Other drugs for anxiety and insomnia

Various alternatives to the benzodiazepines are available as hypnotics and/or anxiolytics, although all have unwanted effects of their own. Antidepressants are often used to treat chronic anxiety or anxiety mixed with depression. Trimipra-mine, trazadone, and mirtazepine are suitable. Some immediate benefit may occur due to the sedative action, and gradual further improvement should follow over several weeks. Other options include beta-blockers such as propranolol, effective mainly for the physical symptoms of anxiety; antipsychotics such as chlorpromazine in low dose; antihistamines such as promethazine, and newer preparations such as buspirone.

For insomnia, long-established remedies include chloral hydrate and promethazine; newer drugs include zopiclone. Hypnotics are recommended for occasional use only; dealing with the cause of the insomnia is a better alternative to drugs. Causes include noise, discomfort, a restless partner, worry, shift work, travel, excess alcohol or caffeine intake, or unrealistic expectations about the amount of sleep required.

Barbiturates, once widely used as hypnotics and anxiolytics before benzodiaz-epines became available, are now obsolete as psychotropic drugs because of the high risk of dependence and high toxicity in overdose.

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