During the 1960s benzodiazepines were routinely used as hypnotics (e.g. nitrazepam and temazepam), and anxiolytics (e.g. diazepam and chlordiazepoxide). The Committee on Safety of Medicines have advised that benzodiazepines are indicated for the short-term relief of anxiety that is severe, disabling, or subjecting the individual to unacceptable distress. By short term, the Committee on Safety of Medicines mean a total time period of 2-4 weeks. They also advise that benzodiazepines should only be used to treat insomnia when it is severe, disabling, or causing extreme distress. Again, only short-term use should be made of benzodiazepines as hypnotics.

Since benzodiazepines may cause dependency, withdrawal needs to be gradual; a withdrawal syndrome may occur as long as 3 weeks after stopping the drug. Benzodiazepines also adversely impair the individual’s ability to operate machinery or drive. They may also, paradoxically, cause increased aggression and hostility.

The following 3 newer hypnotics are less likely to cause dependency than benzodiazepines, and may be used for the short-term relief of insomnia:

This is an azaspirodecanedione which acts as a central 5-HT1A partial agonist and may be used in the short-term treatment of anxiety. Its main sideeffects are dizziness, headache, light-headedness, excitement, and nausea.

Beta-blockers, such as propranolol, block peripheral beta-adrenergic receptors (for instance in the heart and peripheral vasculature). They are occasionally used in clinical psychiatric practice to treat anxiety symptoms, but do not help directly address the psychological symptoms of anxiety, such as fear.

These are only extremely rarely used these days, e.g. to treat severe intractable insomnia in those patients who are already on such treatment.

These are used mainly for the treatment of ADHD (or related hyperkinetic states) or sleep disorders (such as narcolepsy). They should be initiated only by specialists in child and adolescent psychiatry, in adult ADHD, or in sleep disorders.