Prescription Alternatives
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Doxylamine (Unisom Nighttime)
What Do They Do in the Body? These drugs contain antihistamines, which cause sleepiness. Some contain pain relievers to help those in pain to sleep.
What Are They Used For? Relief of insomnia and pain. More than 30 percent of adults use nonprescription drugs to help them sleep.
What Are the Potential Side Effects? Dry mouth and throat, constipation, ringing in the ears, and blurred vision may occur. In older men, prostate enlargement and difficult urination can be side effects of these drugs. Elderly people are prone to other side effects such as delirium, excitement, nervousness, and agitation.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have asthma, chronic lung disease, glaucoma, or prostate gland enlargement.
• You still need them after two weeks. (Look for the underlying cause.)
Never use over-the-counter sleep aids for more than two weeks at a time.
Avoid driving or other hazardous tasks requiring coordination or dexterity while using these medications.
Be Aware. Any sedating drug will add to the depressant effects of sleeping pills. Avoid using prescription sedatives and alcohol with doxyla-mine or diphenhydramine.
Antianxiety Drugs
The “benzos” are divided into two subclasses: the hypnotics (sleep-inducing) and the anxiolytics (anxiety-reducing). Hypnotics are shorter-acting than anxiolytics—their effect is more intense and lasts for less time—and are usually the choice for treating insomnia. Withdrawal symptoms between doses and cravings for the next dose are more likely with short-acting versions. All benzodiazepine generic names end in -pam or -lam.
Examples of Hypnotic and Anxiolytic Benzodiazepines
Hypnotic benzodiazepines: brotizolam (Lend-ormin), estazolam (ProSom), flunitrazepam (Rohypnol, Hypnodorm), flurazepam (Dal-mane), loprazolam (Dormonoct), lormetazepam (Loramet), midazolam (Versed, Dormicum), nimetazepam (Ermin), nitrazepam (Alodorm, Mogadon), temazepam (Normison, Restoril), triazolam (Halcion)
Anxiolytic benzodiazepines: alprazolam (Xanax), bromazepam (Lexotan, Lexotanil), chlordiazepoxide (Librium), clonazepam (Klonopin, Rivotril), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan, Tavor, Temesta), oxazepam (Serax, Serepax), prazepam (Centrax, Lysanxia)
What Do They Do in the Body? We don’t have an in-depth understanding of how these drugs work, but we do know that they affect the action of neurotransmitters in the brain, bringing about relaxation and decreased anxiety.
What Are They Used For? Small doses quell anxiety. Often, they are prescribed in tandem with antidepressants to reduce the anxiety that the antidepressant drugs may cause. In higher doses, benzodiazepines are prescribed as sleep aids. Benzodiazepines are also used as antiseizure and antiepileptic drugs, and as muscle relaxants. They may be given right before an unpleasant medical procedure or as a preparation for more intense anesthesia before surgery. These drugs are also prescribed for irritable bowel syndrome, restless legs syndrome, nausea and vomiting caused by chemotherapy, panic attacks, depression, and premenstrual syndrome (Xanax), acute withdrawal from alcohol addiction, and chronic insomnia. They do not heal any of these health problems; they only temporarily relieve symptoms.
What Are the Potential Side Effects? Transient mild drowsiness in the first few days of use is common. This side effect may be more pronounced in the elderly or debilitated, who are more likely to experience loss of muscular coordination and confusion when starting out on a course of benzodiazepines.
Other possible side effects include sedation, depression, lethargy, apathy, fatigue, decreased activity, light-headedness, memory impairment, disorientation, amnesia, restlessness, confusion, crying, delirium, headache, slurred speech, loss of voice, stupor, seizures, coma, fainting, rigidity, tremor, abnormal muscle tone, vertigo, dizziness, euphoria, nervousness, irritability, difficulty concentrating, agitation, inability to perform complex mental functions, paralysis of half the body, unsteadiness, loss of coordination, strange dreams, glassy-eyed appearance, paradoxical reactions (increased anxiety or hyperactivity), behavior problems, hysteria, psychosis, suicidal tendencies, constipation, diarrhea, dry mouth, coated tongue, sore gums, nausea, changes in appetite, vomiting, difficulty swallowing, increased salivation, stomach inflammation, incontinence, changes in libido, urinary and menstrual problems, heart rhythm and blood pressure changes, cardiovascular collapse, retention of fluid in the face and ankles, palpitations, vision disturbances, twitching of the eyeballs, decreased hearing, nasal congestion, auditory disturbances, rashes, itching, hair loss or growth, hiccups, fever, sweating, tingling of the extremities, muscular disturbances, growth of breasts in males, milk production in the breasts of females, respiratory disturbances, increased levels of enzymes in the bloodstream indicating tissue damage, hepatitis or jaundice (both very rarely), changes in blood cell counts, decrease in body weight, swelling of lymph nodes, and joint pain.
CAUTION!
• Don’t take these drugs if you have a psychological disorder that doesn’t have anxiety as a prominent feature and is mainly manifested as depression.
• The long-term effectiveness (four months or more of treatment) of these drugs has not been assessed. Please don’t use these drugs long term.
• These drugs may cause drowsiness, so avoid driving or other tasks that require alertness.
• Dependency can occur in as little as two weeks. Withdrawal symptoms may include anxiety, sensory disturbances, sleeping too much, flulike symptoms, difficulty concentrating, fatigue, restlessness, loss of appetite, dizziness, sweating, vomiting, insomnia, irritability, nausea, headache, muscle tension or cramping, tremor, vocal changes, confusion, abnormal perception, depersonalization, muscle twitches, psychosis, paranoid delusions, hallucinations, memory impairment, and grand mal seizures. If you have been using benzodiazepines regularly for a couple of weeks or more, decrease the dosage gradually and carefully.
• Rarely, people have what are known as paradoxical reactions to benzodiazepines: instead of becoming calmer, less anxious, or more sleepy, they may become manic, angry, impulsive, anxious, or suicidal, or even display symptoms of schizophrenia. If symptoms like these emerge during benzodiazepine therapy, your medical team may want to see it as the emergence of a previously masked mental illness—but it may be simply a drug side effect.
• Alcoholics may be put at extra risk if they take benzodiazepines. A study published in the journal Behavioral Pharmacology found that when people who tend toward alcoholism take even low doses of a benzodiazepine, they tend to consume more alcohol.
• Use caution if you have liver problems or if you are elderly or debilitated; you may need a lower dose.
Be Aware. Benzodizepines can interact dangerously with many other drugs. Do not add a new drug without consulting a pharmacist or reading the drug information sheet.
Reportedly, the herb kava-kava can potentiate (increase) the intensity of a benzodiazepine’s effects—severely enough to lead to coma.
What Are the Interactions with Food? Don’t drink alcohol while using these drugs. Avoid charcoal-broiled foods, as they increase the rate at which this drug is emptied from your system. You can take benzodiazepines with water or food if stomach upset occurs, but this may slow down the absorption of the drug.
Antidepressant Drugs
Examples of Tricyclic Antidepressants
Nortriptyline (Pamelor)
Amitriptyline (Elavil)
Imipramine (Tofranil)
Clomipramine (Anafranil)
What Do They Do in the Body? They affect levels of the neurotransmitters serotonin, norepinephrine, and dopamine in the synapses between nerve cells.
What Are They Used For? Tricyclics are older drugs, first developed to treat depression. They can help relieve symptoms of anxiety disorders, including panic disorder and obsessive- compulsive disorder. They may also be used to treat attention-deficit/hyperactivity disorder (ADHD), chronic headache pain, diabe
tic neuropathy, cancer pain, and bed-wetting, and are sometimes prescribed for migraine prevention.
What Are the Potential Side Effects? Tricyclics have a long, long list of adverse effects, which is one reason they have been almost completely replaced for treatment of depression and anxiety with newer SSRI and SNRI drugs. These effects may include sedation; dry mouth; blurred vision; problems focusing; increased intraocular pressure that can lead to glaucoma; dilation of the pupils; constipation; dysfunction of parts of the small intestine; urinary problems; drastic dips in blood pressure when going from lying to sitting or from sitting to standing; high blood pressure; heart rhythm abnormalities; congestive heart failure (CHF); stroke; electrocardiogram changes (indicating damage to heart tissue); confusion (especially in the elderly); disturbed concentration; hallucinations; disorientation; impaired memory; feelings of unreality; delusions; anxiety; nervousness; restlessness; agitation; panic; insomnia; nightmares; mania; worsening of psychotic symptoms; drowsiness; dizziness; weakness; fatigue; headache; depression; excessive tension in the muscles or artery walls; sleep disorders; psychosomatic disorders; yawning; abnormal dreaming; migraines; depersonalization; irritability and mood swings; numbness; tingling; hyperactivity; lack of coordination; tremors; peripheral neuropathy; seizures; twitching; partial paralysis; allergic reactions, including rash, itching, and swelling; changes in blood cell counts; nausea; vomiting; loss of appetite; diarrhea; flatulence; trouble swallowing; strange taste in the mouth; increased salivation; abdominal cramps; inflammation of the stomach, throat, or esophagus; black tongue; indigestion; breast development in males; testicular swelling; breast enlargement; spontaneous flow of milk; vaginitis and menstrual difficulties in women; changes in libido; painful ejaculation; voiding of urine during the night; cystitis; urinary tract infection; changes in blood glucose levels; increased secretion of the hormones prolactin and vasopressin (antidiuretic hormone); pharyngitis; laryngitis; sinusitis; coughing; spasm of the airways; nose-bleed; shortness of breath; problems speaking; ringing of the ears; excessive tearing of the eyes; conjunctivitis; difference in the size of the pupils; inner ear inflammation; eye allergy symptoms; nasal congestion; excessive appetite; body weight changes; increased sweating; high body temperature; flushing; chills; hair loss; dental problems; abnormal skin odor; chest pain; fever; bad breath; thirst; back pain; and joint aches. In some people, tricyclic antidepressants cause increased sensitivity to the sun.
CAUTION!
Think Twice About Taking These Drugs If . . .
• You have recently had a heart attack. If you have any other heart problems, use extreme caution.
• You are taking an MAOI.
• You have any of the following health problems: seizure disorders, difficulty urinating, spasm of the urethra or ureter, angle-closure glaucoma (even the average dose can cause an attack of glaucoma and permanent loss of vision), high intraocular pressure, or high levels of thyroid hormone (hyperthyroidism), or if you are taking any kind of drug to regulate thyroid hormone levels, or kidney or liver disease. You should be closely monitored while taking tricyclics.
• You are taking anticholinergic drugs such as those prescribed for Parkinson’s disease. You may not react well to tricyclics, so use caution.
Your ability to drive and perform hazardous tasks may be impaired while using tricyclics. The symptoms of both manic depression and schizophrenia may be worsened by tricyclic antidepressants.
You should stop taking tricyclics for as long as possible before having elective surgery. Work with your doctor on this, though; don’t stop cold on your own.
If you develop a fever or sore throat while taking this medication, it may be an indication of a serious drug-related side effect.
Be Aware. When combined with cimetidine, methylphenidate (Ritalin), antipsychotic drugs, or calcium channel blockers, levels of tricyclic antidepressants in the bloodstream can rise to dangerous levels.
Drugs given to regulate heartbeat can interact dangerously with tricyclics, leading to potentially fatal changes in heart rhythm. So can anti-psychotics and the antihistamines astemizole and terfenadine. Never mix tricyclics with alcohol, benzodiazepines, or barbiturates, as they will have additive effects.
Stopping these drugs suddenly can cause symptoms like nausea, dizziness, headache, lethargy, and flulike symptoms.
Suicidal thoughts or depression may get worse while you are taking tricyclics.
Examples of Monoamine Oxidase Inhibitors (MAOIs)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Isocarboxazid (Marplan)
What Do They Do in the Body? These drugs, which belong to the oldest existing class of antidepressant medicines, block an enzyme that breaks down the neurotransmitters serotonin, norepinephrine, and dopamine in the brain.
What Are They Used For? Treatment of panic disorder, social phobia, and depression.
What Are the Potential Side Effects? Because they cause a long list of potentially serious adverse effects, these drugs are not used unless others prove ineffective or inappropriate. They include drowsiness, constipation, nausea, diarrhea, stomach upset, fatigue, dry mouth, dizziness, low blood pressure, light-headedness, reduced urine output, reduced sexual function, sleep disturbances, muscle twitching, increased appetite, weight gain, blurred vision, headache, restlessness, shakiness, trembling, weakness, and sweating.
What Are the Interactions With Other Drugs? The MAOIs interact dangerously with a very long list of other medications. These interactions usually involve a spike in blood pressure or a spike in levels of serotonin great enough to cause a life-threatening “serotonin storm.” A partial list of medications that can have either or both of these effects when combined with MAOIs: desipramine, clomipramine, bupropion, SSRIs, trazodone, nefazodone, mirtazapine, venlafaxine, bronchodilating asthma inhalers, theophylline, terfenadine, dextromethorphan, oxymetazoline, phenylephrine, pseudoephedrine, dopamine, isoproterenol, metaraminol, carbamazepine, lithium, L-tryptophan, and methyldopa. Overall, any person taking an MAOI should never add a drug or herbal supplement without clearance from his or her psychiatrist and pharmacist.
When MAOIs are combined with insulin or hypoglycemic drugs, blood sugar may drop too fast.
Some blood-pressure-lowering drugs may cause pressure to fall too low when combined with MAOIs; others may cause it to rise too high.
When combined with alcohol, barbiturates, buspirone, or tranquilizers, MAOIs can have additive effects, causing extreme sleepiness.
What Are the Interactions with Food? MAOIs can be deadly when combined with foods that contain the amino acid tyramine. It interacts with MAOIs to cause a rapid, extreme spike in blood pressure, leading to severe headache, sweating, palpitations, and even heart arrhythmia, heart failure, or brain hemorrhage. Any person on MAOIs is best off avoiding alcoholic beverages entirely, as well as nonalcoholic beers and wines. Fava beans, cheeses (except for cream and cottage cheese), tofu, miso, aged meat, smoked fish, fermented fish, pickled fish, and other fermented soy products must also be avoided. Also not allowed are ginseng, meat extracts (as might be found in a seasoning packet), protein powders, avocado, soy sauce, sausage, bologna, pepperoni, salami, sauerkraut, shrimp paste, soups, and yeast. If you end up taking MAOIs, your doctor will give you a comprehensive list of foods to avoid.
Buspirone (BuSpar)
What Does It Do in the Body? It is not known exactly how buspirone works.
What Is It Used For? Treatment of anxiety.
What Are the Potential Side Effects? Buspirone may cause temporary or permanent damage to the nervous system. It can also cause drug dependence, sedation, and withdrawal reactions. Adverse reactions have included dizziness, drowsiness, restlessness, nervousness, insomnia, light-headedness, nausea, numbness, headache, fatigue, dream disturbances, tinnitus, sore throat, and nasal congestion. There are dozens and dozens of individualized side effects possible with this drug, most having to do with interference with or damage to the n
ervous system.
CAUTION!
Please think twice about taking this drug, period. There are too many other safer alternatives.
Examples of Selective Serotonin Reuptake Inhibitors (SSRIs)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac, Sarafem)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
What Do They Do in the Body? Neurons use a neurotransmitter substance called serotonin to relay messages through the nervous system. Researchers found that some people who suffer from depression have low levels of serotonin in their synapses. SSRIs inhibit the reuptake of serotonin and so allow more of it to remain in the synapses for a longer period. SSRIs also weakly inhibit the neuronal uptake of norepinephrine and dopamine, which also play a role in mood.
What Are They Used For? Depression (fluoxetine, paroxetine, sertraline, citalopram, escitalopram), generalized anxiety disorder (paroxetine, escitalopram), obsessive-compulsive disorder (fluvoxamine, fluoxetine, paroxetine, sertraline), bulimia nervosa (fluoxetine), panic disorder (sertraline, paroxetine), and premenstrual syndrome (fluoxetine, paroxetine, sertraline).
These drugs are also prescribed off-label for just about any ailment you can think of, for periods of time that extend far beyond what is known to be safe. According to a 2005 report published by the Medical Expenditure Panel of the Agency for Healthcare Research and Quality (AHRQ), 11 percent of noninstitutionalized women and 5 percent of noninstitutionalized men in the United States are taking an antidepressant.
While it’s true that a small number of people with serious psychological problems can benefit from the short-term use of these drugs, in the majority of instances they are used to treat people who are only mildly depressed, going through a tough time in their lives, or think their personality or feelings are somehow wrong and are improved on medication. General practitioners and ob-gyn physicians untrained in psychiatry are passing out prescriptions for these drugs without a second thought. Taking antidepressants for these reasons is the ultimate symptom of thinking we all should behave alike and be happy all the time.