Sedative–hypnotic and Anxiolytic Drugs
The primary use of sedative–hypnotic and anxiolytic drugs is to encourage calmness (anxiolytics or sedatives) or to produce sleep (sedative–hypnotics). All people are subject to states of emotional tension and uneasiness. For otherwise healthy individuals, these occasions are usually sufficiently mild and short that pharmacological intervention is unnecessary. However, at times the symptoms of anxiety become quite discomforting and can interfere with a person’s ability to function effec-tively. Anxiety almost invariably accompanies many medical and surgical conditions, and it is often a symp-tom of psychiatric illness. When the symptoms become intolerable or interfere with the treatment of the un-derlying disease and if counseling is not sufficient, drug treatment can be considered as a means of helping pa-tients cope with their anxiety.
All central nervous system depressants have some ability to relieve anxiety. However, most of these drugs relieve symptoms of anxiety only at doses that produce noticeable sedation. Drugs used to produce sedation and relieve anxiety are consistently among the most commonly prescribed drugs. Whether they are pre-scribed too frequently remains a matter of controversy.
Insomnia includes a wide variety of sleep distur-bances, such as difficulty in falling asleep, early or fre-quent awakenings, and remaining unrefreshed after sleep. Use of sedative–hypnotic drugs is one approach to the therapy of insomnia. Other measures include ad-vice to avoid stimulants before retiring, maintenance of a proper diet, initiation of an exercise program, and avoidance of stressful or anxiety-provoking situations.
Most anxiolytic and sedative–hypnotic drugs pro-duce dose-dependent depression of central nervous sys-tem function. The ideal anxiolytic drug should calm the patient without causing too much daytime sedation and drowsiness and without producing physical or psycho- logical dependence. Similarly, the ideal hypnotic drug should allow the patient to fall asleep quickly and should maintain sleep of sufficient quality and duration so that the patient awakes refreshed without a drug hangover. Also, both types of drugs should have very low toxicity and should not interact with other medica-tions in such a way as to produce unwanted or danger-ous effects.