Anxiolytics and hypnotics

Meet the patient

A 41-year-old man with generalised anxiety disorder has been taking zopiclone nightly for three years on repeat telehealth scripts, with alprazolam "for the bad days". He wants the dose increased because neither works the way it used to.^[1][3][28]

His partner mentions, almost apologetically, that twice he has got up in the night, eaten in the kitchen and remembered none of it. He drives to work at 6am.^[28][7]

Three examiner questions are already live: which receptor is each of those tablets actually hitting?, why has tolerance outrun the anxiolysis?, and what treats his anxiety when the GABAergic bridge comes down? The rest of this topic answers them.^[1][13][22]

Fellowship language here is concrete: half-life maps, agent-level doses, written exit plans, Beers-listed elderly harm, and knowing when not to reach for alprazolam. Long-term anxiety control is SSRI/SNRI plus psychological therapy; GABAergic drugs are bridges, crisis tools or specialised exceptions — never lifestyle maintenance.^[13][14][5]

References28ShowHide

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