Speed ??of onset of sleep is determined ...

Rapid onset of sleep by the rate of absorption. High-speed suction out some drugs benzodiazepine (flunitrazepam, triazolam), third-generation drugs zopiclone and zolpidem. Hypnotics of third generation can be taken immediately before bedtime in the elderly and the elderly requires great care appointment of combined preparations containing benzodiazepines and barbiturates (reladorm) in connection with the risk of breathing during sleep. Benzodiazepine tranquilizers nocturnal exhibit clearly pronounced dose-dependent effect. In this case, the minimal therapeutic dose provided primarily protivotrevozhny effect, and actually soporific effect occurs with increasing dose. This property of drugs of this group guards against the development of drug dependence. The greatest risk of dependence is observed in the application of clonazepam, which at the same time has the most pronounced soporific effect. It is believed that this addiction to drugs, which so often afraid of the patients and physicians is rare and usually occurs among patients who use alcohol and drugs. Duration of hypnotics is determined by various factors, including the clinical situation, the term onset of effect, tolerability. Clinical recommendations are usually limited to 23nedelnomu receive the drug in the form of a course of treatment with a daily appointment. In the presence of a positive effect appropriate to continue therapy with dose reduction by half. In the case of persistent hypnotic effect of the drug recommended a transition to intermittent use of the drug on separate days. In the absence of the effect of therapy can change to another drug in the same group or the appointment of agents of another generation. Abolition of the drug should be made gradually over a period of 12 months by reducing the dose. At lower doses of the drug should pay attention to non-medicated hygiene, psychotherapy and other methods. Often the drug can be administered for a long time (more than one month) in the minimal therapeutic dose, which, as experience shows, does not lead to the formation of dependence. When selecting the drug, taking into account the clinical situation must be borne in mind that benzodiazepine drugs should be used with caution in patients with a chronic respiratory failure, sleep apnea syndrome, pregnant and lactating women, patients with chronic alcohol intoxication. Absolute contraindications to benzodiazepines is myasthenia gravis and various myasthenic syndrome. Published with permission from Russian Medical Journal.

Pirazidol in the treatment of depression. Positions are saved

MD NM Mikhailov, MD TM Siryachenko Research Center of Mental Health, RAMS, Moscow In the second half of last century the problem of depression has become a key not only in psychiatry, but more and more attention has been paid to depression in general somatic practice.