SEDATIVES – INTRODUCTION
Sedatives are central nervous system (CNS) depressants, a category of drugs that slow normal brain function. There are various kinds of CNS depressants, most of which act on the brain by affecting the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals that conduct communication between brain cells. GABA works by decreasing brain activity. Although the different types of CNS depressants each work in their own way, ultimately it is through their ability to increase GABA activity that they produce a relaxing effect that is beneficial to those suffering from anxiety or sleep disorders.
SEDATIVES – INDICATION
Drug that calms a patient, easing agitation and permitting sleep. Sedatives generally work by modulating signals within the central nervous system. If sedatives are misused or accidentally combined, as in the case of combining prescription sedatives with alcohol, they can dangerously depress important signals that are needed to maintain heart and lung function. Most sedatives also have addictive potential. For these reasons, sedatives should be used under supervision and only as necessary.
SEDATIVES – INFORMATION
History of sedatives
Before the era of modern medicine, the most commonly prescribed sedative to ease tension, cause relaxation and help forget problems was alcohol. Its beneficial effects were definitely the reason why alcohol gained such popularity and is still the most commonly abused sedative of all time.
Attempts to find sedatives other than alcohol for treating anxiety and nervousness began in the 19th century with the introduction of bromides, which were discovered in 1826. These drugs were extremely popular for this purpose until their propensity to build up in the body and produce toxic effects became known in the medical community.
Because of their toxicity, bromides were replaced by barbiturates in the early 20th century, which were initially also heralded as effective and safe sedative drugs. However, in a short period of time problems with dependence, tolerance and lethal overdosing became evident. As the margin of safety for barbiturates was too narrow, research endeavors for safer sedatives continued.
In 1950s the first benzodiazepines were marketed as valid substitutes for dangerous barbiturates. Although initially viewed as completely safe and free from problems of dependence, tolerance and withdrawal, today we know that benzodiazepines are less than ideal antianxiety drugs, and that their long-term usage can cause all the aforementioned effects associated with their sedative predecessors.
During the 1970s and 1980s, there was an epidemic of prescriptions written for sedatives (for example, 100 million prescriptions were written for benzodiazepines alone in 1973). They are still one of the most prescribed classes of drugs, even though the medical community has become more aware of the problem.
Symptoms of dependence: tolerance resulting in higher levels needed to achieve the same calming effect.
Symptoms of psychological dependence: needing the drug to function and being obsessed with obtaining the drug.
Symptoms of withdrawal: restlessness, insomnia, anxiety, seizures, even death in some cases.
To be clinically diagnosed as dependent on a substance, 3 or more of the following symptoms must be exhibited simultaneously during a 12-month period:
- Amount and duration of substance intake is longer than intended
- Efforts to control intake are not successful
- A great deal of effort is put into obtaining, using, or recovering from effects of the substance
- Due to use of substance, other activities (social, work-related, leisure) are reduced or abandoned
- Substance is used even when known to cause or exacerbate a persistent or recurrent psychological, or physical problem
- Tolerance of the substance
- Withdrawal from the substance
Regular use over a long period results in an increased tolerance to the drug so that larger doses are needed to achieve the same effect.
There are several ways that patients can prevent prescription drug abuse. When visiting the doctor, provide a complete medical history and a description of the reason for the visit to ensure that the doctor understands the complaint and can prescribe appropriate medication. If a doctor prescribes a pain medication, stimulant, or CNS depressant, follow directions carefully and educate yourself about the effects that the drug could have, especially during the first few days during which the body is adapting to it. Also be aware of potential interactions with other drugs by reading all information provided by the pharmacist. Do not use another person’s prescription, and do not increase or decrease doses or abruptly stop taking a prescription without consulting a health-care provider first. For example, if you are taking a pain reliever for chronic pain and the medication no longer seems to be effectively controlling the pain, check with your doctor rather than increasing the dosage on your own.