Successful treatment of switching from benzodiazepine to orexin receptor antagonists improves cognitive function in psychiatric disorders: four case reports

Abstract

Benzodiazepines are used in the treatmentof anxiety and insomnia. On the other hand, they not only have side effects such as drowsiness, poor concentration, and muscle relaxation but also persistent cognitive decline. Even if we try to reduce the dose of these drugs to improve drug-induced cognitive function, it is difficult to do so due to dependence and worsening insomnia. I report four cases in which cognitive dysfunction was improved by switching from benzodiazepines to orexin receptor antagonists (suvorexant and lemborexant ). Orexin receptor antagonists were effective to improve cognitive impairment. In cognitive dysfunction caused by benzodiazepines, switching to orexin receptor antagonists may be effective.

Contribution of changes in the orexin system and energy sensors in the brain in depressive disorder - a study in an animal model

“…Orexins A and B act via G-protein type 1 and type 2 coupled receptors (OxR1 and OxR2, respectively). Orexins are known to contribute to cognitive function [ 2 ] and the stress response [ 3 ]. A reduction in orexin system function in animal models of depression was observed in a model of endogenous depression in Wistar-Kyoto rats [ 4 ] and in a model of social stress [ 5 ].…”

Comparative efficacy and safety of suvorexant and lemborexant for insomnia treatment

“…Dual orexin receptor antagonists (DORAs), which have a mechanism of action that is not mediated by GABA receptors, were developed to address this issue. One study indicated that cognitive improvement was achieved after switching from benzodiazepine to DORAs 1 …”

“…One study indicated that cognitive improvement was achieved after switching from benzodiazepine to DORAs. 1 …”

Interplay of environmental and clinical factors in psychiatric disorders

“…In this journal, we recently reported and discussed the potential benefit of the newly available orexin receptor antagonists for insomnia (Albadrani et al ., 2023; Serretti, 2023). In this issue, a case report from Hori underlines the benefit of cognitive function after switching from benzodiazepines to the orexin receptor antagonists suvorexant and lemborexant (Hori, 2022). The results were interesting also because in two cases the benefit was observed when switching from eszopiclone, a Z-drug, which is known for a reduced potential impact on cognitive performance compared to benzodiazepines.…”