BENZODIAZEPINES: USE, ABUSE, WITHDRAWAL AND DEPENDENCE
INTRODUCTION: Benzodiazepine is considered as a drug with high addictive potential. Dependence develops with long term use of even with therapeutic dose. As benzodiazepines are widely prescribed for various conditions, particularly insomnia and anxiety, therapeutic dose dependence are the largest category of people dependent on benzodiazepine. Benzodiazepines are one of the most prescribed drugs which have abuse potential. There must be special attention toward the patient's addiction history before these agents are prescribed. Understanding the abuse pattern and alternative anxiolytic and hypnotic agent can help health care providers maximize treatment result and reduce medico legal liability.
Mechanism of action
It acts by following ways
• Benzodiazepine receptors are linked mainly to γ amino butyric acid (GABA) receptors, which sensitize benzodiazepine receptors to the neurotransmitter GABA, the most prominent inhibitory neurotransmitter in the central nervous system.
• Accentuates the affinity of the recognition site for GABA by inducing conformational changes that make GABA binding more efficacious.
• Activation of the benzodiazepine- GABA-chloride ionophor complex is responsible for producing the therapeutic anxiolytic effects of benzodiazepines and for mediating many of the side effects and, possibly, dependence and withdrawal from these drugs.
Clinical use
Following are the use of benzodiazepines
• Amnesia before or after surgery
• Anxiety disorders
Generalized anxiety disorder
Panic disorder
Phobias (social, simple)
Post-traumatic stress disorder
Obsessive-compulsive disorder
• Insomnia
• Somatoform disorder
• Convulsive disorders
• Tetanus
• Parapleg...
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...cts or side effects.
Clonazepam is a high-potency benzodiazepine with a long half-life. It is widely prescribed for a variety of psychiatric and neurologic conditions. Although clonazepam is perceived as “safe,” addiction medicine specialists have found that it is also frequently abused as a street drug. On the other hand, oxazepam (Serax), clorazepate (Tranxene) and chlordiazepoxide appear to have lower reinforcing effects than other benzodiazepines
CONCLUSION: Benzodiazepine remains to be one of the most prescribed agent for variety of anxiety and sleep disorders. Keeping in mind their highly abusive potential clinician must pay special attention towards patient’s addiction and medication history before these agents are prescribed. Proper education of patient, regular follow up and using alternative therapy can reduce the risk of benzodiazepine dependence.
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There are also explanations dealing with clozapine's interaction with the serotonin 5HT2 receptors and the glutamate receptors. ... ... middle of paper ... ... hin a week levels will increase with treatment of colazopine.(Naheed & Green, 2000) Andreasen, N.C. (1994).
Treating depressive and bipolar disorders with antidepressants remains a popular option in clinical practice. Most clinicians choose the drug or class of drugs, usually selective serotonin reuptake inhibitors, SSRI's, that is most effective and best tolerated with fewer severe side effects. These drugs are beneficial because they specifically target serotonin-based areas of the brain without affecting other neurotransmitter systems. SSRI's largely replaced tricyclic antidepressants which work by blocking the absorption (reuptake) of the neurotransmitters serotonin and norepinephrine, thereby increasing the levels of these two neurotransmitters in the brain. Tricyclic antidepressants present severe side effects and thus are usually only used when other treatments have failed. If SSRI's or tricyclics are not effective Monoamine oxidase inhibitors may be prescribed. MAOI's, enhance tyramine to increase norepinephrine and serotonin. While taking MAOI's you must abstain from foods and alcohol that contain tyramine such as, yogurt, aged cheese, and substances such as cold medications. This is because a potential toxic reaction could occur. Additionally, other antidepressants may be utilized such as Wellbutrin (bupropion) an NDRI-
Basically, serotonin levels will provide various benefits regarded to health and mental. It is also called feel good chemical which will apply benefits to both biological and psychological functions. Most of this supplement’s application is found primarily in digestive tract and blood plates. Only small amount of this supplement will be served for its purpose in central nervous systems and brains. If users says that they are in way to achieve serotonin levels, then it is clearly understood that the small percentage will exists in the brain. It is capable of delivering various benefits regarding to mental function and maintenance of serotonin levels of the brain. The neurotransmitter has various things to do
Barbiturates fall into the class of sedative-hypnotics. Some of the medical uses include: short-acting barbiturates that can be used for anesthesia induction, while the long acting barbiturates are utilized in anti-convulsant therapy. Barbiturates attach to the β subunit of the GABAA receptor. Stimulation of this inhibitory receptor causes an influx of chloride into cell membranes, which affects the threshold potential of the postsynaptic terminal. Barbiturates at high doses can actually cause direct opening of the chloride channel, essentially mimicking GABA without the actual presence of GABA. Barbiturates also have the ability to suppress depolarization, which is induced by glutamate, an excitatory neurotransmitter within the CNS. These drugs are highly effective at causing neuronal inhibition within the CNS. Barbiturates have a very narrow therapeutic window, which can result in life threatening side effects if not monitored properly. Some of the serious side effects corresponding to the cardiovascular system include: hypotension, decreased cardiac contractility, decreased cardiac output and decreased cerebral blood flow. In long-term barbiturate use cytochrome P450 enzymes are induced which can rapidly metabolize and affect other drugs utilizing this pathway. Tolerance to the depressant effects is common amongst chronic users. Barbiturates have both a tissue specific tolerance and metabolic tolerance. Tissue specific tolerance occurs in the reticular activating
United States. National Institute of Mental Health. “Mental Health Medications.” 2008. Health and Education. Web. 16 Nov. 2013
...ossible adverse interactions between an antidepressant medication and the substances a patient is abusing (such as the potential for increased sedation or intoxication).” (p 29).
γ-aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the CNS. GABAA is a ligand gated ion channel composed of five subunits. Through positive allosteric modulation ethanol binds to the δ subunit of the receptor and enhances the inhibitory effect of GABA. Once ethanol has bound to the GABAA receptor, chloride ions enter the post-synaptic neuron. This cascade of ions hyperpolarises the neuron, thus increasing inhibitory effects and makes the neuron less excitable. Ethanol alters the enzyme kinetics enabling the ion...
FDA research has shown that tricyclic antidepressants such as Paxil can actually increase the severity of depression and suicidal behavior in teens and young adults. In the shocking expose “Treating the Mentally Ill,” medical journalist Rob Waters warns “Antidepressants including Paxil, Prozac, Zoloft, and Effexor have provoked hostile behavior and thoughts about suicide in a number of teenagers who have been prescribed the drugs. Some of th...
Antidepressant are a form of pharmacotherapy treatment developed to treat the symptoms of major depression. Antidepressants are used for many other types of conditions including anxiety disorders, obsessive compulsive disorder, dysthymia, eating disorders, sleeping disorders, and substance abuse, pain syndromes, gastrointestional disorders. Antidepressants usually require several weeks to notice significant effects. There are no antidepressants or any medication that is completely free of adverse effects. This article explains that the adverse effects of antidepressant can decrease compliance and slow down the rate of recovery. It is important for one to take note of potential side-effects before choosing the best antidepressant to suit their personalized needs. Statistics show that about 28 percent of patients sto...
Addiction is a dependence on a substance where the individual who is affected feels defenseless and unable to stop the obsession to use a substance or prevent a particular behavior. Millions of Americans have addictions to drugs, alcohol, nicotine, and even to behaviors such as obsessive gambling. Pharmacotherapy is a treatment process in which a counselor can use a particular drug to counter act an addictive drug or behavior. Not all counselors agree with this type of treatment. However in order to provide a client with an ethical treatment and unbiased opinions they should be made aware of all scientific evidence of different treatment options. “Thus, attention to addiction pharmacotherapy is an ethical mandate no matter what prejudices a counselor may have” (Capuzzi & Stauffer, 2008, p. 196). Some particular pharmacotherapy’s a counselor may use for the treatment of addiction are Bupropion (Wellbutrin, Zyban), Disulfiram (Antabuse), Naltrexone (ReVia, Depade), Methadone (Dolophine), and Buprenorphine (Temgesic, Suboxone).
Addiction is a complex psychiatric disorder that consists of social and psychological factors, but at its most basic level it is a biological process. Addiction may come in many forms, but its primary choice of substance is drugs. In particular, prescription medications in the form of pills have become a major health problem, not only to those addicted but the clinicians who prescribe them. In order to fully understand this disorder, considering what brain mechanisms and functions are involved with addiction, the next area to look into is the factors that make the prescription drugs so addictive, along with long term effects, and to discover any new treatment options out in practice today, whether it be through medicine and/or counseling.
Benzodiazepine or know as benzo on the street. Benzos effect the central nervous system by slowing down the ...
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