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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. Stress If a sudden stressful situation is impairing your sleep, medication may be the fastest and best way to get the rest you need. Hypnotics or benzodiazepines are invariably effective. Both can cause short-term memory problems, and benzodiazepines can impair muscle coordination (leading to an increased risk of car accidents and falls). Benzodiazepines are habit-forming and lose their effectiveness with nightly use, so don't take them for more than four weeks. 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...

TABLE 51 Sleep Hygiene Techniques

Do not catch up on your sleep on the weekend. 7. 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...

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...

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. First, establish a regular sleep schedule such that you go to bed and get up at the same time each day. Varied schedules, like the jet lag people get when they travel to other time zones, can interfere with the development of a routine that promotes good sleep. This can occur if you vary your sleep hours because of your work schedule or any other reason. Avoid caffeine, alcohol, tobacco, and recreational drugs. Avoid nonprescription preparations that contain stimulating adrenaline-like decongestants like pseu-doephedrine (Sudafed), phenylephrine, or phenylpropranolamine. If you have asthma, work with your physician to find medications that will not impair your sleep. 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...

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...


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

Hot flushes, headache, fatigue, insomnia, nausea, vomiting, and diarrhea have been observed with large doses, but it is difficult to tell to what extent these are real rather than placebo effects. The best evidence of problems caused by high doses relates to stone formation, mainly in patients with chronic renal insufficiency. Certain hematological and metabolic effects have been reported in premature infants however, these have not been corroborated (10). Several cases of hemolysis have been reported. Respiratory and cutaneous allergies to ascorbic acid have been described (11). Tumor-inducing effects have not been reported.

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.

USA Availability Prescription and nonprescription drug also in food Pregnancy Category C

Caffeine makes people more alert, and experimentation finds that it can help persons function more effectively during sleep deprivation. Caffeine is commonly used in the workplace to increase employees' energy and output. Laboratory measurements indicate that a single dose of 250 mg to 400 mg at the beginning of a night work shift is more effective than several smaller doses spread out during the work period. Some studies find that caffeine helps extroverts perform simple physical assignments but overstimulates introverts and thereby worsens their performance. Scientific measurements prove that caffeine, by itself or in combination with ephedrine, improves athletic performance.

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.

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

Exercise Regular exercise can be very beneficial if you are depressed. It can improve your energy during the day as well as your sleep at night. The physical feelings of increased energy, elevated heart rate, and powerful exertion help you to feel competent and strong in at least one area of your life, especially when other areas may be in some disarray. Maintaining the discipline to perform regular exercise helps to counteract the paralyzed helplessness that you may feel. 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...

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....

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.

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...

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...

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...

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.

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.

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.

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...

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.

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).

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.

Monoaminergic Candidate Genes

SERTPR variants may also not be specifically associated with response to SSRIs but confer a more general predisposition to respond to any kind of antidepressant treatment targeting the serotonin system. The l allele of SERTPR has not only associated been associated with a better response to SSRIs but also a good response to total sleep deprivation (Benedetti et al. 1999). An enhancement of serotonergic transmission has been proposed as one possible mechanism of action of sleep deprivation (Gardner et al. 1997).

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.

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.

Polonovski Rearrangement Lorazepam

Fuel Cell Anaesthesia

Oxazepam is similar to chlordiazepoxide in terms of pharmacological properties however, it has a somewhat less harsh effect, is less toxic, and exhibits a less expressed myorelaxant effect. It is often tolerated better by patients than other tranquilizers. It is used in neurosis, conditions of anxiety, fear, stress, trouble falling asleep, and psychovegatative disorders. The most common synonyms are nozepam and tazepam.

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...

Lactate Infusion Challenge

Lactate is metabolized to bicarbonate, resulting in a peripheral metabolic alkalosis, and bicarbonate in turn is metabolized to CO2, which stimulates both medullary chemoreceptors and the locus coeruleus, causing panic in vulnerable individuals. It has been suggested therefore that panic patients have enhanced sensitivity of ventral medullary chemoreceptors to fluctuations in pH and that panic attacks would result from the chemoreceptors' misperception of life-threatening central hypoxia and acidosis secondary to cerebrovascular vasoconstriction due to lactate-induced peripheral metabolic alkalosis (Carr and Sheehan 1984). Consistent with the assumption of locus coeruleus stimulation is the finding that clonidine partially attenuates lactate-induced panic (Charney et al. 1992). A comprehensive theory suggests that both CO2 (see Sect. 6 and lactate induce panic by triggering a suffocation false alarm in susceptible individuals with a hypersensitive suffocation detector (Klein 1993)....

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

Recreational Drugs America

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

Phenylalkylamine Spirits

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 &...

Endocannabinoids in the modulation of pain

Thermal hyperalgesia, an effect reversed by rimonabant (Richardson, Kilo et al., 1998). Interestingly, selective activation of cannabinoid CB2 receptors suppresses hyperalgesia evoked by intradermal capsaicin (Hohmann et al., 2002). Similarly, it was demonstrated that AM1241, a selective CB2 receptor agonist, dose dependently reversed tactile and thermal hypersensitivity produced by ligation of the L5 and L6 spinal nerves in rats (Ibrahim et al., 2003). These effects were antagonized by CB2, but not CBj, receptor antagonists AM1241 was also effective in CBj KO mice, suggesting the potential utility of selective CB2 receptor agonists for neuropathy (Ibrahim et al., 2003). Pain inhibition by activation of CB2 receptors that are not present in the brain is an attractive approach, as CB2 receptor agonists are not likely to produce the euphoria and high associated with marijuana smoking or the use of synthetic cannabinoids that activate the CBj receptors. It has been suggested that whereas...

Steps in Pain Perception

Los Receptores Cbj

There is a descending system of nerves through the spinal cord back to the dorsal horn cells which can inhibit or enhance the pain perceived. Various neurotransmitters are involved. Descending inhibition damps down incoming pain impulses, providing analgesia. It operates when, for example, someone is injured but feels no pain until away from the site of danger. Inhibitory signals travel from the brain down the spinal cord and damp down incoming pain impulses. Similarly pain may be increased. This is the mechanism by which for example, happiness or distraction will reduce pain, whilst depression, anxiety or sleeplessness will aggravate it.

Benzodiazepines Introduction One of

A group of structurally related drugs used mainly as sedatives hypnotics muscle relaxants, and anti-epileptics, and once referred to by the now-deprecated term minor tranquillizers . These agents are believed to produce therapeutic effects by potentiating the action of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter. Benzodiazepines were introduced as safer alternatives to barbiturates. They do not suppress REM sleep to the same extent as barbiturates, but have a significant potential for physical and psychological dependence and misuse. Short-acting benzodiazepines include halaze-pam and triazolam, both with rapid onset of action alprazolam, flunitrazepam, nitraze-pam, lorazepam, and temazepam, with intermediate onset and oxazepam, with slow onset. Profound anterograde amnesia ( blackout and paranoia have been reported with triazolam, as well as rebound insomnia and anxiety. Many clinicians have encountered particularly difficult problems on discontinuing...

Cholinergic Pathways And Function

Cholinergic Pathways The Brain

Figure 6.7 Cholinergic pathways, (a) Acetylcholine is found in intrinsic neurons within the striatum but the main pathways are the cortical projections from the nucleus basalis magnocellularis (BM) which also sends axons to the thalamus and amygdala. There are other projections from the medial septum (Ms) and the nucleus of the diagonal band, or diagonalis broco (DB), to the hippocampus and from the magnocellular preoptic nucleus (MPO) and DB to the olfactory bulb (OB). The DM and BM are sometimes referred to as the substantia inominata. Collectively all these nuclei are known as the magnocellular forebrain nuclei (FN). Other cholinergic nuclei are found more caudally in the tegmentum. The paramedian (or pendunculo) pontine tegmental nucleus (PPTN) sends afferents to the paramedian pontine reticular formation and cerebellum but more importantly to the thalamus (lateral geniculate nucleus) and the more cephalic cholinergic neurons in MPO. Activation of neurons in PPTN during REM sleep...

Anandamide And Oleamide

Drowsiness and sleepiness are commonly observed in the later stages of marijuana intoxication. Increased sleeping time and slow wave sleep have been recorded upon acute administration of A9-THC, the major psychoactive ingredient of marijuana (Paton and Pertwee, 1973 Pivik et al., 1972). Anandamide was shown later to increase slow-wave and REM sleep in rats at the expense of wakefulness (Murillo- Rodriguez et al., 1998), while, conversely, the CBX receptor antagonist SR141716A increased wakefulness at the expense of slow-wave and REM sleep (Santucci et al., 1996). These findings support a role for the endocannabinoids in sleep regulation.

Stimulants Relaxants Weight Control and Pain

Nervous Synapse

Although amphetamine may produce some positive reactions, these effects are clearly outweighed by the problems it causes, which include insomnia, nervousness, agitation, psychosis, and, at high doses, hyperthermia (overheating) and heart failure. Over the years, amphetamine use has resulted in a number of deaths in athletic competition. Danish cyclist Kurt Enemar Jensen and British cyclist Tommy Simpson died from amphetamine use during the Summer Olympics (1960 and 1967, respectively). Countless other athletes have collapsed in

The Lure Of The Mandrake

International Women Day

Mandrake, along with datura (jimson weed), deadly nightshade (belladonna) and henbane, (thorn apple), contains the powerful alkaloids scopolamine, atropine and hyoscyamine. Sometimes called the belladonna alkaloids, these drugs pack profound, otherworldly and unpredictable highs. People often experience the sensation of flying and hallucinations that can completely replace reality for extended periods of time, unlike the everchanging visual tricks that characterize the LSD trip. The main aphrodisiacal effect of these substances is that users become so tripped out, losing not only their inhibitions but their consciousness, that there is no chance of sexual resistance. They also stimulate the nervous system (it is not known precisely how), and the peak of the experience is'typically followed by a long period of stu pored but awake dreaming before a deep sleep sets in.

Soporific Agents Hypnotics and Sedative Drugs

Insomnia is a symptom, and its proper treatment depends on finding the cause of sleeplessness and treating the underlying etiology. The most common type of insomnia is transient insomnia due to acute situational factors. The typical factor is stress. Chronic insomnia is most commonly caused by psychiatric disorders. Numerous medical disorders can cause insomnia. Many drugs have been implicated as causing insomnia alcohol, antihypertensives, antineoplastics, -blockers, caffeine, corticosteroids, levodopa, nicotine, oral contraceptives, phenytoin, protriptyline, selective serotonin reuptake inhibitors (SSRIs), stimulants, theophylline, and thyroid hormones. The underlying cause or causes of insomnia should be treated whenever possible. The primary indication for use of hypnotic agents in patients with insomnia is transient sleep disruption caused by acute stress. Soporific agents are drugs that facilitate the development and normalization of sleep. However, sleep induced by the majority...

4-ho M1pt Drug Street Name

SYNTHESIS To a solution of 3.0 g 5-methoxy tryptamine (see under melatonin for its preparation) in 20 mL sulfolane (tetramethylenesulfone) there was added 8.2 g diisopropylethyl amine and 10.7 heated on the steam bath with frequent shaking. After 3 h, the mixture was brought back to room temperature and stirred vigorously for an additional 16 h. After the removal of all volatiles under vacuum, the residue (30 g) was diluted with 100 mL H2O, which gave a clear solution. The addition of 10 mL 5 aqueous NaOH produced a cloudy suspension that was extracted with Removing one of the N-methyl groups provides N-methyl-5-methoxytryptamine (5-MeO-NMT), which has its own entry. Removal of both methyl groups from the nitrogen gives 5-methoxytryptamine (5-MeO-T) which has been explored most extensively by Soviet researchers as a treatment for exposure to radiation this aspect of its action is discussed and expanded upon in the commentary under Melatonin. It is also known by the trade name Mexamine...

Deatf and Rebirtl in Santo Daime

Santo Daime

Shortly before leaving for an expedition to South America to participate in some sessions with the UDV (Uniao do Vegetal), I was told that a new female acquaintance, R., would be joining us. I was not pleased to hear this news. R. was recently unattached and alluring. I was encountering ambivalence about my marriage, but not to the point of wanting to leave my family. R. had apparently decided one week before our departure that she wanted to accompany me on the journey. Before informing me of this, she had purchased her ticket. The day to leave came. We traveled together to South America, to the distant Amazon. Culture shock, sleep deprivation, the excitement of our mission. Opportunities to join in ceremonies employing ayahuasca, freshly prepared from local rain forest flora. R., filled with enthusiasm, embracing our vision, bonding with our hearts.

Mental Health Problems Associated With Mdma

Like other mind-altering drugs, MDMA was perceived as one with few adverse effects when it was first introduced. However, as its use spread from psychotherapy into the general community, it became linked with a variety of mental health problems. When MDMA was used as an aid to psychotherapy in the late 1970s, therapists characterized the effects as feelings of empathic understanding for others and a release of emotions. Since then, however, there have been reports of confusion, anxiety, amnesia, panic attacks, depression, mania (excessive excitation), suicide, insomnia, nightmares, depersonalization (feeling unreal), derealization (feeling that the surroundings are unreal), hallucinations, flashbacks, post-traumatic stress disorder (PTSD), paranoia and other persistent false beliefs, other types of psychosis, automatic or repetitive behavior, dissociative disorders, irritability and aggression with mood swings, tolerance, dependence, and increased risk of problems with other drugs...

Emotional And Psychosomatic Changes In The Postsession Intervals

Richard was a twenty-six-year-old student who had suffered for more than four years from severe unrelenting depression, and had made six serious suicidal attempts, one of them with rat poison. In addition, he had frequent attacks of free-floating anxiety, excruciating headaches, agonizing cardiac pains and palpitations, and severe insomnia. Richard himself related most of these emotional problems to disturbances in his sexual life. Although he had many friendly relationships with women, he was not able to approach them sexually and had never had sexual intercourse with a female. He tried to reduce his sexual tension by occasional masturbation however, this resulted in self-hatred and tormenting guilt feelings. At irregular intervals, he got involved in homosexual activities, always in the role of the passive partner. Although he could reach momentary satisfaction in these situations, the feelings of guilt associated with them reached seJf-destructive proportions. In the state of...

Enuresil Amfetamine sulfate Enuretine Phenobarbital Environmental Tobacco Smoke

Ephcodral Phenobarbital. Ephed-organidin Phenobarbital. Ephedhal Phenobarbital. Ephedra-phen Phenobarbital. Ephedral Phenobarbital. Ephedrine Mild, slow-acting drug used to treat moderate attacks of bronchial asthma and to relieve nasal congestion from hay fever or infection of the upper respiratory tract. Non-addictive, ephedrine may cause insomnia and restlessness. Ephedrine is obtainable from plants of the genus Ephedra, particularly the Chinese species Ephedra sinica, and it has been used in China for more than 5,000 years to treat asthma and hay fever. It is effective


6-Methoxytetrahydro-P-carboIine (6-MeO-THpC, pinoline) is a naturally occurring component of human blood and cerebral spinal fluid. Like 6-MeO-THH, it is readily formed from 5-methoxytryptamine, but with formaldehyde rather than with acetaldehyde. The levels have been found to be similar in schizophrenics and psychiatrically healthy patients, suggesting that it is not a factor in the chemistry of mental illness. It is a natural component of the human pineal gland and is quite effective in binding to serotonin sites in human platelets. It has been suggested that the balanced interplay between melatonin and pinoline in the manipulation of serotonin levels might be an explanation of the sleep dream state. The carbolines just might play an endogenous role in creating dreams, our asleep visual tripping. result of the removal of a molecule of water from melatonin, which is a major actor in the biochemistry of the pineal gland. It is also a pretty effective monoamineoxidase inhibitor. (with...

Methyl1 2Hbenzodiazepine14 one2

Chloral hydrate C2H3Cl3O2, Molecular weight 165.42. First synthesized in 1832 but was not introduced into medicine until 1869, when Mathias E.O. Liebreich discovered its effectiveness in inducing sleep. Chloral hydrate acts as a depressant on the central nervous system, with sedative effects similar to those of barbiturates. A therapeutic dose (500 mg to 1 g) produces a deep sleep lasting four to eight hours with few aftereffects, but habitual use of the drug results in addiction. Symptoms of overdose may include deep stupor, dilation of blood vessels, fall in blood pressure

Pathophysiology of the GABA System

If the balance between excitatory and inhibitory activity is shifted pharmacologically in favour of GABAergic transmission, then anxiolysis, sedation, amnesia and ataxia arise. On the other hand, an attenuation of the GABAergic system results in arousal, anxiety, restlessness, insomnia, exaggerated reactivity and even seizures. These pharmacological manifestations point to the contribution of inhibitory neurotransmission to the pathophysi-ology of brain disorders. A GABAergic deficit is particularly apparent in anx

Neurotransmitter Systems

Ips Drug Screening

(2) Augment, or more probably, break up thalamic-cortico synchrony and its tendency to promote slow-wave EEG activity and non-REM sleep. Whether this results in full arousal, or merely a temporary disruption of sleep to give REM periods without full awaking, will depend on the balance of inputs and the overall state of cortical activity. Studies of several animal species, ranging from rats to sheep, have shown that the release of acetylcholine (ACh) into cortical cups (see Chapter 4 and 6) is increased in proportion to cortical (EEG) activity, being maximal during convulsions and lowest under deep anaesthesia. These findings are consistent with evidence that cortical arousal (EEG desynchronisation) is increased by injection of ACh into the carotid artery of animals, or by direct stimulation of the ascending reticular system (ARAS), and that both these actions are blocked by the muscarinic receptor antagonist, atropine. It has even been shown in humans that REM sleep is induced by...

Investigating The Earths Alchemical Skin

Of the sleep cycle in which we dream - known as REM sleep - then we will subsequently have more dreams at some later time (known as the REM-rebound effect). And so if there are indeed dream-inducing chemicals like, for instance, DMT, then the brain would by necessity have to not develop tolerance to DMT since tolerance would stop dreams from taking hold. It is also the case that both dreams and DMT-induced visions are of a fairly similar nature. Both are conditions which, willy-nilly, an experiencer finds themselves utterly involved in.

Tolerance and Dependence

The extreme fatigue, excessive sleeping, anxiety, insomnia, and depression that follow cessation of long-term amphetamine use are regarded as a bona fide withdrawal syndrome. It has not yet become apparent which aspects of this clinical picture may be shared by long-term users of high-dose Ecstasy. MDMA has an effect on dopaminergic systems that is similar to that of stimulants associated with dependency, and it activates dopamine-based pleasure systems in a manner resembling amphetamine and cocaine (Nichols and Oberlender 1989).

Name Of Sleeping Drug In Brain

Names Sleeping Pills

Figure 22.4 Idealised EEG-like patterns in sleep and waking. When we are awake and aroused the EEG is desynchronised (a). As we become drowsy and pass into sleep the EEG waves become more synchronised with 8-12 Hz alpha waves (b), sleep spindles then appear (c) before the EEG becomes even more synchronised with slow (about 1-2 Hz) high-voltage waves characteristic of deep slow-wave sleep (SWS). About every 90 min this pattern is disrupted and the EEG becomes more like that in arousal (d) except that the subject remains asleep. This phase of sleep is also characterised by rolling, rapid eye movements, the so-called REM sleep. SWS is consequently also known as non-REM sleep. These tracings have been drawn to show the main features of the different EEG phases of sleep and as such are much simpler than those that are actually recorded Figure 22.4 Idealised EEG-like patterns in sleep and waking. When we are awake and aroused the EEG is desynchronised (a). As we become drowsy and pass into...

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...

Barbiturates Complications

Barbiturates are central nervous system (CNS) depressants (downers). These drugs produce sedative, hypnotic, and anesthetic effects. Depending on the dose used, any single drug in this class may produce sedation (decreased responsiveness), hypnosis (sleep), and anesthesia (loss of sensation). A small dose will produce sedation and relieve anxiety and tension a somewhat larger dose taken in a quiet setting will usually produce sleep an even larger dose will produce unconsciousness. The sleep produced by barbiturates, however, is not identical with normal sleep. Normal sleep consists of several phases, including slow-wave sleep, or deep sleep, and rapid-eye-movement (REM) sleep. In the REM sleep phase, skeletal muscles relax, eyes move rapidly and frequently, and dreaming occurs. Dreaming is believed to play an important role in learning and memory. Barbiturates decrease REM (or dreaming) sleep, which may explain why the sleep associated with barbiturates is less restorative than...

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....

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