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Few who aren’t themselves in pain may realize what harm such articles are doing to tens of millions of people.

In March of this year, the US Centers for Disease Control released “voluntary guidelines” on prescription of opioid medications to adults with chronic non-cancer pain.

Because of the complexity of serotonin involvement in sleep-wake regulation, drugs that modulate serotonin activity can produce prominent and sometimes diverse effects on sleep.

Some patients who took fluoxetine reported insomnia as an adverse effect, whereas other patients experienced daytime somnolence.

In polysomnographic studies, tranylcypromine has been demonstrated to prolong sleep onset latency and increase awakenings and arousals during sleep.

Phenelzine is more typically sedating and is less frequently associated with complaints of insomnia.

In recent years, clinicians have scaled down the dosages of these antidepressants to well below established ranges to treat insomnia symptoms.

Pharmacologically, the TCAs noted for their sleep-enhancing effects are more potent in blocking the serotonin transporter than the norepinephrine transporter, in addition to exerting prominent blockade of histamine HDoxepin has been studied at very low dosages in patients with primary insomnia.

Be mindful that treatment of a patient with depression may produce significant improvement in symptoms of depression in general, yet may not address insomnia. Many psychiatric disorders are accompanied by disturbance of sleep.In addition to resolving sleep-related symptoms through their primary therapeutic effects, many psychiatric medications have secondary effects on sleep that can contribute to their overall therapeutic benefit or sometimes counter them through adverse effects.Much has been written lately about an “epidemic” of opioid overdose deaths, in some cases advocating for a blanket reduction in the availability of prescription opioids.Regrettably, many readers will not penetrate beneath the sensational headlines to grapple with the complicated realities of this issue.

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