Sedative dependence Some sedatives can cause psychological and physical dependence when taken regularly over a period of time, even at therapeutic doses. 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 dependencies, finding and using the sedative becomes the focus in life. Both physical and psychological dependence can be treated with therapy.
Misuse 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. Benzodiazepines comparatively have a wider margin of safety and rarely result in overdose unless mixed with other CNS depressants. 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. 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. 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.
Dangers of combining sedatives and alcohol 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,
post-traumatic 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). As with alcohol, the effects of
benzodiazepines on neurochemistry, such as decreased levels of
serotonin and
norepinephrine, are believed to be responsible for their effects on mood and anxiety. 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). 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, they 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).
Dementia Sedatives and hypnotics should be avoided in people with dementia, according to the
medication appropriateness tool for co‐morbid health conditions in dementia criteria. The use of these medications can further impede cognitive function for people with dementia, who are also more sensitive to side effects of medications.
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. Additionally, the prolonged use of tranquilizers increases the risk of obsessive and compulsive disorder, where the person becomes unaware whether he has performed a scheduled activity or not, he may also repetitively perform tasks and still re-performs the same task trying to make-up for continuous doubts. Remembering names that were earlier known becomes an issue such that the memory loss becomes apparent.
Disinhibition and crime Sedatives — most commonly
alcohol, but also
GHB,
flunitrazepam (Rohypnol), and to a lesser extent,
temazepam (Restoril) and
midazolam (Versed) — have been reported for their use as
date rape drugs (also called a
Mickey Finn) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. Statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape. 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 offense, and the
amnesia produced by the drug makes it difficult for police to interrogate them if they are caught. == See also ==