Mental health articles

OF mental health care and mentally ill

Anti-anxiety and sedative-hypnotic drugs

Benzodiazepines are the most widely prescribed group of drugs in the world although in recent years their popularity has waned because of their potential to cause tolerance and dependence. Benzodiazepines have a wide range of uses including anxiety, anxiety-related phobias, alcohol withdrawal and sleep disorders. They are also widely used in the treatment of acute agitation and aggression in services users with psychosis. Benzodiazepines (for example, diazepam, lorazepam and temazepam) reduce anxiety by potentiating the inhibitory neurotransmitter GABA. There are few clinical differences between the different types of benzodiazepines except for different half lives (the time for the plasma level of the drug to reduce to half of peak level).

Overdoses of benzodiazepines are almost never fatal (unless taken in conjunction with other central nervous system depressants such as alcohol and opiates) and the effect can be reversed by the specific antagonist, flumazenil. Side effects are rare and tend to be dose related. When used regularly tolerance increases therefore people need higher doses to obtain the same level of symptomatic relief. Prolonged use can result in physical dependency. Withdrawal symptoms range from insomnia and anxiety, to extreme agitation and convulsions. It may be fatal if not treated appropriately. However, if prescribed over a short term (around two weeks) dependence should not be an issue, especially if treatment is stopped gradually. It is also useful to advise service users to use benzodiazepines intermittently rather than regularly to reduce the risk of tolerance and dependence. The use of barbiturates has largely been replaced by benzodiazepines as anti-anxiety and sedative-hypnotic drugs because of tolerability and safety issues (the range between therapeutic and toxic dose, leading to coma and respiratory arrest, is very narrow).

Two drugs that are not structurally related to benzodiazepines and are licensed for the treatment of insomnia are zopiclone and zolpidem. Other drugs that may be useful anti-anxiety and sedativehypnotic drugs include some antihistamines, propranolol and buspirone.

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