Depression is a common medical issue that affects people of all ages. Ladies are more prone to depression than men, owing to hormonal differences and genetic predispositions. In order to combat depression, thorough clinical assessment, diagnosis, and management are required. Antidepressants are used as pharmacological therapies, whilst non-pharmacologic techniques include electric convulsion induction, psychotherapy, vagus nerve stimulation, and transcranial magnetic stimulation (American Psychiatric Association, 2010). To establish remission, psychotherapy can be used in conjunction with drugs.
Serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), bupropion, and mirtazapine are used to treat depression (American Psychiatric Association, 2010, p. 17). Examples of selective serotonin reuptake inhibitors include drugs like fluvoxamine, fluoxetine, citalopram, and paroxetine. Serotonin-norepinephrine reuptake inhibitors include duloxetine and venlafaxine. Alternatively, monoamine oxidase inhibitors (MAOIs) such as isocarboxazid can are used in unresponsive patients. Tricyclic antidepressants (TCAs) such as nortriptyline and amitriptyline are also used. Some patients have shown a preference for complementary and alternative therapies which include drugs like St. John’s wort and S-adenosyl methionine (SAMe) (American Psychiatric Association, 2010, p. 17).
Psychotherapy features in almost all management plans. Some of the specific therapies include 1) assessment of behavior and cognition; 2) interpersonal psychotherapy; 3) therapy involving psychoanalytical skills; 4) therapy involving problem-solving; 5) family therapy; and 6) group therapy (American Psychiatric Association, 2010, p. 47-49). Electroconvulsive therapy has shown to have the highest remission rate among all treatments with a 70% to 90% success rate (American Psychiatric Association, 2010). It can be done either unilaterally or bilaterally or unilaterally in the frontal and temporal regions. Antidepressants can also be administered alongside the therapy. Vagus nerve stimulation is recommended for chronic depression patients but not for acute cases (American Psychiatric Association, 2010, p. 46)
Withdrawal Symptoms for Benzodiazepine used to treat Insomnia
Short-acting benzodiazepines such as triazolam, alprazolam, estazolam and lorazepam can be used as hypnotic drugs for the treatment of insomnia due to their short elimination half-lives (Katzung, Masters, & Trevor, 2012, p. 376). Diazepam, a long-acting benzodiazepine, can also be used to treat insomnia. Withdrawal from the medication regimen causes a syndrome commonly referred to as benzodiazepine withdrawal syndrome. The symptoms occur due to the dependence developed by the body to the drugs. The most common withdrawal symptoms include 1) panic attacks; 2) sweating; 3) dryness of the mouth with nausea; 4) stiffness and muscle pain; 5) inability to concentrate; 6) weight loss; 7) tension and anxiety; 8) headaches; and 9) irritability (Petursson, 1994, p. 1456). Both the long acting and short acting benzodiazepines exert the above effects.
Seizures and psychotic episodes occur as a result of withdrawal from long-acting agents such as diazepam (Petursson, 1994, p. 1456). Benzodiazepines potentiate the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by binding to the A-subtype GABA receptor in the central nervous system (Katzung, Masters, & Trevor, 2012, p. 379). Withdrawal from the benzodiazepine will lead to increased neuronal activity in the CNS leading to spontaneous nerve firings. Such action potentials lead to seizures and body tremors.
Abrupt withdrawal of barbiturates also leads to insomnia and rebound anxiety. Patients who take the drugs with the primary role of treating insomnia experience normal sleep patterns during drug administration. After discontinuation of hypnotic treatment, rebound insomnia develops possibly due to the development of tolerance from continued use of the drugs (Petursson, 1994, p. 1457). Another effect of benzodiazepines, alongside sedation, is relief of anxiety. The use of the drug for hypnosis leads to alleviation of anxiety. Discontinuation of treatment results to rebound anxiety due to reduced GABA activity. Patients are advised to practice gradual withdrawal from benzodiazepines so as to reduce the withdrawal syndromes (Petursson, 1994, p. 1457).
References
American Psychiatric Association. (2010). Practice guidelines for the treatment of patients with major depressive disorder.
Katzung, B. G., Masters, S. B., & Trevor, A. J. (2012). Basic & clinical pharmacology. New York [u.a.:: McGray-Hill Medical.
Petursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89, 1455-1459.
