial melatonin has been questioned (3). One group analysed three commercial melatonin formulations and identified analogues of the contaminant of l-tryptophan compounds implicated in an epidemic of eosinophilia-myalgia syndrome in the 1980s (23). There have been no reports of this condition associated with melatonin consumption, but food supplements are not required to comply with the same manufacturing and monitoring quality control standards as drugs.

Use of methadone in opioid withdrawal

Methadone is used to substitute for a variety of opioid drugs. It is well absorbed after oral ingestion, with peak blood concentrations after about 4 hours. Steady-state concentrations are reached after about 5 days. By virtue of its long duration of action (the half-life with regular dosing is about 22 hours), methadone suppresses opioid withdrawal symptoms for 24-36 hours. In the early stages of treatment patients may report problems such as drowsiness, insomnia, nausea, euphoria, difficulty in micturition, and excessive sweating. With the exception of chronic constipation and excessive sweating, these effects do not generally persist.

Herbal Alert Ginseng

Adverse reactions are rare, but sleeplessness, nervousness, and diarrhea have been reported in individuals taking large amounts of the herb. The herb should not be taken in combination with stimulants including those containing caffeine. Dosage is 200 to 500 mg day of the standardized extract or 1 to 4 g of powdered root a day. Ginseng is contraindicated in individuals with high blood pressure and during pregnancy.

Drug Administration Drug formulations

A modified-release, once-daily formulation has been evaluated in 282 children with ADHD in a double-blind, placebo-controlled trial for 28 days (37). For core ADHD symptoms, both once-daily modified-release and thrice-daily immediate-release methylphenidate were superior to placebo and not different from each other. A similar percentage of patients reported at least one adverse event with both formulations. The most commonly reported adverse events were headache and upper respiratory infections, followed by abdominal pain, cough, pharyngitis, vomiting, and otitis media. Of these, only headache and abdominal pain were considered to be related to the study medication. One patient withdrew because of depression with modified-release methylphenidate and one because of tics with placebo. Headache occurred in 14 , 5.8 , and 10 of patients taking modified-release methylphenidate, immediate-release methylphenidate, or placebo respectively, and abdominal pain in 6.7 , 5.8 , and 1.0 . Other...

Prescription Medications

Of sedating antidepressants (e.g., trazodone) as sleep aids, is common clinical practice. The melatonin agonist ramelteon, the most recently FDA-approved hypnotic in the US, is an agent with unique mechanism of action. The pyrazolopy-rimidine indiplon, not yet available in the US, is also a non-BZD GABA A modulator with promising side-effect profile. Other pharmacological options, limited to a few well-defined conditions with many caveats, include anticonvulsants (e.g., gabapentine, valproate, tiagabin) and antipsychotics (e.g., haloperidol, quetiapine).

Pharmacology Benzodiazepines

All BZDs are central nervous system depressants via gamma-aminobutyric acid (GABA) agonism. Due to non-selective GABA binding, BZDs also possess anxiolytic, anticonvulsant, and myorelaxant properties. By modulating the effects of GABA, BZDs increase the frequency of chloride channel openings. In contrast, barbiturates and alcohol increase the duration of chloride channel opening. This seemingly minor distinction accounts for the greater safety of BZDs in overdose, with less likelihood of respiratory depression or coma. When alcohol is mixed with a BZD overdose, the synergism may result in fatal respiratory depression. Although effective hypnotics, BZDs significantly alter normal sleep architecture daytime fatigue is probably related to reduced slow-wave, restorative sleep, while the memory problems reported by BZD users may be due to reduced REM sleep. REM suppression causes REM rebound upon BZD discontinuation, manifesting as vivid dreams and nightmares.

Organs and Systems Cardiovascular

Insomnia and daytime somnolence and fatigue have been reported with tranylcypromine, phenelzine, and isocar-boxazid (SEDA-16, 8) (SEDA-17, 16). In a comparison of phenelzine and imipramine (15) there were important and significant differences between the drugs 19 of the patients taking phenelzine reported drowsiness compared with none of those taking imipramine moreover, 18 patients taking phenelzine had to be withdrawn, compared with one taking imipramine (who developed urinary retention). Central nervous system toxicity was also reported after an abrupt switch from phenelzine to iso-carboxazid (SEDA-17, 17).

Peyote And Mescaline Absence Of Dreams

Despite the vivid nature of the hallucinations and exaggerated sensory experiences produced by peyote, many users report that for several nights after having taken the drug, there is a general absence of normal dreaming during sleep. Perhaps the grandiose visions produced by peyote have actually replaced dreaming, albeit temporarily. More than likely, however, the stimulation of 5-HT2 receptors by mescaline actually interferes with the normal cycles of various sleep stages intricately regulated by the brain.

Organs and Systems Nervous system

Nefazodone is unusual amongst antidepressants in that it does not reduce and in fact may increase rapid eye movement (REM) sleep or dream sleep. In a controlled study in depressed patients nefazodone 400 mg day increased REM sleep, while fluoxetine 20 mg day produced the opposite effect (3). In addition, nefazodone increased sleep efficiency, while fluoxetine reduced it. The patients' subjective assessments of sleep improved more with nefazodone than with fluoxetine. However, the overall antidepressant effects of the drugs were similar. The function of REM sleep and its relation to depressive disorders is not clear, so it is uncertain whether preservation of REM sleep by nefazodone is likely to be of clinical consequence.

Other Prescription Hypnotics

These agents have not been approved by the FDA for insomnia, but due to their sedating properties, they are considered useful alternative hypnotics in cases of treatment resistance, intolerable side effects, drug-drug interactions, certain comorbid conditions, current or past history of drug use etc. At present, the most frequently used, non-FDA-approved hypnotic in the US is the triazolopyridine trazodone, marketed as an antidepressant. It is rarely used alone as an antidepres-sant because of its strong sedating qualities and the need for b.i.d. administration. Tolerance to its sedating effects develops only rarely with long-term use, making it an excellent option for those with chronic insomnia. In spite of a paucity of data in support of efficacy, trazodone is also the most popular choice to counter SSRI-induced insomnia. Hypnotic dosages vary markedly, from 25 to 300 mg, depending on individual susceptibility to its sedating effects. Trazodone increases slow wave sleep and total...

Treatment Implementation

It is always advisable to provide patients with information on good sleep hygiene practices (see Table 5-1). Although behavioral techniques such as stimulus control, progressive muscle relaxation, biofeedback, and sleep-restriction seem to complement pharmacotherapy, cognitive-behavioral therapy (CBT) alone may have better long-term outcome, compared to the combination of CBT and medications. In contrast, added CBT seems to facilitate the tapering of hypnotics. Some patients with chronic insomnia may benefit from longer-term use, provided that there is careful monitoring by the prescribing physician. No criteria are presently available to identify this subpopulation. It seems reasonable to consider several short-term trials, with gradual tapering at the end of each period and a drug-free interval between each period, to establish the patient's need for and the appropriateness and value of continued therapy. Drug-free time intervals between initial treatment periods should range from...

Drug Interactions And Special Precautions

The CYP 1A2 isoform is also important in insomnia but from a different perspective. Methylxanthines (e.g., caffeine) and certain bronchodilators, such as theophylline, are significantly metabolized via CYP 1A2-mediated pathways. Inhibition of CYP 1A2 activity by the SSRI fluvoxamine or by certain fluroquinolone antibiotics (e.g., ciprofloxacin) in patients also ingesting caffeinated beverages or in those requiring theo-phylline may result in insomnia, agitation, or increased anxiety. pregnancy, especially during the first trimester due to an increased risk of congenital malformations. A variety of congenital malformations, including cleft palate, delayed ossification of a number of bony structures, and an increased occurrence of rudimentary ribs have been reported. Chronic usage of benzodiazepines during pregnancy may lead to physiologic dependence and withdrawal symptoms in the neonate. The use of benzodiazepine hypnotics during the last weeks of pregnancy may result in neonatal...

Additional Reading

N Engl J Med 2005 353 803-10 2. Roth T, Krystal A, Walsh J et al Twelve months of nightly eszopi-clone treatment in patients with chronic insomnia assessment of long-term efficacy and safety. Sleep 2004 27 A260 3. Buysee DJ, Reynolds CF, Kupfer DJ et al Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories a report from the APA NIMH DSM-IV Field Trial. Sleep 1994 17 630-37 4. Morin CM, Colecchi C, Stone J et al Behavioral and pharmacological therapies for late-life insomnia a randomized controlled trial. JAMA 1999 281 991-99 5. National Institutes of Health State of the Science Conference Statement Manifestations and Management of Chronic Insomnia in Adults. June 13-15, 2005. Sleep 2005 28(9)

Andrew M Kleiman MD and Julie Holland MD

Although MDMA has been available to researchers for decades, there are few reliable clinical studies looking at its effects. Many published articles concerning MDMA cite animal data, using rats, mice, or nonhuman primates, such as squirrel monkeys or baboons. Most of the human studies take their data from people who are long-term Ecstasy users and then compare them with data from non-Ecstasy users. These retrospective studies are suspect for a number of reasons. First, we have no idea if the chemical these study participants ingested was MDMA. Second, it is likely that other chemicals (specifically ketamine, dextromethorphan, and marijuana) were ingested by these research subjects, which might explain any differences recorded between the groups. Third, many variables are at play among people who take drugs often, for example, diet, exercise, sleep habits, and preexisting psychiatric diagnoses.

Natural and Cultural History of Datura

She also reports witnessing an operation in which the Zuni curer used a flint knife to open the abscessed breast of a woman who had been placed into a deep sleep with Datura inoxia (then still called D. meteloides). When she awoke she said she had experienced only beautiful dreams but no pain whatever.

Clinical Management of Anxiety

Patients tend to present when their anxiety impairs their occupational, social or domestic functioning, and identification of the key complaints and motivations for seeking treatment is critical in drawing up an effective management plan. For example, a patient with generalized anxiety disorder (GAD) may present because her resulting insomnia is impairing her ability to work management should include strategies to improve sleep efficiency as well as treatment of the anxiety.

Drug dosage regimens

A randomized double-blind comparison of two dosage regimens of risperidone, 8 mg od and 4 mg bd for 6 weeks, in 211 patients has provided further information (149). Neither efficacy nor ESRS scores differed significantly. At least one adverse event was reported in 72 of the patients taking once-daily therapy and 87 of the patients taking twice-daily therapy. The most frequently reported were insomnia, anxiety, extrapyramidal symptoms, agitation, and headache. The only statistically significant difference between the groups was in the incidence of anxiety, which was reported by 31 of those taking twice-daily therapy and 17 of those taking once-daily therapy.

Generalised Anxiety Disorder

GAD is a prevalent, chronic, disabling anxiety disorder. It is comorbid with other anxiety or mood disorders in the majority of cases (Ballenger et al. 2001). Whilst it is a relatively new diagnostic concept, longitudinal studies have reinforced its validity (Kessler et al. 1999). The core symptoms are chronic worry and tension, and GAD frequently presents with somatic complaints such as headache, myalgia or insomnia (Lydiard 2000). The diagnosis requires symptoms to be present for at least 6 months, although the duration of illness at presentation is usually much longer than this. The presence of comorbidity leads to a worse prognosis (Yonkers et al. 1996). Cognitive behavioural therapy (CBT) has been shown to be effective in GAD and should be considered if available (Durham et al. 1994). Benzodiazepines are effective as monotherapy (Rickels et al. 1993) but are rarely used as first-line in this context because of their side-effect profile. They have a useful short-term role for the...

The Neurobiology Of Depression

(4) Changes in neuroendocrine responses to challenges with drugs that target specific monoamine receptors (e.g. the a2-adrenoceptor agonist, clonidine, stimulates growth hormone secretion while -adrenoceptor activation stimulates melatonin secretion from the pineal gland).

Posttraumatic Stress Disorder

Diagnosis is given when specific psychological and physical symptoms follow exposure to a traumatising event that invokes fear, horror and helplessness. Symptoms fall into three categories re-experiencing phenomena (flashbacks, nightmares, distress when memories of trauma are triggered) persistent avoidance of triggers to memory of the trauma and general numbing hyperarousal (insomnia, irritability, poor concentration, hypervigilance, increased startle response). Symptoms must persist for more than 1 month after the trauma. The evidence base for pharmacotherapy is shallow although improving. Efficacy is established for the SSRIs, particularly paroxetine (Tucker et al. 2001), fluoxetine (Connor et al. 1999) and sertraline (Brady et al. 2000) and the TCA amitriptyline (Davidson et al. 1993a). Treatment is started at standard dose but may be required to be titrated upwards (e.g. paroxetine 20-50 mg). Results from long-term studies are awaited but treatment should be continued for a...

Hi M M M JiiiM Mil Minlitil MIH Mi

Thalidomide was introduced in the 1950s as a sedative that was prescribed for nausea and insomnia in pregnant women. However, it was found to be the cause of severe birth defects in children whose mothers had taken the drug in their first trimester of pregnancy. In 1965, it was serendipitiously discovered that thalidomide was effective at improving the symptoms of patients with erythema nodo-sum leprosum (ENL), and was approved for this use in 1998. In 1994, thalidomide was found to inhibit angiogenesis through a complex mechanism that includes inhibition of the synthesis by activated monocytes of TNF-a, which seems to have a role in angiogenesis by upregulation of the expression of the endothelial integrin and VEGF, among others. It has been demonstrated that inhibition of angiogen-esis by thalidomide requires prior metabolic activation,38 which has prompted the synthesis and evaluation of a large number of potential metabolites of this lead compound.

Pregnancy Category X

Insomnia is one of the main medical conditions treated by this drug, which also has anticonvulsant properties. The compound has been found useful to counteract insomnia actions of some psychiatric medicines. Although one insomnia study showed doses losing some effectiveness over time, patients continued to sleep better for 15 nights after dosage stopped, an improvement not observed when people stop taking some other antiinsomnia drugs. Similar findings have come from other experimentation. Antiinsomnia drugs commonly have rebound effects in which insomnia temporarily becomes worse than ever when dosage stops. Little or no rebound is observed with quazepam, perhaps because it is eliminated rather slowly from the body. A study noted that quazepam not only reduced anxiety among insomniacs but that the decline in anxiety continued for 15 days after dosage stopped. The drug has been tested against other substances used against insomnia triazolam, temazepam, and flurazepam. In some...

The Nature of the Syndrome

The relatively low intensity of physiological withdrawal symptoms resulting from heavy marijuana use may have contributed to marijuana's not being viewed as dependence producing. However, studies have documented that people who use marijuana heavily and chronically may develop both physiological and psychological dependence and that cessation from use may produce a withdrawal syndrome broadly characterized by restlessness, irritability, mild agitation, insomnia, decreased appetite, sleep disturbance, anxiety, stomach pain, nausea, runny nose, sweating, and cramping (Crowley et al. 1998 Haney et al. 1999b Wiesbeck et al. 1996). These symptoms commonly abate within a few days to 2 weeks of abstinence from marijuana.

Drug Administration Drug dosage regimens

Benzodiazepine prescribing for sleep induction in an elderly medical inpatient population has been examined, to determine if hospital prescribing increases the use of benzodia-zepines after discharge (5). The secondary objectives included monitoring for adverse effects and assessment of the quality of sleep in hospital compared with the quality of sleep at home. Inpatient and outpatient prescribing of ben-zodiazepines used for insomnia was recorded over 3 months. Benzodiazepines were prescribed for 20 of patients, and 94 of the prescriptions were for temazepam. Of the 57 patients who were given benzodiazepines during a hospital admission, 57 had not taken a benzodiazepine at home before admission. Benzodiazepines were effective in the short-term for inducing sleep in hospital, with little evidence of adverse effects.

Pharmacotherapies for Cannabis Dependence

The results of other potential pharmacotherapies were less encouraging than those found for THC. Divalproex decreased marijuana craving during marijuana abstinence however, it increased ratings of anxiety, irritability, bad effect, and sleepiness during marijuana abstinence (Haney et al. 2004), thus limiting its utility. Although bupropion has been well established to be an effective treatment for nicotine withdrawal (Ferry and Johnston 2003 Richmond and Zwar 2003), it not only failed to alleviate symptoms associated with marijuana withdrawal, but also exacerbated them (Haney et al. 2001). Specifically, bupropion worsened mood during marijuana abstinence as reflected by increased self-reports of irritability, misery, restlessness, depression, and lack of motivation compared to placebo. It also worsened subjective reports of sleep quality during marijuana withdrawal compared to placebo. One concern with bupropion is that its stimulatory effects were the cause of the increased severity...

Symptomatic Relief in Multiple Sclerosis and Spinal Cord Injury

More recent trials of cannabis-based medicines in MS have given mixed results. Vaney and colleagues (2002) enrolled 57 MS patients in a randomised, crossover comparison of 15 mg THC daily in divided doses for 15 days with placebo. A significant improvement in a subjective rating of spasm frequency was not accompanied by objective improvement as represented by the Ashworth Score (Ashworth 1964). This is a measure of biological impairment, as opposed to disability or handicap, and relies upon an estimation by a clinician. A trend towards improvement in mobility was noted, but no effect on tremor, sleep quality, or lower urinary tract symptoms. Adverse events occurred with similar frequency in the active and control groups, but were more severe in the former. Killestein et al. (2002) reported an unambiguously negative study in 16 MS patients. In a randomised, double-blind crossover design, they compared synthetic THC with a cannabis plant extract containing the same amount of THC and...

Evaluating Alternative Remedies

If you decide you want to take an alternative remedy, you should inform your physician (and psychiatrist). It's possible that any remedy you take can impair your functioning or interact with another medication that you are on. Green tea is touted as a health aid, but the caffeine can worsen anxiety and insomnia. St. John's wort may aid mild depression, but can cause the serotonin syndrome (a potentially dangerous reaction with symptoms of fever, hyperactivity, and alterations in mental status, pulse, and blood pressure) if taken in combination with SSRIs.

Psychiatric Disorders

A controlled trial in 15 insomniac volunteers suggested that CBD (160 mg) may be an effective hypnotic (Carlini and Cunha 1981), but in a more recent sleep laboratory study in healthy subjects (Nicholson et al. 2004) much smaller doses of CBD (5 and 15 mg) appeared to have alerting properties. When CBD (15 mg) was given in combination with THC (15 mg) at 10 pm, it counteracted the morning-after sedative effects seen when THC was given alone and increased wakeful activity during sleep. Effects on sleep architecture were modest, but some effects of both cannabinoids on slow wave sleep were reported. Overall, these results suggest that the improvement in sleep quality frequently reported in clinical trials is mainly due to nocturnal symptom relief rather than a primary hypnotic effect.

Pregnancy Category B

Zolpidem became available for medical purposes in the United States during the 1990s, after already being used in Europe. The substance can be used to relax people shortly before they undergo surgery. Zolpidem promotes sleep and has both sedative and anticonvulsant properties. Generally insomnia patients are not supposed to take the drug for much more than a week. They are also not supposed to take the drug until they are ready for sleep the substance is fast acting, and a person could doze off while in the middle of doing something. Elderly nursing home residents have been known to fall after taking zolpidem. People may forget things they do while under the drug's influence a U.S. Army test found that the amnesia can be prevented if the drug flumazenil is taken soon enough after a zolpidem dose (flumazenil is used to counteract benzodiazepine depressants). Many insomnia medicines produce a rebound effect, meaning that the insomnia comes back worse than ever for a few days after...

LparaHalophenyl2methyl2aminopropane and methylaminopropanes by Kefalas December 21 1959

It has been shown in the past that certain sympathomimetic agents exert anorexigenic effects. However, it has also been found that while agents of this nature are in fact highly useful for their appetite suppressant effect, they simultaneously exert a strong stimulatory effect, with resulting symptoms of anxiety, restlessness and insomnia. As examples of sympathomimetic agents already known to play such a dual role may be mentioned amphetamine (l-phenyl-2-aminopropane), meth-amphetamine (d-phenyl-2-methyl-aminopropane), and l-phenyl-2-me-thyl-2-aminopropane. It would obviously be highly desirable to have available a composition which would be anorexigenically active and effective without attendant undesirable central stimulatory effect. For a considerable number of years, investigators have made a determined effort to find such a satisfactory drug in the amphetamine area. Failing here, they have turned to other structural areas. Some of the results of these investigations have been...

Is DXM Really Addictive

While there is no question of whether or not DXM is being abused, there is speculation as to whether or not that abuse leads to addiction. There is evidence that DXM abuse causes emotional dependence, since users report that they feel the need to take more of it and that some find it hard to quit abuse. There is also some evidence that abuse can cause physical addiction to some degree. One sign of physical addiction to a substance is the appearance of withdrawal symptoms when quitting. Some users experience a mild form of withdrawal after stopping their abuse of DXM, including insomnia and some depression. Limited clinical tests suggest that physical dependence only occurs after DXM is used heavily for a long period of time, not when it is used for short periods of time and with light use. As OTC drug abuse is being brought to light, more research will be done concerning addiction and possibly recovery.

Convolvulus pleuricaulis

Balance and vitiation in kapha-vata-pitta doshas (physiological functions), and the herb is astringent and bitter. C. pleuricaulis is used traditionally to treat nervous debility, insomnia, fatigue, low energy levels, and as a brain tonic, alterative, and febrifuge. The whole herb is used medicinally in the form of a decoction along with cumin and milk in fever, nervous debility, and memory loss. The plant is reported to be a prominent memory improving drug, psychostimulant, and tranquilizer, and it reduces mental tension. The methanolic extract of C. microphyllus Sieb. Ex Spreng (C. pleuricaulis Choisy) showed enhanced release of nerve growth factor (NGF). NGF prevents experimentally induced or age related degeneration of basal fore-brain cholinergic cell bodies in adult rats and can also restore lesion-induced loss of cognitive functions 49, 50 . The plant of Nardostachys jatamanasi is used by Santhal tribals in the treatment of madness, epilepsy, loss of unconsciousness,...

Hypnosedatives and anxiolytics

Hypnotics and sedatives are commonly prescribed drugs, especially in older people. The ideal hypnotic would induce sleep rapidly, keep patients asleep without disrupting sleep architecture, have no adverse effects, produce no next-morning sedation, lack dependence and rebound insomnia, and be safe in the medically unwell and in overdose. Although the newer drugs, including zaleplon, Zolpidem, and zopiclone, satisfy many of these criteria, it is unlikely that the perfect drug will ever be developed.

Serotonin As A Neurotransmitter And Psychoactive Agent

In addition to serving as a neurotransmitter, serotonin is also the metabolic precursor of melatonin, which the human body makes during the night and when eyes are closed, as in some forms of meditation. Deficiencies in tryptophan and serotonin have been linked to mental

Mendeiguina Pethidine

Mepro-analgesic Drug containing more than one substance whereof one under international control Meprobamate. Mepro-mepha Drug containing more than one substance under international control Meprobamate and Phenobarbital. Mepro-nervamin Drug containing more than one substance under international control Meprobamate and Phenobarbital. Mepro-secergan Meprobamate. Mepro-serenol Drug containing more than one substance whereof one under international control Meprobamate. Meproatropa Meprobamate. Meprobadal Drug containing more than one substance under international control Mepro-bamate and Phenobarbital. Meprobadal compositum Drug containing more than one substance whereof one under international control Meprobamate. Meprobalen Meprobamate. Meprobam Meprobamate. Meprobamaat Meprobamate. Meprobamat Meprobamate. Meprobamat, -e, -o, -um Meprobamate. Meprobamate C9H18N2O4. Synthetic substance, under international control according to the UN Convention on Psychotropic Substances 1971, Schedule...

Ghb Overdoses Inspire A Federal

One peculiar effect of GHB is that it seems to reduce the symptoms of narcolepsy, a relatively rare sleep disorder. People with narcolepsy are excessively sleepy all the time and often have a condition called cataplexy, in which the person can suddenly and unexpectedly lose all muscle tone and fall immediately into rapid eye movement (REM) sleep (the stage of sleep during which dreaming occurs). Thus, a person with narcolepsy can immediately go from being awake right into REM sleep. (Normally, it takes at least 60 minutes to enter into REM after falling asleep.) These rapid transitions from waking to REM sleep can result in frightening hallucinations. Interestingly, bouts of cataplexy are usually brought on by laughter or strong emotional experiences.

Ecgonine phenylacetylmethylester

Many problems users encounter with MDMA are similar to those found with the use of am-fetamines and cocaine. They are Psychological difficulties, including confusion, depression, suicide, sleep problems, drug craving, severe anxiety, and paranoia-during and sometimes weeks after taking MDMA (even psychotic episodes have been reported) Physical symptoms such as muscle tension, involuntary teeth-clenching, nausea, blurred vision, rapid eye movements, faintness, and chills or sweating increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease. 2. South African colloquial term for nutmeg oil. Intense joy or delight rapture. From Greek ek-stasis, astonishment, ex-, out of, histanai, to

Poisoning cases and toxic and fatal concentrations

Case 1 5 A 35-year-old female was found collapsed in the morning at her house by her family member. Although she was sent to a doctor by an ambulance car, she had been dead already. Many empty packages for tablets were discovered in her room the death due to drug poisoning was suspected. As her past history, hypotension, depression and insomnia were disclosed antidepressants and antianxiety drugs had been prescribed by a doctor. Among the empty packages, the number of them was largest for Tecipul (setiptiline maleate) as many as 200 tablets of Tecipul were found missing. As results of GC MS analysis, setiptiline was

Square dancing tickets Colloquial term

Squires extract Patent medicine introduced in the 1840s by the British pharmacist Peter Squire. It contained cannabis and was used against lost appetite, insomnia, menstrual pain and was also used during child-birth. It was also recommended to cure alcoholism and morphinism.

Tranquilizantes 1 Colloquial term for

Drugs that slow down the central nervous system (CNS), and thus are similar to such other CNS depressants as alcohol and barbiturates. The term major tranquillizer was formerly applied to drugs used to treat severe mental illnesses, such as schizophrenia. However, these drugs are now more commonly called neuroleptics their action specifically relieves the symptoms of mental illness, and they are rarely misused for other purposes. Anti-anxiety agents share many similiarities with barbiturates both are classified as sedative hypnotics. These newer agents were introduced under the term tranquillizer because, it was claimed, they provided a calming effect without sleepiness. Today, tranquillizers have largely replaced barbiturates in the treatment of both anxiety and insomnia because they are safer and more effective. The degree of sleepiness induced depends on the dosage. Tranquillizers are also used as sedatives before some surgical and medical procedures, and they are sometimes used...

Withdrawal from Opiates

The time to onset of withdrawal symptoms depends on the duration of action of the opiate. Symptoms typically begin 6-24 h after the last dose of a short-acting agent such as heroin but 48-72 h after longer-acting opiates like methadone. The administration of an opiate antagonist (e.g., naloxone) can precipitate severe withdrawal symptoms, including dysphoria, nausea and vomiting, muscle aches, lacrimation or rhinorrhea, dilated pupils, piloerection, diarrhea, diaphoresis, yawning, fever, and insomnia. A number of nonnarcotic medications are useful in treating the symptoms of opiate withdrawal. These include the a-adrenergic receptor agonist and antihypertensive clonidine, which is particularly helpful with the autonomic symptoms of withdrawal as well as the anxiety, benzodiazepines (clonazepam is typically used), which are particularly helpful for anxiety and insomnia, antiemetics, and NSAIDs for muscle aches (oral agents such as ibuprofen, or toradol which can be given parenterally)....

Clormetaminodiazepoxid Chlordiazepoxide

Many problems MDMA users encounter are similar to those found with the use of amphetamines and cocaine. Psychological difficulties can include confusion, depression, sleep problems, severe anxiety, and paranoia. Physical problems can include muscle tension, involuntary teeth clenching, nausea, blurred vision, faintness, and chills or sweating. Use of the drug has also been associated with increases in heart rate and blood pressure, a special risk for people with circulatory or heart disease. Recent research also links Ecstasy use to long-term damage to those parts of the brain critical to thought, memory, and pleasure. Club soda Mixer of carbonated water with some minerals (midway between seltzer and mineral water).

Anterior pituitary hormones

Melatonin is secreted by the pineal gland. Melatonin secretion is regulated on the basis of photic stimuli in the absence of photic stimuli (at night), melatonin secretion increases. Melatonin coordi nates biological rhythms. It also stimulates progesterone secretion, inhibits prostaglandin synthesis, and has (experimentally) a tocolytic effect (Ayar 2001). The human fetal suprachiasmatic nucleus expresses melatonin-binding sites, and is therefore likely to be affected by both endogenous and exogenous melatonin, with consequences for the prenatal and postnatal expression and entrainment of circadian rhythms. The relevance of melatonin to the maintenance of pregnancy at the feto-maternal interface has been investigated, and results suggest that melatonin seems to regu late the human placental function in a paracrine autocrine manner (Iwasaki 2005). There is insufficient experience with the therapeutic use of melatonin (for instance, for prevention of jetlag after intercontinental...

Monoamine Oxidase Inhibitors Isocarboxazid Phenelzine Tranylcypromine Selegiline Moclobemide

Tricyclic Antidepressant Diagram

Monoamine oxidase inhibitors (MAOIs) are less commonly prescribed than TCAs. Their use is one of last resort, when no other drugs can cure a patient's depression. As with TCAs, MAOIs are quite effective in curing patients experiencing severe depression and also atypical depression. Depression is termed atypical when an affected person sleeps more than normal and gains weight, the opposite effects of more commonly experienced depressive behavior such as insomnia and weight loss. Other depressive symptoms such as extreme fatigue during the day and feelings of hopeless and worthlessness are seen in both kinds of depression. Researchers have discovered that there are two types of monoamine oxidase enzyme MAO-A and MAO-B, each located in different regions of the body. Older MAOIs, such as Nardil, inhibit both versions of monoamine oxidase, resulting in increased serotonin and norepinephrine inside the cell (and also leakage into the synapse, thus activating receptors). Increases in...

Amfetamines Introduction One of a

Class of sympathomimetic amines with powerful stimulant action on the central nervous system The class includes amfetamine, dexamfe-tamine, and metamfetamine. Pharmacologically related drugs include methylphenidate, phenmetrazine, and amfepramone (diethyl-propion). In street parlance, amfetamines are often referred to as speed. Symptoms and signs suggestive of intoxication with amfetamines or similarly acting sympathomimetics include tachycardia, pupillary dilatation, elevated blood pressure, hyper-reflexia, sweating, chills, anorexia, nausea or vomiting, insomnia, and abnormal behaviour such as aggression, grandiosity, hypervigi-lance, agitation, and impaired judgement. In rare cases, delirium develops within 24 hours of use. Chronic use commonly induces personality and behaviour changes such as impul-sivity, aggressivity, irritability, suspiciousness, and paranoid psychosis (see Amfetamine psychosis). Cessation of intake after prolonged or heavy use may produce a withdrawal...

Phenomorphan methylbromide

Phenylpiperone Dipipanone. Phenylpropanolamin, -e Cathine. Phenylpropanolamine Common ingredient of street stimulants has actions similar to ephedrine, nervousness, restlessness, insomnia, headache, nausea, heart palpitations, rise in blood pressure, cerebral hemorrhage. Phenyral Phenobarbital. Phenytoin C15H12N2O2, An anticonvulsant drug, chemically related to the barbiturates and used most commonly in the treatment of epilepsy. Also called diphenylhydantoin. Phenzine Phendimetrazine bitartrate. Phepracet Amfetamine p-aminophenylacetate.

Cumulative index of special reviews Annuals 1625

Macrolides, intestinal motility, 18.269 Malaria vaccines, 22.306 MAO inhibitors, 17.361 Measles immunization autism, 23.350 Crohn's disease, 23.350 neurological adverse effects, 23.348 Melatonin, 25.523 Metformin, lactic acidosis, 23.459 Methyldibromoglutaronitrile, contact allergy, 16.150, 19.151

Classical Mandrake Prescriptions

Theophrastus One should draw three circles round the mamirakv with a sword and at the cutting of the second pitee onti should dancc around the patient. The leaf, they say, is useful for wounds, and the root for red skin welts, when scraped and steeped in vinegar, and also for gout, for sleeplessness, and Sot low potions. Soon Taoisl magicians were seeking immortality, with kung fu, health food and a host of drugs. Undoubtedly many were charlatans-but the greatest, an alchemist named Ko Hung (ca. a.d. 300), was not Ko allegedly succeeded in transforming herbs and precious metals into an elixir of immortality, with cinnabar, and it is said that when he died his coipse felt, incredibly light, as if the shrouds had been emptied of the body. Ko formulated rules to strengthen breathing and blood circulation with tonics and special diets. He emphasized the need for simple, inexpensive cures for common ailments, such as his prescription for asthma-a compound of ephedra, cinnamon, licorice and...

CH2CNH2 stimulatory activity

Amphetamines were covered in the section on the peripheral nervous system since they will have stimulation at adrenergic synapses leading to an increase in heart rate and dilation of the pupils. Their anorexic effects are both peripheral and central. The CNS effects include increased alertness, a delayed need for sleep (REM sleep is decreased), and euphoria. Because of their structural similarity to norepinephrine and dopamine, these compounds stimulate NE and Da production as well as prevent their reuptake. They may also inhibit monoamine oxidases. The principal sites of action seem to be the limbic system and the RAS. amphetamine psychosis, a state almost indistinguishable (except by testing) from paranoid schizophrenia. The psychotic aberrations may include vivid visual, tactile, auditory, and olfactory hallucinations. Withdrawal from heavy amphetamine use is not usually life-threatening. Rebound fatigue, depression and sleep, especially REM sleep, are experienced. During the...

Enhancing performance the American way

The outcomes make for fascinating reading. He claimed that alcohol might be useful for warming up but is detrimental to muscular performance even in small doses. Alkalies such as sodium bicarbonate might benefit athletes' performance. The research on ammonium chloride was considered contradictory and its usage was not recommended. Benzedrine, a form of amphetamine, had been the subject of a range of studies that had not offered definitive conclusions (Ivy and Krasno 1941). Karpovich claimed its chemical composition and physiological action were closely related to those of adrenalin. The main benefit was that amphetamine could counteract fatigue but had risky side effects 'it is a powerful and dangerous drug and its excess may lead to insomnia, hypertonia, and circulatory collapse' (1941 437). However, he acknowledged that the lack of scientific evidence and these associated risks did not stop it being used, as there had been 'rumours that Benzedrine has been responsible for an...

History of Medical Marijuana

The cannabis plant's history as the source of hemp is separate from its story in medicine. Cannabis's use as a treatment for a variety of illnesses helped it spread from ancient Asia throughout the world. The plant consistently appeared in pharmacopoeia and folk medicine as a treatment for pain, seizure, muscle spasm, poor appetite, nausea, insomnia, asthma, and depression. Its potential to alleviate labor pains, premenstrual symptoms, and menstrual cramps also received attention in multiple medical reports from ancient times to the present. Marijuana's possible medical application has continued to increase its popularity, even with individuals who would frown upon recreational use. Therapeutic cannabis has also provided intriguing scientific and legal research, as discussed later in this book. The history of marijuana as medicine is extensive and includes many characters on many continents. appetite, sexual interest, mental disorders, gout, cholera, hydrophobia, and insomnia (Wood...

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