Sedative

A sedative or tranquilliser (or tranquilizer, see English and American spelling differences) is a substance that induces sedation by reducing irritability[1] or excitement.[2]

At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Doses of sedatives such as benzodiazepines, when used as a hypnotic to induce sleep, tend to be higher than amounts used to relieve anxiety, whereas only low doses are needed to provide a peaceful effect.[3]

Sedatives can be misused to produce an overly-calming effect (alcohol being the classic and most common sedating drug). In the event of an overdose or if combined with another sedative, many of these drugs can cause unconsciousness (see hypnotic) and even death.

Terminology

There is some overlap between the terms "sedative" and "hypnotic".

Advances in pharmacology have permitted more specific targeting of receptors, and greater selectivity of agents, which necessitates greater precision when describing these agents and their effects:

The term "chemical cosh"

The term "chemical cosh" (a club) is sometimes used popularly for a strong sedative, particularly for:

Types of sedatives

Therapeutic use

Doctors often administer sedatives to patients in order to dull the patient's anxiety related to painful or anxiety-provoking procedures. Although sedatives do not relieve pain in themselves, they can be a useful adjunct to analgesics in preparing patients for surgery, and are commonly given to patients before they are anaesthetized, or before other highly uncomfortable and invasive procedures like cardiac catheterization, colonoscopy or MRI. They increase tractability and compliance of children or troublesome or demanding patients.

Risks

Sedative dependence

Some sedatives can cause physiological and psychological dependence when taken regularly over a period of time, even at therapeutic doses.[5][6][7][8] Dependent users may get withdrawal symptoms ranging from restlessness and insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although physical dependence does not necessarily occur, particularly with a short course of use. In both types of dependences, finding and using the sedative becomes the focus in life. Both physical and psychological dependence can be treated with therapy. (see Sedative Dependence).

Misuse

Main article: Drug overdose
Further information: Combined drug intoxication

Many sedatives can be misused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative use due to their widespread recreational or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Some heroin users may take them either to supplement their drug or to substitute for it. Stimulant users may take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or when sedatives are taken with alcohol.

A study from the United States found that in 2011, sedatives and hypnotics were a leading source of adverse drug events (ADEs) seen in the hospital setting: Approximately 2.8% of all ADEs present on admission and 4.4% of ADEs that originated during a hospital stay were caused by a sedative or hypnotic drug.[9] A second study noted that a total of 70,982 sedative exposures were reported to U.S. poison control centers in 1998, of which 2310 (3.2%) resulted in major toxicity and 89 (0.1%) resulted in death. About half of all the people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs.[10]

There are also serious paradoxical reactions that may occur in conjunction with the use of sedatives that lead to unexpected results in some individuals. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis.[11]

Dangers of combining sedatives and alcohol

Further information: Combined Drug Intoxication

Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong depressant that slows brain function and depresses respiration, the two substances compound each other's actions and this combination can prove fatal.

Worsening of Psychiatric Symptoms

The long-term use of benzodiazepines may have a similar effect on the brain as alcohol, and are also implicated in depression, anxiety, posttraumatic stress disorder (PTSD), mania, psychosis, sleep disorders, sexual dysfunction, delirium, and neurocognitive disorders (including benzodiazepine-induced persisting dementia which persists even after the medications are stopped).[12][13][14] As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of serotonin and norepinephrine, are believed to be responsible for their effects on mood and anxiety.[15][16][17][18][19][20] Additionally, benzodiazepines can indirectly cause or worsen other psychiatric symptoms (e.g., mood, anxiety, psychosis, irritability) by worsening sleep (i.e., benzodiazepine-induced sleep disorder). Like alcohol, benzodiazepines are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep but, while asleep, the drugs disrupt sleep architecture: decreasing sleep time, delaying time to REM sleep, and decreasing deep slow-wave sleep (the most restorative part of sleep for both energy and mood).[21][22][23]

Amnesia

Sedatives can sometimes leave the patient with long-term or short-term amnesia. Lorazepam is one such pharmacological agent that can cause anterograde amnesia. Intensive care unit patients who receive higher doses over longer periods, typically via IV drip, are more likely to experience such side effects.

Disinhibition and crime

Sedatives — most commonly alcohol[24] but also GHB, Flunitrazepam (Rohypnol), and to a lesser extent, temazepam (Restoril), and midazolam (Versed)[25] — have been reported for their use as date rape drugs (also called a Mickey) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. These drugs are also used for robbing people.

Statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape.[26] Cases of criminals taking rohypnol themselves before they commit crimes have also been reported, as the loss of inhibitions from the drug may increase their confidence to commit the offence, and the amnesia produced by the drug makes it difficult for police to interrogate them if they are caught.

See also

References

  1. ↑ "Johns Hopkins Colon Cancer Center - Glossary S".
  2. ↑ "sedative" at Dorland's Medical Dictionary
  3. ↑ Montenegro M, Veiga H, Deslandes A, et al. (June 2005). "[Neuromodulatory effects of caffeine and bromazepam on visual event-related potential (P300): a comparative study.]". Arq Neuropsiquiatr 63 (2B): 410–5. doi:10.1590/S0004-282X2005000300009. PMID 16059590.
  4. ↑ "'Chemical cosh' will be cut for dementia sufferers". Telegraph.co.uk. 25 October 2010. Retrieved 12 September 2015.
  5. ↑ Yi PL; Tsai CH; Chen YC; Chang FC (March 2007). "Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration". J Biomed Sci 14 (2): 285–97. doi:10.1007/s11373-006-9137-z. PMID 17151826.
  6. ↑ Ebert B; Wafford KA; Deacon S (December 2006). "Treating insomnia: Current and investigational pharmacological approaches". Pharmacol Ther 112 (3): 612–29. doi:10.1016/j.pharmthera.2005.04.014. PMID 16876255.
  7. ↑ Sarrecchia C; Sordillo P; Conte G; Rocchi G (Oct–December 1998). "[Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication]". Ann Ital Med Int 13 (4): 237–9. PMID 10349206. Check date values in: |date= (help)
  8. ↑ Proudfoot H; Teesson M; Australian National Survey of Mental Health and Wellbeing (October 2002). "Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing". Soc Psychiatry Psychiatr Epidemiol 37 (10): 451–6. doi:10.1007/s00127-002-0576-1. PMID 12242622. Cite uses deprecated parameter |coauthors= (help)
  9. ↑ Weiss AJ, Elixhauser A. Origin of Adverse Drug Events in U.S. Hospitals, 2011. HCUP Statistical Brief #158. Agency for Healthcare Research and Quality, Rockville, MD. July 2013.
  10. ↑ Professor Jeffrey S Cooper (10 December 2007). "Toxicity, Sedatives". USA: eemedicine. Retrieved 18 December 2008.
  11. ↑ "benzo.org.uk - Benzodiazepines: Paradoxical Reactions and Long-Term Side-Effects". Retrieved 12 September 2015.
  12. ↑ Guina, Jeffrey; Rossetter, Sarah R.; DeRHODES, Bethany J.; Nahhas, Ramzi W.; Welton, Randon S. (2015-07-01). "Benzodiazepines for PTSD: A Systematic Review and Meta-Analysis". Journal of Psychiatric Practice 21 (4): 281–303. doi:10.1097/PRA.0000000000000091. ISSN 1538-1145. PMID 26164054.
  13. ↑ Semple, David; Roger Smyth; Jonathan Burns; Rajan Darjee; Andrew McIntosh (2007) [2005]. "13". Oxford Handbook of Psychiatry. United Kingdom: Oxford University Press. p. 540. ISBN 0-19-852783-7.
  14. ↑ American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  15. ↑ Collier, Judith; Longmore, Murray (2003). "4". In Scally, Peter. Oxford Handbook of Clinical Specialties (6 ed.). Oxford University Press. p. 366. ISBN 978-0-19-852518-9.
  16. ↑ Professor Heather Ashton (2002). "Benzodiazepines: How They Work and How to Withdraw".
  17. ↑ Lydiard RB, Laraia MT, Ballenger JC, Howell EF (May 1987). "Emergence of depressive symptoms in patients receiving alprazolam for panic disorder". Am J Psychiatry 144 (5): 664–5. doi:10.1176/ajp.144.5.664. PMID 3578580.
  18. ↑ Nathan RG; Robinson D, Cherek DR, Davison S, Sebastian S, Hack M (1 January 1985). "Long-term benzodiazepine use and depression". Am J Psychiatry (American Journal of Psychiatry) 142 (1): 144–5. PMID 2857068. Cite uses deprecated parameter |coauthors= (help)
  19. ↑ Longo, L. P.; Johnson, B. (2000-04-01). "Addiction: Part I. Benzodiazepines--side effects, abuse risk and alternatives". American Family Physician 61 (7): 2121–2128. ISSN 0002-838X. PMID 10779253.
  20. ↑ Tasman A, Kay J, Lieberman JA, eds (2008). Psychiatry, third edition. Chichester, England: John Wiley & Sons. pp. 2603–2615.
  21. ↑ Ashton, Heather (2005-05-01). "The diagnosis and management of benzodiazepine dependence". Current Opinion in Psychiatry 18 (3): 249–255. doi:10.1097/01.yco.0000165594.60434.84. ISSN 0951-7367. PMID 16639148.
  22. ↑ Morin, Charles M.; Bélanger, Lynda; Bastien, Célyne; Vallières, Annie (2005-01-01). "Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse". Behaviour Research and Therapy 43 (1): 1–14. doi:10.1016/j.brat.2003.12.002. ISSN 0005-7967. PMID 15531349.
  23. ↑ Poyares, Dalva; Guilleminault, Christian; Ohayon, Maurice M.; Tufik, Sergio (2004-06-01). "Chronic benzodiazepine usage and withdrawal in insomnia patients". Journal of Psychiatric Research 38 (3): 327–334. doi:10.1016/j.jpsychires.2003.10.003. ISSN 0022-3956. PMID 15003439.
  24. ↑ Weir E. (July 10, 2001). "Drug-facilitated date rape". Canadian Medical Association Journal 165 (1): 80. PMC 81265. PMID 11468961.
  25. ↑ Negrusz A; Gaensslen RE. (August 2003). "Analytical developments in toxicological investigation of drug-facilitated sexual assault". Analytical and Bioanalytical Chemistry 376 (8): 1192–7. doi:10.1007/s00216-003-1896-z. PMID 12682705.
  26. ↑ Thompson, Tony (19 December 2004). "'Rape drug' used to rob thousands". The Observer. Retrieved 2008-05-08.

Further reading

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