Transcript
The first one we’re going to discuss is sleep disturbance or insomnia which is a common problem in people with GAD. There are multiple causes of insomnia. You can’t just assume it’s part of the GAD. Some of the treatments that we have actually worsen insomnia. So that may lead you to want to skip those options and consider other ones. For example, SSRIs and SNRIs generally are not effective for insomnia and may make it worse. Some 10% to 20% of patients given those products can have worsened or new onset of insomnia as a side effect.
Key Points
The key points probably are as follows. That insomnia is a symptom. It’s not a disease usually. So you have to consider the differential diagnoses in your GAD patients and treat accordingly. A second key point, avoid benzodiazepines in patients with anxiety who are substance abusers. Next, avoid antidepressants in bipolar patients with anxiety. And the final bullet point then on summarizing this node 2 is to use prazosin for PTSD-related sleep problems and daytime hyperarousal and irritability added to the antidepressants they’re on for their GAD for this comorbidity.
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