Benzodiazepine Hypnotics and Serotonergic Hypnotics
Comparison of Benzodiazepine Hypnotics and Serotonergic Hypnotics
Benzodiazepine hypnotics are a group of central nervous system depressants that induce feelings of sleep and drowsiness. Benzodiazepines work by facilitating the binding of gamma-aminobutyric acid (GABA) to various GABA receptors (Roehrs, T., & Roth, 2012). GABA is an inhibitory neurotransmitter whose occupation of receptors as agonists stops nerve activity. Occupation of the receptors also leads to opening of chloride ion channel. Benzodiazepine hypnotics are appropriate for treating primary insomnia (insomnia that is not associated with other co-morbid condition). These hypnotics are considered the first choice for treatment of insomnia but are associated with significant adverse effects and risk of dependency and tolerance. Recommended benzodiazepines like flurazepam, estazolam, triazolam and temazepam increase sleep time and enhance sleep quality by decreasing sleep-onset latency and wakefulness after sleep. Because dependence and tolerance happen with protracted use, these hypnotics are most beneficial for short-term treatment (Griffin, & Kaye, & Bueno, & Kaye, 2013). This means they are not useful when used in the long term such as a mother or more.
Like benzodiazepine, serotonergic hypnotic work to improve sleep quality. However, serotonergic hypnotics treat depression-induced insomnia and insomnia produced by selective serotonin and serotonin-norepinephrine inhibitors (SSRIs) (Ensrud et al., 2012). Treatment of co-morbid insomnia require a combination of hypnotics and thus serotonergic hypnotics are used in combination with other medications. Serotonin is a neurotransmitter substance that regulate sleep and wakefulness, contribute to depression, cognition, pain, and circadian rhythm. Serotonergic hypnotics improve insomnia symptoms, sleep quality, and mood. The work by selectively inhibiting uptake of serotonin. Examples of these drugs include paroxetine, fluoxetine, and citalopram. Many studies indicate that treatment of insomnia with serotonergic hypnotics at standard clinical doses may improve sleep quality otherwise lower or high doses disrupt sleep. Additionally, complaints of daytime somnolence and insomnia have been reported in depressed patients being treated with these medications (Wichniak, Wierzbicka, Walęcka, & Jernajczyk, 2017). Serotonergic hypnotic may cause adverse side effects for persons who are not tolerant such as headache, dizziness, nervousness and drowsiness.
References
Ensrud, K.E, et al. (2012). Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial. Menopause, 19(8):848-855.
Griffin, C.E., & Kaye, A.M., & Bueno, F.R., & Kaye, A.D. (2013). Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects. The Ochsner Journal, 13(2); 214-223
Roehrs, T., & Roth, T. (2012). Insomnia pharmacotherapy. Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics, 9(4), 728–738. https://doi.org/10.1007/s13311-012-0148-3
Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of Antidepressants on Sleep. Current psychiatry reports, 19(9), 63. https://doi.org/10.1007/s11920-017-0816-4
