Why Is It Important To Treat Insomnia
Sleep plays a number of important functions in your health. It helps you learn and form new memories, and it removes toxins from your brain that build up while youre awake. After a sleepless night, it can be harder for you to concentrate on work or school, and youre more at risk for accidents or injuries.
In addition to increasing your risk for anxiety disorders or making them worse, lack of sleep or poor sleep over a long period of time can increase your risk for a number of health problems, including:
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Heart disease
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Obesity
In short, sleep is vital to your physical and mental health. Besides helping to improve your anxiety, a regular good nights sleep can make you feel more alert and refreshed, and help you function well in everyday life.
Using Antidepressants For Anxiety And Depression
It should be mentioned that SSRI antidepressants are a great first-line treatment option for people with anxiety and comorbid depression and individuals with depression and comorbid anxiety. Although most doctors will simply throw SSRIs at you if you mention anxiety and depression, they may tweak treatments based on whether you are experiencing more anxiety than depression or vice versa. Below are various scenarios of how a person may be affected by anxiety.
Anxiety with comorbid depression: In this diagnosis, a person is primarily dealing with anxiety. The anxiety may be causing them to feel depressed and/or may be significantly more problematic than the depression. In this case, treating the anxiety may help the depression. In other cases, both the anxiety and depression need to be targeted.
Depression with comorbid anxiety: In this diagnosis, a person primarily is dealing with major depression. The depression could be causing them to feel anxiety and/or may be significantly more problematic than the anxiety. In this case, treating the depression may help the anxiety. In other cases, a doctor may need to target the depression and the anxiety for a person to feel relief.
Pure anxiety: For individuals with pure anxiety, it may be better to pursue anxiolytics prior to using antidepressants. If you get no relief from any drugs that your psychiatrist prescribes, you may get put on a benzodiazepine.
How To Cope With Side Effects
What to do about:
- feeling sleepy or tired take trazodone in the evening and cut down the amount of alcohol you drink. If you take trazodone twice a day, talk to your doctor. Feeling sleepy should become less of a problem after a few days as your body gets used to the medicine. In the meantime, do not drive or use tools or machinery if you’re feeling this way.
- headaches make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if the headaches last longer than a week or are severe.
- feeling sick try taking trazodone with or after food to see if that helps. It’s best to avoid rich or spicy food while you’re taking this medicine.
- constipation eat more high-fibre foods, such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or another non-alcoholic liquid every day. If you can, it may also help to do some exercise. Watch a short video on how to treat constipation.
- a dry mouth chew sugar-free gum or sugar-free sweets.
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Types Of Antidepressant Medications
There are several classes of antidepressants within each class there are many individual medications. While all antidepressants work well overall, no drug or type of drug works equally well for everyone who takes it. You may be advised to try more than one type of antidepressant or to use a combination of antidepressants to seek relief from your distress.
The different types of antidepressants are listed in the order in which they are most commonly prescribed. Medications are referred to in two ways: by their generic name and by their brand or trade names. Brand names available in Canada appear in brackets.
SSRIs
This group of drugs, including fluoxetine , paroxetine , fluvoxamine , citalopram , escitalopram and sertraline , is usually the first choice for treatment of depression and anxiety disorders. These medications are known to have milder side-effects than some other antidepressants. Buspirone is similar to SSRIs and has been found to help with anxiety but not depression.
Common side-effects include nausea, vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation and a decrease in sexual desire and response. This group of drugs may also cause a jittery or restless feeling and sleep difficulties, such as problems falling asleep, waking in the night, vivid dreams or nightmares.
SNRIs
NDRIs
Common side-effects are jitteriness and insomnia.
NaSSAs
Common side-effects are drowsiness and weight gain.
Nonselective cyclics
MAOIs
How Antidepressants Are Thought To Work
Chemicals like serotonin, norepinephrine and dopamine are naturally present in our bodies. They are needed for normal brain function. In people with depression, it is thought that there may be an imbalance of these chemicals in the brain. Antidepressants are believed to work by bringing one or more of these chemicals back into balance.
There are many types of antidepressants on the market. Talk to your health care provider to see if taking antidepressants is the best choice for you, and if so, which one you should take.
Many people see an improvement with the first antidepressant they use. But you may need to try another type, a higher dose or a combination of drugs to find what works best for you. Also, it may take up to a month to notice the full benefit of the drug.
Even once you start to feel better, keep taking the antidepressant as directed by your health care provider. Most people take antidepressants for at least 6 to 12 months, and some for longer. Make sure you talk to your health care provider before you stop using yours.
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How Are Sleep And Depression Linked
Sleeping too much or not sleeping at all can be a sign of depression. These sleep problems alone are not the same thing as depression, but they can be one of its important symptoms.
Depression is a mood disorder that is characterized by sadness or feeling blue along with a series of physical symptoms such as low energy, disrupted sleep, and appetite changes. Nearly everyone feels normal sadness or feels down from time to time. Sometimes, however, the sad feelings become intense, last for long periods of time, and involve other physical symptoms that prevent a person from leading a normal life. These feelings often lead to a medical diagnosis of clinical depression.
Lack of sleep caused by another medical illness or by personal problems can also lead to daytime fatigue and make diagnosed depression worse.
An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed.
Best Ssris For Anxiety Include: Paxil Lexapro Zoloft
Below is a list of various SSRIs that have been used specifically for the purpose of treating anxiety. Although Paxil, Lexapro, Zoloft, and Luvox are the only ones FDA approved for various types of anxiety, others have been found effective as well. Additionally it should be mentioned that the SNRI drug Effexor is also approved to treat anxiety.
SNRI: This class of drugs works by inhibiting the reuptake of both serotonin and norepinephrine in the brain. The serotonin reuptake inhibition can create a sense of anxiety, but the norepinephrine reuptake inhibition can actually increase anxiety. For this reason, SNRIs are not as commonly used to treat anxiety disorders. Of all SNRIs, the drug Effexor is the only one that is approved to treat generalized anxiety disorder.
- Effexor : This is the only SNRI approved to treat generalized anxiety disorder. It is likely effective due to the fact that it acts on serotonin significantly more than other SNRIs. The ratio of serotonin to norepinephrine reuptake inhibition is approximately 30:1. Most other SNRIs have ratios 10:1 or less in favor of serotonin.
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Time It Right To Avoid Adverse Effects
Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.
Determining if you should take your antidepressant at night or in the morning depends on the specific medication you’re taking, its side effects, and how it influences your quality of life. Often, the decision comes down to which side effects are associated with the medication you’ve been prescribed and how it affects you personally.
For example, if your doctor has prescribed you Prozac , some of the most common side effects include insomnia, feeling agitated, nausea, and vomiting. Not everyone experiences these effects as medications can affect each person differently.
Your doctor can help you better understand your potential side effects and when to take the medication to best avoid them. Additionally, here is a quick cheat-sheet as to when it may be best to take your antidepressant based on the side effects you are having.
| Timing Suggestions Based on Side Effect |
|---|
| Side Effect |
| Morning |
Learn More About Treating Anxiety
Anxiety disorders are extremely common, with data from the National Institute of Mental Health indicating that an estimated 31.1 percent of American adults will experience an anxiety disorder at some point in life.
Our guide to coping with anxiety goes into more detail about the treatments that are available for anxiety disorders, from cognitive behavioral therapy to meditation and more.
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Antidepressants For Anxiety: What Medication Options Exist
Medically reviewed by Kristin Hall, FNP
If youve been diagnosed with an anxiety disorder, your healthcare provider may recommend one of several medications, including anti-anxiety medications, beta-blockers and, for certain types of anxiety, antidepressants.
Although antidepressants are typically viewed as treatments for depression, several modern antidepressants are approved to treat anxiety disorders such as generalized anxiety disorder and panic disorder.
Below, weve explained how antidepressants may help to treat anxiety, as well as the specific antidepressants your healthcare provider may prescribe if you have an anxiety disorder.
Weve also discussed how long it usually takes for anxiety to improve, the side effects you may experience while using antidepressants to treat anxiety and more.
But Treating Anxiety Is Within The Reach Of Many
Many people report experiencing a great deal of benefit from antidepressants for their anxiety. However, because individuals given placebos experience a similar benefit that was almost 80 percent as effective, most of their improvement is not due to the specific ingredients in the drugs. Notably, people who receive placebos fare much better than those given no treatment at all, such as individuals on waiting lists to be enrolled in the clinical trials.6 These findings indicate that taking action to enroll in a treatment program and participating in some type of intervention may be therapeutic in itself. The belief that an individual is receiving treatment is a major component of symptom relief. The specific chemicals in the drugs may be less responsible for the improvement, and these drugs come with risks.
Our study demonstrates that paroxetine provides only a modest benefit in treating anxiety. We believe that this benefit is not large enough to justify SSRI use for anxiety, given the risks associated with the medication. For individuals looking to take control of their anxiety, it is important to understand the limitations of antidepressants and to know that other options are available. Talk with your doctor about psychotherapy and other treatment options that could be well suited to you and your symptoms.
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How Does Anxiety Cause Insomnia
Anxiety can disrupt sleep in a few ways.
The nighttime hours are quieter and there isnt as much going on, which gives you more time to think. You may focus on fears or other things in your life that are bothering you, which can make it hard to relax and fall asleep.
In addition, researchers believe that anxiety can cause you to have a number of false alarms of danger throughout the day. These episodes can lead to a state of feeling on edge, which can make it harder to fall and stay asleep.
Some people may also fear falling asleep, which is known as somniphobia. They may be scared of having nightmares, dying in their sleep, or sleep paralysis . Somniphobia can lead to sleep loss, extreme tiredness, and problems doing everyday activities.
What Is The Relationship Between Anxiety And Sleep
Serious sleep disturbances, including insomnia, have long been recognized as a common symptom of anxiety disorders. People who are plagued with worry often ruminate about their concerns in bed, and this anxiety at night can keep them from falling asleep.
In fact, a state of mental hyperarousal, frequently marked by worry, has been identified as a key factor behind insomnia. People with anxiety disorders are inclined to have higher sleep reactivity, which means they are much more likely to have sleeping problems when facing stress.
Sleeping difficulties have been found for people with various types of anxiety including generalized anxiety disorder, OCD, and PTSD. In several studies, over 90% of people with PTSD associated with military combat have reported symptoms of insomnia.
Distress about falling asleep can itself complicate matters, creating a sleep anxiety that reinforces a persons sense of dread and preoccupation. These negative thoughts about going to bed, a type of anticipatory anxiety, can create challenges to healthy sleep schedules and routines.
Related Reading
At the same time, strong evidence indicates that sleeping problems are not only a symptom of anxiety. Instead, sleep deprivation can instigate or worsen anxiety disorders. Researchers have found that people who are prone to anxiety are especially sensitive to the effects of insufficient sleep, which can provoke symptoms of anxiety.
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Personal Opinion: When To Use Antidepressants For Anxiety Disorders
It is highly debatable as to whether antidepressants should be considered first-line treatments for anxiety. There are people that are in favor of antidepressants because they believe benzodiazepines are dangerous, while there are other people that believe antidepressants end up creating more problems over the long-term than a benzo. Most professionals will not hesitate to recommend antidepressants as a safe first-line treatment option for anxiety.
I believe that certain medications like Buspar and Clonidine for anxiety are superior to antidepressants in managing pure anxiety if they work. When it comes to treating anxiety, it is always best to start with medications that are specifically created for treating anxiety and not necessarily depression. I have personally used Clonidine for anxiety and found it to be a pretty effective option for generalized anxiety symptoms. Additionally it doesnt seem to impede my focus like a benzodiazepine would nor did it affect my mood like an antidepressant.
Buspar is also relatively safe and is a non-benzodiazepine medication that has been approved specifically for anxiety. If you have just anxiety without depression, you may want to consider taking a medication specifically created for anxiety as opposed to an antidepressant. Why? Because over the long-term, using antidepressants can create a chemical imbalance and may even make you depressed.
Side Effects Of Antidepressants
All drugs, including antidepressants, have some risk of side effects, even if you use them as directed. For most people, these side effects are usually temporary and manageable. But some may be serious.
If you have a side effect that bothers you, or you experience something unusual, talk to your health care provider about what to do. You can also report side effects to Health Canada toll-free at 1-866-234-2345 or online at MedEffect.
Family members should closely watch patients for any new or worsened mood or behaviour problems, such as unexpected hostility, agitation or anxiety. This is especially important in the first few weeks after a patient starts an antidepressant.
As a patient, it is also very important to follow up regularly with your health care provider and keep talking about how you are feeling.
More information on the potential side effects of a drug is available in its official Canadian “product monograph,” which contains important prescribing and safety information for health professionals and patients. Product monographs are available by searching Health Canada’s Drug Product Database.
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Talk Therapy A Good Investment Our Survey Finds
Talk therapy offers two advantages over medication: no drug side effects and tools you can use for the long term.
“When you take medication, you stop the medication and the problem may come back,” says Michael First, M.D., professor of clinical psychiatry at Columbia University. “When you have a run of cognitive behavioral therapy, you actually learn a skill. It’s something that sticks with you.”
Going to therapy requires a time commitment, and the insurance claims process might be more cumbersome than with medications. Still, if your plan will pay or you can swing the out-of-pocket portion of the cost, our survey suggests it’s an investment worth making. Of the respondents who visited a mental-health professional for talk therapy, either alone or in conjunction with taking medication, 46 percent said the therapists had made things “a lot better” and 45 percent said they had made things “somewhat better.”
That finding was consistent regardless of whether the person had seen a psychologist, a social worker, or a licensed counselor. Helpfulness scores were somewhat higher for people who had seen a psychiatrist, a medical doctor who can prescribe medication. Of patients who went to psychiatrists, 59 percent received some talk therapy, usually in combination with medication the rest got only meds. In two states, appropriately trained psychologists have a limited authority to prescribe medications, but in general psychologists typically specialize in talk therapy.
What to do
