Give me a list of non sedating anxiety medications
Treating depression without addressing comorbid insomnia will not only decrease the effectiveness of treating the depression, but contribute to its relapse (Roth T, an episode of anxiety.A large European study of 14,915 people showed that it was more common for a period of insomnia to come before a depression (41%), as opposed to depression preceding insomnia (29%).Mirtazapine often causes too much weight gain to be useful for the long-term.Some of the antipsychotics, especially quetiapine (Seroquel) and olanzapine (Zyprexa), are also sedating and are often used off-label to manage insomnia—but given their high expense and risk of sometimes significant weight gain, hyperglycemia, tardive dyskinesia, and EPS, they are best reserved for the toughest cases.SSRIs are particularly effective for obsessive-compulsive disorder and post-traumatic stress disorder.SNRIs are generally recommended for anxiety disorders.
Trazodone’s long half-life (mean of seven to eight hours) is helpful for keeping patients asleep all night, but can lead to next day sleepiness.If your patient does respond well to diphenhydramine, recommend the solo preparation rather than the combination with acetaminophen or ibuprofen, which have their own side effects. Surprisingly to many, only five older benzodiazepines are formally FDA approved for insomnia: flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), estazolam (Prosom), and quazepam (Doral).With the exception of temazepam, these medications are no longer commonly prescribed.Ramelteon may also be a safer choice for older patients (Srinivasan V et al, 2010;27(11):796–813).Ramelteon doesn’t deliver the expected “kick” of a sleeping pill, and some patients do not feel it is as effective as a benzodiazepine or non-benzodiazepine hypnotic.
These medications can take 4 to 6 weeks to begin working.