What do sedatives do?

Types of Anesthesia

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There are four main categories of anesthesia used during surgery and other procedures: general anesthesia, regional anesthesia, sedation (sometimes called “monitored anesthesia care”), and local anesthesia. Sometimes patients may choose which type of anesthesia will be used.

Your physician anesthesiologist will discuss the types of anesthesia that would be safe and appropriate for the operation or procedure you need, and will explain your options clearly. Below, you will find more details and links to short videos that will give you more information.

  • General anesthesia is what people most often think of when they hear the word “anesthesia”. During general anesthesia, you are unconscious and have no awareness or sensations. Many different medications may be used during general anesthesia. Some are anesthetic gases or vapors that are given through a breathing tube or a mask. Some medications are given through the IV to induce sleep, relax muscles, and treat pain.

    UCLA physician anesthesiologists work with each patient individually to determine which combination of medications is best, depending on your state of health, your other medical conditions, the medications you take, any allergies, and the type of surgery you are having.

    The most frequent side effect of general anesthesia is drowsiness afterward. This typically goes away within the first hour or two after surgery ends. Some patients may experience a sore throat or nausea. If you have a history of motion sickness or nausea after prior operations, be sure to mention that to your physicians and nurses, as you may need medication before surgery to help prevent nausea afterward.

    Serious reactions to general anesthesia are very rare. Your anesthesia team has immediate access to emergency medications to treat any kind of reaction, and will monitor your vital signs continuously throughout surgery and recovery.

  • Regional anesthesia makes an area of the body numb to prevent the patient from feeling pain. It can completely block sensation to the area of the body that requires surgery. The anesthesiologist injects local anesthesia (numbing medication) near the cluster of nerves that provides sensation to that area.

    Two very common types of regional anesthesia are spinal and epidural anesthesia. Either one may be used for childbirth, or for orthopedic procedures such as total knee and total hip replacement. Sometimes, an epidural catheter is left in place to allow continuous pain relief to be given for one or more days after surgery. This is common after surgery on the chest or abdomen, even when general anesthesia is used during the operation.

    Nerve blocks are another type of regional anesthesia that can provide pain relief to a smaller area, such as an arm or leg. Examples include femoral nerve block to numb the thigh and knee, or a brachial plexus block to numb the shoulder and arm.

    Having regional anesthesia for surgery doesn’t mean that you have to be completely awake. Many patients prefer to receive sedation so that they can relax and doze off during the procedure. Sometimes regional anesthesia is used in combination with general anesthesia for major surgery on the chest or abdomen. This technique has the advantage that patients don’t need as much opioid pain medication after surgery.

  • Sedation, also known as “monitored anesthesia care”, is what people have often referred to in the past as “twilight”. Medications are given, usually through an IV, to make the patient feel drowsy and relaxed. Different levels of sedation are possible, depending on the type of procedure and the patient’s preference.

    Under mild sedation, often used for eye surgery, a patient is awake and can respond to questions or instructions. With moderate sedation, the patient may doze off but awakens easily. Deep sedation is nearly the same as general anesthesia, meaning that the patient is deeply asleep though able to breathe without assistance. Deep sedation with a medication called propofol is often used for procedures such as upper endoscopy or colonoscopy.

  • Local anesthesia is the term used for medications such as lidocaine that are injected through a needle or applied as a cream to numb a small area. Local anesthesia alone may provide enough pain relief for limited procedures such as sewing up a deep cut or filling dental cavities. It is often used along with sedation during minor outpatient surgery. At the end of many operations, the surgeon may inject local anesthesia to provide additional pain relief during recovery.

What should you know about the facility and physicians?

Although outpatient surgeries may not be for medical emergencies and are often less complex than surgeries requiring an overnight hospital stay, it’s still important to do your homework to make sure you’re getting the best care.

Here are some questions to ask:

  • What are the qualifications of the surgeon and other medical staff? Ask about the qualifications and experience of the physician leading your care to make sure he or she is certified to perform the procedure. Those who are qualified have special training and have passed exams given by a national board of surgeons. Also ask your surgeon about his or her record with the specific procedure you’re having, and about successes and complications.
    Be sure the nurses and other clinical staff who support the surgeon are also experienced with the procedure and have the appropriate medical education and training.
  • Who is providing and monitoring the anesthesia? Be sure a physician anesthesiologist is leading your anesthesia care, especially if you are having general anesthesia or sedation. A physician anesthesiologist also can make sure you get the most effective pain management after your procedure.
  • Is the surgery center licensed and well-equipped to handle your procedure? Although rare, emergencies can occur during surgery. Unlike hospitals, an office-based or same-day surgery site may not have an emergency facility nearby, so it’s important to ask if the surgery center has emergency medications, equipment and procedures in place to safely care for you if there is an emergency. The outpatient surgery center should be licensed and accredited.

For more information on preparing for surgery, visit Preparing for Surgery.

Physician anesthesiologists are the most highly skilled medical experts in anesthesia care, pain management and critical care medicine. They have the education and training that, in some circumstances, can mean the difference between life and death.

• Debate on continuity of nutritional support and hydration;

• Obtaining informed consent;

• Written order for no resuscitation22.

Selection of drugs

The beginning of palliative sedation is an emotionally charged occasion for the family, especially if it rapidly induces loss of consciousness and communication. Medical interventions are sometimes need at the beginning of sedation. In subsequent phases, the administration of drugs can be handed to a nurse or caregiver 3. Once sedation has been determined, the following principles should be followed 22:

• Choose the appropriate agent to start sedation, considering the symptoms presented by the patient;

• Monitor the level of sedation, using specific scales, such as Ramsay;

• Titrate sedative dose to obtain the desired level of sedation;

• Give additional bolus doses or associate other drugs to maintain the achieved level.

The choice of drug to be used for sedation in most cases depends on the professionals’ experience and institution. The most used drugs are benzodiazepines, especially midazolam, and barbiturates. Other drugs widely used are neuroleptics22. Benzodiazepines have been used alone or in combination with neuroleptics and opioids13.

In a review of sedation at home, 93% of patients received midazolam and 7% levomepromazine14. In another review, the drugs were midazolam, morphine, haloperidol, promethazine, and transdermal fentanyl 15. In a palliative care unit, 70% of patients received benzodiazepines, but only 3.1% received continuous deep sedation 23.

Benzodiazepines

Benzodiazepines are considered first-choice drugs in the absence of delirium. They should be administered subcutaneously or intravenously by intermittent bolus or continuous infusion 24.

Midazolam is the most used drug for palliative sedation and is considered a first-choice drug8,18,25. We found no study comparing midazolam with other drugs. Due to its favorable pharmacodynamic characteristics, it is supposed to have advantages over other benzodiazepines. Midazolam is a greatanxiolytic, has anticonvulsant effect, promotes amnesia, and causes few adverse effects. Its pharmacokinetic characteristics are also favorable. Its half-life is short (an important factor, especially in intermittent sedation), dosage is easily titrated, can be combined with other drugs used in palliative care, and yet can be administered parenterally. Moreover, its effect can be antagonized by flumazenil 4,24. In a palliative care unit, midazolam was used in 10% of patients for sedation 16.

Benzodiazepines were administered orally or sublingually in 71.8% of patients23. Lorazepam was administered mainly for anxiety and agitation, oxazepam to induce sleep, and midazolam for sedation 23. Agitation caused by delirium can be relieved with midazolam 12. Diazepam and clonazepam are prescribed for prevention or treatment of seizures23.

The use of benzodiazepines for sedation, however, does not always imply adequate control of symptoms 26.

Opioids and tramadol

Patient’s symptoms must be taken into account when choosing sedatives. If the patient is experiencing pain, which is the most common symptom in end-stage patients, the use of opioids is indicated for relief. Sometimes, opioids are used alone for sedation 13. When the patient is experiencing pain, this drug can be sufficient to relieve pain and promote palliative sedation. The action of this class of drug is synergic with most hypnotics and neuroleptics. The most appropriate choice of opioid should be based, in principle, on pain intensity. Among the available opioids, morphine stands out as the gold standard for treating moderate and severe pain, according to literature 25. In a palliative care unit, patients received intravenous morphine more frequently 27.

Some opioids should not be used. Propoxyphene, a synthetic derivative of methadone, has weak opioid action and long half-life. It is metabolized in the liver to yield norpropoxyphene, which can cause increased excitability of central nervous system, causing tremors, myoclonus, and seizures. Meperidine is an opioid with erratic oral absorption, has a relatively short half-life and toxic metabolites. This drug is metabolised in the liver to yield normeperidine, which has half the analgesic potency of the parent compound, but causes twice as much toxic effects on central nervous system. The neurotoxicity of normeperidine can occur rapidly, especially in patients with renal insufficiency. Other factors that may contribute to central nervous system excitability induced by meperidine are prolonged treatment, high doses, history of seizures, and concomitant administration of other potentially neurotoxic agents 28.

The use of tramadol, a week opioid agonist and serotonin and norepinephrine reuptake inhibitor, as a palliative drug is limited by its power (more than 600 mg.day-1 are not recommended). However, it may be used for non-severe pain in combination with other drugs.

Transdermal fentanyl is not indicated for sedation, but there is report of its use in literature 25. When the patient is receiving analgesia with this drug, it should be replaced by intravenous morphine.

Opioid administration in order to produce only sedation in a patient experiencing no pain is considered inappropriate because sedation may occur associated with undesirable effects, or even not be achieved despite the use of large doses 3,29. When the patient is experiencing pain, which is present in most patients with terminal cancer, morphine is the first drug to be administered and, sometimes, sufficient for analgesia and sedation. The administration of opioid did not change the duration of sedation 12.

Other

Sedation of delirious patients should be considered only after treatment with neuroleptics. In refractory cases, the association of benzodiazepines and neuroleptics should be considered. The neuroleptics used are chlorpromazine 18, levomepromazine 24, and haloperidol 18,25,30. Other drugs used are promethazine 25 and scopolamine 18. For patients with intense agitation, barbiturates or propofol may be used 24.

If adequate sedation is not achieved, other drugs may be associated in order to maximize the effect 22,24. Drug combination is very useful, but requires reduction of doses used due to the synergistic effect of most sedatives. Antidopaminergic and antihistamines, sedative drugs that also have antiemetic effect, are often used 26. There is report of a number of cases using ketamine in combination with opioids and benzodiazepines for sedation in terminally ill patients31,32 and a case report of its use as monotherapy for palliative sedation 33.

The symptoms are sometimes refractory to benzodiazepines and antipsychotics, which requires alternative medication. Propofol, a sedative and hypnotic drug, can provide relief from agitation and refractory fatigue 34. In a systematic review, only four articles were found reporting the favorable effect of propofol for sedation in the last days of life, but all of them are only case reports35. This drug was administered when other drugs have failed.

Dose and route of administration

Drugs may be administered by intravenous, subcutaneous, oral (until the patient loses consciousness), enteral, sublingual, and rectal routs, depending on the route that has been used 22.

The initial dose of sedatives may be small, with the patient able to communicate regularly 8. Dose of medication should be increased gradually as needed36.

Literature is limited and there is no consensus on the dose of sedatives, but some authors recommend the following drugs to induce and maintain sedation 14,17,22,27:

• Morphine: 20-80 mg.day-1.

• Midazolam: 0.5-0.7 mg.kg-1, followed by infusion of 0.5-2 mg.h-1 IV or 10 mg followed by 1-6 mg.h-1 subcutaneously.

• Chlorpromazine: 10-25 mg.(2-8)h-1 by oral, sublingual, or rectal routs, or intravenous infusion.

• Haloperidol: 0.5-5 mg.(2-4).h-1 orally or subcutaneously, or infusion of 1-5 mg.day-1.

• Pentobarbital: 2-3 mg.kg-1 intravenously, followed by infusion of 1 mg.kg-1.

• Phenobarbital: 200 mg intravenous or subcutaneous bolus injection followed by 600-1,600 mg.day-1.

• Thiopental: 5-7 mg.kg-1 intravenous bolus injection followed by infusion of 70-180 mg.h-1.

• Levomepromazine: 12,5-25 mg.d-1 subcutaneously.

Regarding dose escalation of sedative medications, there are no protocols or guidelines; however, dose should not be increased unless there is evidence of inadequate sedation 22. Higher doses of midazolam were necessary for sedation of young people who had used the drug previously and for log time 37. The initial dose of opioids depends on patients’ history of analgesics use 38.

The routes of administration were subcutaneous and intravenous infusions 17. The most common route of administration is intravenous, as it quickly provides adequate plasma levels that can be maintained.

Duration of Sedation

The duration of sedation is variable. In a review of sedation at home, the authors report that it ranges from one to more than one week9,12-15,25,36.

The time for symptom management was 24 hours 15.

Sedation does not necessarily mean that the patient will be maintained sedated until death. In a palliative care unit, 23% of patients receiving palliative sedation were discharged 16.

Monitoring

Unfortunately, there are no specific scales to assist in the management of sedation depth in terminally ill patients. Thus, many clinicians have used scales, such as the Ramsay and Richmond, for assessing the level of sedation-agitation, although they have not been validated for palliative sedation 22.

Palliative sedation is safe and effective for most patients with terminal cancer and refractory symptoms 37. However, complications (respiratory and circulatory) occur in small numbers of patients. Thus, it is necessary to compare studies of different types of sedation to determine the more effective and safer protocol 37.

Nutritional support and hydration

During the course of the terminal disease, the need for nutrition and hydration is variable. While there are numerous studies in literature on nutrition and hydration in patients with cancer in palliative care, there are no specific guidelines for terminal-stage patient. There is evidence that artificial nutrition will prolong the life of these patients, and due to the associated risks, some authors do not suggest that artificial nutrition be prescribed for these patients, which should be banned from the moment sedation is started24,39,40. In clinical practice, enteral nutrition is often maintained.

The opinions on hydration in terminally ill patients are varied. In a systematic review of the literature on the subject, the author concluded that hydration is not beneficial or harmful to these patients. Some authors argue against the use of fluid in terminally ill patient because water restriction can result in decreased pulmonary, salivary, or gastrointestinal secretions and, thus, reduce coughing, vomiting, and the need for interventions such as aspiration for relief. Less fluid administration results in decreased urine output and, therefore, less need for bladder catheterization. Theoretically, there is also a decrease in symptoms caused by ascites and edema around the tumor. Proponents of hydration in terminally ill patients say that in well-hydrated patient there is lower risk of sedation, seizures, constipation, pressure sores, dry mouth, and opioid toxicity, especially if kidney failure occurs. Some authors also believe that hydration decreases the incidence of delirium, although two randomized studies found no influence of hydration on its occurrence. Some authors believe that in patients whose death is expected for more than a week, dehydration can hasten it41.

The legal, ethical and cultural implications of fluid and nutritional support in palliative care of patients should also be considered. Although fluid and nutritional support may be physiologically unnecessary in these circumstances, is maintenance may lead to cultural and psychological benefits. The heterogeneity of attitudes toward hydration in terminally ill patients reflects the lack of consensus in expert opinion. There is no evidence to support either view24.

In a palliative care unit, only 3 out of 266 patients received artificial hydration after the beginning of sedation 9. In one study, 63% of patients received sedation after hydration, and the remainder did not receive it due to fluid retention or patient’s request17.

Decision on whether or not to hydrate the patient should be taken separately from the sedation, and provide it if benefit is greater than damage 8.

Palliative sedation for patient care at home

Many patients prefer to be at home at the time of death and, therefore, palliative sedation for outpatients may be an important area of research. However, few studies have been published on the subject.

Despite being much propagated, the idea that sedation at home is better because patient is comforted among family members, the author of a review article found that it is performed in 5-36% of patients 13.

Some authors consider that patients with refractory and unbearable symptoms, with short life expectancy, who reside less than 20 minutes from the hospital, and are already being assisted by a medical team for a long period, preferably during all stages of disease, are candidates for palliative sedation at home. They also considered as criteria to indicate sedation at home the absence of any other sources of suffering for the family, such as serious chronic disease, alcoholism, and drug abuse 42.

For palliative sedation at home, a protocol for induction and maintenance may be followed. Intravenous bolus of midazolam 0.07 mg.kg-1 may be used to induce sedation. Maintenance is initiated with midazolam 1 mg.h-1 administered subcutaneously; in case of failure, it is increased to 2 mg.h-1. If it still fails, chlorpromazine 3 mg.h-1 and promethazine 3 mg.h-1 are added; in case of failure, midazolam 2 mg.h-1, chlorpromazine 6 mg.h-1, and promethazine 6 mg.h-1 are administered. According to some authors, physician and nurse must follow the induction of sedation 3,43.

Sedation level should be monitored twice daily during induction and after stabilization by physician or nurse using Ramsay’s scale of sedation. Sedation failure is considered if score on Ramsay’s scale is less than 5 after 12 hours of treatment 22,42.

Opioids should be maintained and dose adjusted when pain is not controlled. The opioid of choice is morphine because dose titration is easier. Transdermal or oral opioids should be switched to morphine in equivalent doses38,42.

The patient must be hydrated, but in a restrictive manner, usually up to 1,000 mL of saline per day. Urinary catheter should be placed to control diuresis and prevent urinary retention41,42. During sedation, the medical and nursing staff must be on call for emergencies42.

CONCLUSION

Although palliative sedation has been lately considered a normal medical practice, there are still many gaps in our current understanding. There is no consensus about which are the standard drugs, maintenance or not of food, fluid intake, and hydration. Moreover, there is no ethical clarification on possible life-shortening effects and decision-making process. It is important to define explicit criteria and conditions for the use of sedation in terminally ill patient in order to contribute to good medical practice in this field.

For now, it is essential that there is debate on the subject, and that doctors and other health professionals are aware of the rules and starting points in order to provide the patient, facing the end of life, with appropriate treatment that may ease his pain and suffering.

2. Gonçalves JAF – Sedation and Expertise in Palliative Care. J Clin Onc, 2006;24(25):44-45.

5. Kettler D, Nauck F – Palliative care and involvement of anaesthesiology: current discussions. Curr Opin Anaesthesiol, 2010;23:173-176.

6. Hoven B. What to do when a competent ICU patient does not want to live anymore but is dependent on life-sustaining treatment? Experience from the Netherlands. Intensive Care Med, 2010;36:2145-2148.

7. Morita T, Tsuneto S, Shima Y – Definition of sedation for symptom relief: a systematic literature review and a proposal of operational criteria. J Pain Symptom Manage, 2002;24(4):447-453.

8. De Graeff A, Dean M – Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med, 2007;10(1):67-85.

9. Claessens P, Menten J, Schotsmans P et al. – Palliative sedation, not slow euthanasia: A prospective, longitudinal study of sedation in Flemish Palliative Care Units. J Pain Symptom Manage, 2010 Sep 9. .

10. Vitetta L, Kenner D, Sali A – Sedation and analgesia-prescribing patterns in terminally ill patients at the end of life. Am J Hosp Pall Care, 2005;22:465-473.

11. Sykes N, Thorns A – Sedative use in the last week of life and the implications for end-of-life decision making. Arch Intern Med, 2003;163:341-344.

13. Mercadante S, Porzio G, Valle A et al. – Palliative Sedation in Patients with Advanced Cancer Followed at Home: A Systematic Review. J Pain Symptom Manage. 2011 Jan 11.

16. Elsayem A, Curry Iii E, Boohene J et al. – Use of palliative sedation for intractable symptoms in the palliative care unit of a comprehensive cancer center. Support Care Cancer, 2009;17(1):53-59.

17. Morita T, Chinone Y, Ikenaga M et al. – Ethical validity of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage, 2005;30(4):308-319.

22. Rousseau P – Palliative sedation in the management of refractory symptoms. J Support Oncol, 2004;2:181-186.

24. De Graeff A, Dean M – Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Pall Med, 2007;10:67-85.

25. Rosengarten OS, Lamed Y, Zisling T et al. – Palliative sedation at home. J Palliat Care, 2009;25(1):5-11.

26. Krakauer EL, Penson RT, Truog RD et al. – Sedation for intractable distress of a dying patient: acute palliative care and the principle of double effect. Oncologist, 2000;5:1:53-62

28. Hasselaar JGJ, Verhagen SCAHHVM, Wolff AP et al. – Changed patterns in Dutch palliative sedation practices after the introduction of a National Guideline. Arch Intern Med, 2009;169(5):430-437.

29. Von Roenn JH, Von Gunten CF – Are We Putting the Cart Before the Horse? Arch Intern, 2009;169(5):429.

37. Morita T, Chinone Y, Ikenaga M et al. – Efficacy and safety of palliative sedation therapy: a multicenter, prospective, observational study conducted on specialized palliative care units in Japan. J Pain Symptom Manage, 2005;30(4):320-328.

39. Hawryluck LA, Harvey WR, Lemieux-Charles L, Singer PA. Consensus guidelines on analgesia and sedation in dying intensive care unit patients. BMC Med Ethics, 2002;3:1-9.

40. Quill TE, Lo B, Brock DW – Palliative options of last resort: a comparison of voluntarily stopping eating and drinking, terminal sedation, physician-assisted suicide, and voluntary active euthanasia. JAMA, 1997;278:2099-2104.

41. Craig GM – On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? J Med Ethics, 1994;20:139-143.

What are Tranquilizers?

Tranquilizers are a class of drugs that are capable of inducing a state of relaxation, or creating the feel of “tranquility”. Tranquilizers are typically used to help calm individuals who have severe mental health issues or who are prone to high anxiety levels. Other uses for tranquilizers include preparation for surgery, to induce sleep, or to alleviate withdrawal symptoms for people who are undergoing medical detoxification from alcoholism. Tranquilizers function in the body by depressing the central nervous system, inducing a sedation-like state. Tranquilizers can also be referred to as hypnotics, downers, anxiolytics, hypnotics, relaxants, antipsychotics, or sleeping pills. Street names for tranquilizers include, “tranx”, “benzos”, “moggies”, or “bennies”. Many tranquilizers can be highly addictive and have an increased potential for being abused and can lead to a Tranquilizer Addiction.

Tranquilizers can be broken into two different categories: major and minor tranquilizers. Major tranquilizers are also referred to as antipsychotics since they are primarily used to treat mental disorders, such as schizophrenia. Brand names for major tranquilizers include the following:

  • Mellaril
  • Haldol
  • Navane
  • Thorazine
  • Prolixin

The category of minor tranquilizers is classified as benzodiazepines. These drugs are used for the therapeutic treatment of anxiety disorders, alcohol withdrawal, seizures, insomnia, and muscle spasms. One of the main differences between these two categories is that minor tranquilizers have the ability to produce a sense of euphoria and have a calming effect, unlike the major tranquilizers. Brand name minor tranquilizers include the following:

  • Xanax
  • Valium
  • Librium
  • Ativan
  • Klonopin

Because of the frequency which tranquilizers are prescribed, it is not uncommon for abuse of these drugs to develop or occur. One of the most dangerous practices in the recreational use of tranquilizers is the combination of these drugs with other depressants, such as heroin. Using a combination of depressants can dramatically increase the risk of death. Tranquilizers can be both physically and psychologically addictive, and the abuse of these drugs should not be taken lightly. If you or a loved one is trapped in the vicious cycle of tranquilizer addiction, it is highly recommend that you seek professional help.

Tranquilizers Use Statistics

Men and women from across the age groups can be vulnerable to developing an addiction to tranquilizers. Studies have revealed the danger associated with the abuse of these drugs. The following are some statistics pertinent to tranquilizer abuse:

  • According to the National Institute on Drug Abuse, barbiturates, a type of tranquilizer, are a factor in approximately one third of all reported drug-related deaths .
  • The Food and Drug Administration (FDA) estimates that over 60 million people are prescribed a type of tranquilizer every year .
  • Studies from the Partnership for a Drug-Free America reveal that 1 in 5 teenagers have indicated that they abuse prescription stimulants and tranquilizers .
  • Also from the Partnership for a Drug-Free America, a national household survey demonstrated that early non-medical users of prescription sedatives, tranquilizers, and opioids were generally more likely to become non-medical users of other prescription drug classes than to develop sedative, tranquilizer or opioid use disorders .

Causes of a Tranquilizer Addiction

Several factors can contribute to the addiction of tranquilizers, as they cause dependency in several ways. Since tranquilizers have the capacity to produce a calming effect, the person using the drug typically desires more once the effect has subsided. When increased dosages of tranquilizers are consumed, a person will build a tolerance to the substance. This will leave the user not only desiring tranquilizers more frequently but also wanting increased quantities of them. Other causes are that individuals may become dependent on using the drug, both physically and psychologically. For example, if a tranquilizer is prescribed to relieve anxiety, a person may become dependent on the drug as it is used repeatedly to ease anxiety on a daily basis. Users may become dependent on feeling the “high” that is achieved when taking a tranquilizer and this can rapidly develop into an addiction. Tranquilizers may be sought as a temporary method of escaping pain, physically and emotionally, and individuals may find themselves trapped in the deadly cycle of addiction due to the fine line between medical use and recreational abuse. It is necessary to obtain professional help in order to prevent the consequences associated with a tranquilizers addiction.

Signs and Symptoms of a Tranquilizer Addiction

You may be concerned that your use of tranquilizers has developed into abuse or addiction. If you or a loved one is struggling with an addiction to tranquilizers, certain signs and symptoms will be evident of this. Look for the following if you are suspecting that addiction to tranquilizers is present:

  • Increased sleepiness
  • Shaky hands
  • Difficulty concentrating
  • Rapid heartbeat, irregular heart rate
  • Irregular respiratory rates or depressed breathing
  • Memory loss or confusion
  • Dulled emotional responses
  • Dizziness, Nausea
  • In cases of overdose, death

Tranquilizer Effects

Unfortunately, an addiction to tranquilizers will be costly to you or your loved one. While the physical signs of addiction may be the most evident, the ramification of tranquilizer abuse does not stop there. An addiction to tranquilizers can impact your life in the following ways:

Physically: The recreational use of tranquilizers can harm your body physically as it interferes with the normal mechanisms. In severe cases, death can occur, especially in the instance of overdose. These are possible physical effects that may result from a tranquilizer addiction:

  • Irregular sleep patterns
  • Disorientation, confusion
  • Restlessness
  • Inability to relax
  • Respiratory distress or arrest
  • Cardiac arrest
  • Gastrointestinal distress
  • Unconsciousness or sedation

Psychologically: A tranquilizer addiction can confuse an abuser’s perception of reality as well as disturb their mental and emotional well being. The following are some psychological effects that may result from the abuse of tranquilizers:

  • Risk of anxiety or paranoia attacks
  • Mood disorders, personality shifts
  • Feelings of rage or aggressiveness
  • Dulled emotional responses
  • Delusions or Hallucinations

Social Impact: The prolonged use of tranquilizers will have a negative impact on an individual’s social life. If you or a loved one is abusing tranquilizers, you may observe these social effects:

  • Estranged relationships with family and friends
  • Difficulty engaging in social functions
  • Isolation and increased seclusion from loved ones
  • Seclusion from loved ones

Men and women abusing tranquilizers will incur damage to the other facets of their lives as well, such as in their financial responsibilities, career, and work and familial duties. For the duration of time that tranquilizers are abused, addicts will continually experience these consequences until professional help is sought and appropriate treatment is received.

Tranquilizer Withdrawal

The withdrawal from tranquilizers can be a dangerous process as the body has become dependent on the drug and a variety of unpleasant symptoms can be induced once the drug is no longer in the body’s systems. Symptoms can vary from person to person depending on how long tranquilizers have been abused. Because of the severity of the symptoms that can result, it is important that the withdrawal process take place under medical supervision. Withdrawal symptoms will usually begin anywhere from 6-36 hours after the last use of the drug and can include the follow:

  • Seizures
  • Convulsions
  • Psychotic episodes
  • Chills
  • Hot flashes
  • Loss of appetite
  • Night sweats
  • Rapid breathing
  • Confusion, altered reality
  • Muscle aches
  • Irritability, Rage

It is usually expected that symptoms worsen and reach the peak of discomfort around the first to second day of the withdrawal process. In certain situations, physicians may be able to prescribe a medication to help ease the discomfort that is experienced while withdrawing from tranquilizers. Treatment programs tailored specifically for tranquilizer addictions will have the necessary resources to help individuals safely withdraw from these substances, and having this support is invaluable during the recover process.

Tranquilizer Addiction Treatment and Help

With adequate support and with the proper resources, you can be well on your way towards recovery from a tranquilizer addiction. If you or a loved one is struggling with a tranquilizer addiction, take comfort in knowing that you are not alone. There is nothing more valuable than your life, wellness, and peace and you are deserving of the freedom that is experienced apart from dependence on a drug. Though it might feel painfully difficult or impossible to break your addiction, take hope in knowing that recovery is always an achievable option. You should find treatment centers that work with a tranquilizers addiction. You will ultimately have the ability to overcome this addiction by receiving the help you need.

: U.S. Food and Drug Administration. http://www.fda.gov/

: Partnership for a Drug-Free America http://www.drugfree.org

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 15th, 2013
Published on AddictionHope.com, Addiction Help

What Are Sedatives?

Sedative drugs are helpful for treating anxiety and sleep problems, but using them can lead to dependence or addiction.

Sedatives are a category of drugs that slow brain activity.

Also known as tranquilizers or depressants, sedatives have a calming effect and can also induce sleep.

There are three main classes of sedative medications:

Barbiturates: These drugs can be taken on their own or along with anesthesia. They’re sometimes used to treat seizure disorders.

Some examples of barbiturates include Nembutal (pentobarbital) and phenobarbital.

Benzodiazepines: These drugs are also used to treat seizures, as well as for muscle spasms, and anxiety before medical procedures.

Rohypnol (flunitrazepam) is a short-acting benzodiazepine that is 10 times stronger than Valium. Rohypnol has been used as a “date rape” drug, and is no longer legal in the United States.

“Z-drug” sleep medications: These drugs act on a specific type of receptor in the central nervous system called BZ1, which makes their action as a sleep aid very targeted.

Some examples of “Z-drug” medications include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon).

Hallucinations and psychosis have been reported in some people who take these drugs, and they’re not intended for long-term use.

Side Effects of Sedatives

The effects of using sedatives can resemble those of alcohol. In addition to their desired calming effects, sedative use can cause:

  • Drowsiness, dizziness, and confusion
  • Problems with movement and memory
  • Slowed heart rate and breathing, which may be worsened if combined with alcohol
  • Increased risk of falls and injury
  • Worsening of depression and anxiety symptoms
  • Impaired attention and judgment
  • Mood swings and inappropriate behavior
  • Risk of dependence and addiction
  • Risk of death from overdose, either intentional or unintentional

If you suspect an overdose in yourself or someone else, contact a poison control center or get to an emergency room immediately.

You can contact a poison control center at (800) 222-1222.

Sedative Dependence and Addiction

Dependence and addiction are risks for all three classes of sedatives.

Addiction means having a compulsive desire to use a drug, even when this has a harmful effect on your work or personal life.

If you’re addicted, you may feel unable to quit using the drug.

Dependence is when your body learns to depend on a drug. It can occur without addiction, but it often accompanies addiction.

If you become dependent on a drug, you may need a higher dose to achieve the desired effect (tolerance), or there may be physical or psychological effects when the drug is stopped (withdrawal).

If you’re using any sedative medication regularly, you shouldn’t stop taking it abruptly, as this can cause severe withdrawal symptoms such as seizures.

In order to stop taking the drug, you may need to have your dose reduced over time (tapered) with the help of a healthcare provider.

According to the National Institute on Drug Abuse, the 3 most common tranquilizers are:6

  • Barbiturates – The use of barbiturates has declined over the years due to the risk of adverse reactions, overdose, and dependence. Their medicinal use for anxiety and sleep has been replaced by benzodiazepines and sleep medications. However, they are still used for anesthesia and to treat seizure disorders.2
  • Benzodiazepines – These medications are typically used to treat anxiety and panic disorders.3 A large class of drugs, benzodiazepines are sometimes sub-classified according to potency, speed of onset of effects, and half-life. Some of the more commonly prescribed drugs include Xanax, Ativan, Klonopin, and Valium, among others.
  • Sleep medications – These medications are considered hypnotic (or, sleep inducing) tranquilizers. They act on the GABA receptors to induce sleep for those who suffer from insomnia. Some popular sleep medications include Lunesta, Ambien, and Sonata.6

Barbiturate Overdose Symptoms

  • Loss of coordination
  • Slurred speech
  • Difficulty thinking and/or concentrating
  • Loss of consciousness
  • Abnormally low blood pressure and heart rate
  • Respiratory depression or the cessation of breathing
  • Shock
  • Kidney failure
  • Death2

Benzodiazepine Overdose Symptoms

  • Loss of coordination
  • Paradoxical agitation
  • Blurred vision or other visual impairments
  • Slurred speech
  • Confusion
  • Amnesia
  • Drowsiness or unresponsiveness
  • Altered mental status
  • Hallucinations
  • Abnormally low blood pressure
  • Dizziness
  • Respiratory depression
  • Coma7

Sleep Medication Overdose Symptoms

  • Agitation
  • Dizziness
  • Confusion
  • Amnesia
  • Altered mental status
  • Hallucinations
  • Low blood pressure
  • Cardiovascular arrest
  • Respiratory depression
  • Unresponsiveness
  • Coma4,5

If you observe any of the above symptoms and suspect that you or someone you love has overdosed on tranquilizers, it is important that you call 911 immediately. Remain with your loved one or friend and attempt to keep him or her awake until emergency medical personnel arrive.

More Information on Barbiturates Addiction & Recovery

  • Effects of Phenobarbital Abuse
  • Barbiturates Overdose
  • Fioricet Treatment Centers
  • Sedative Addiction Recovery
  • Stop Abusing Phenobarbital
  • Amytal Rehab Facilities
  • Barbiturate Addiction Rehab
  • Treating Tranquilizer Abuse
  • Find Recovery for Butalbital Use
  • Forum Topic Discussions

Risk Factors for Overdose

  • Age – Younger and older people may react differently to medications and be more sensitive to their effects.3,4,5
  • Length of time of use – The long-term use of barbiturates can lead to tolerance. People who develop tolerance may take more of a prescribed medication than was previously necessary to receive the same benefit. Unfortunately, although the person’s tolerance may have increased, the lethal dose of barbiturates remains the same, making an accidental overdose more likely the longer barbiturates are taken.2
  • Use of other central nervous system depressants – Tranquilizers used in combination with other central nervous system depressants, such as alcohol, can increase the chances of a fatal overdose.2
  • Existence of certain medical conditions – Tranquilizers slow many of the body’s natural processes, including breathing and heart rate. Someone who has a pre-existing heart or lung condition may be at greater risk for overdose.

Tranquilizer Overdose Treatment

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According to the National Institute on Drug Abuse, there are currently no FDA-approved medications to specifically treat prescription sedative addiction.6

Flumazenil, a GABA receptor antagonist, has been shown to help with some of the sedative effects of some tranquilizers. It may be used in the case of a tranquilizer overdose, though it may cause withdrawal and seizures in long-term users.4,5,7,8

Treatment for a tranquilizer overdose is primarily supportive and can include:

  • Maintaining the airway and using ventilation support.
  • Stomach pumping.
  • Activated charcoal, particularly for barbiturates.
  • Administration of fluids via IV.4,5,8

Can You Die from a Tranquilizer Overdose?

A barbiturate overdose can be fatal.

  • Barbiturates – An overdose of barbiturates can be fatal. It is estimated that 1 out of every 10 people who overdose on barbiturates or a mixture containing barbiturates will die.1 There is a slim margin between the dose of barbiturates that is therapeutic and the amount that can be fatal. The risk of death by intentional or unintentional barbiturate overdose is amplified by combining them with other central nervous system depressants.
  • Benzodiazepines – An overdose on benzodiazepines alone is unlikely, as they carry a very low risk for acute toxicity. But when benzodiazepines are used in combination with other central nervous system depressants, such as alcohol, the combination can be fatal. It is estimated that up to 41% of those abusing alcohol will also abuse a benzodiazepine medication at some point in their lifetime. Up to 80% of benzodiazepine abuse is part of polysubstance abuse.3
  • Sleep medications – A fatal overdose on a sleep medication is rare. However, as with the other classes of tranquilizers, the risk of depression of breathing and heart rate is significantly increased if you are taking sleep medications with depressants such as alcohol or opiates.4,5

Recovering from an Overdose


The likelihood of surviving a tranquilizer overdose is increased if it is the only substance in a person’s system. However, many people abuse other substances in combination with tranquilizers, making the potential for fatality much more likely.

If you or a loved one has been fortunate enough to recover from a tranquilizer overdose, it is important that you seek help. Seeking addiction treatment can help you change the course of your life and drastically reduce the chance of a future overdose. If you are considering treatment as an option, there are several levels of care that could be appropriate.

  • Residential or Inpatient tranquilizer rehab programs can last anywhere from 28 days to several months. You will be in a safe environment surrounded by others who understand what you are going through. You will receive medical, psychiatric, therapeutic, and nutritional care throughout your stay. Many programs also include detox.
  • Outpatient tranquilizer recovery can take many forms, from meeting weekly with a therapist to attending a program multiple days a week. Programs can vary in terms of time commitment and level of care. Outpatient offers more flexibility than inpatient, but people who have serious substance abuse problems may need a higher level of care.
  • 12-step programs – Twelve-step programs such as Narcotics Anonymous and Pills Anonymous provide a free, mentor-based recovery program that involves making amends to those you have harmed in addiction and embracing a higher power. Non-12-step options include SMART Recovery and Secular Organizations for Sobriety.

Find a Recovery Center

If you or a loved one is recovering from a tranquilizer overdose or fear that you may be headed in that direction, please contact a representative today at 1-888-319-2606 Who Answers? . We can help you or your loved one get on the road to recovery.

Sources

. U.S. National Library of Medicine. (2015). Barbiturate intoxication and overdose.

. European Monitoring Centre for Drugs and Drug Addiction. (2015). Barbiturates drug profile.

. U.S National Library of Medicine. (2016). Label: Lunesta – eszopiclone tablet, coated.

. U.S. National Library of Medicine. (2016). Label: Ambien – zolpidem tartrate tablet, film coated.

. National Institute on Drug Abuse. (2016). Commonly abused drug charts.

. Gresham, C. (2016). Benzodiazepine toxicity: Practice essentials.

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Benzodiazepines, Tranquilizers and Sleeping Pills

Here are some of the common tranquilizers and sleeping pills, and their generic names.

A Benzo Story

It’s easy to become dependent on tranquilizers. People can become dependent on them inadvertently, even if you take them for just a few months. For example, if you followed your doctor’s orders and never abused your prescription, you could still experience significant withdrawal symptoms if you stop them suddenly after a few months.

This is a true story about dependence to prescription tranquilizers (sometimes called benzos). Unfortunately it is a story that happens almost every day. Cheryl (not her real name) came to me after ten years of being prescribed Ativan. Although the story is about Ativan, I have heard similar stories about all tranquilizers.

Cheryl was a happy young lady at twenty years old. She rarely took Tylenol for a headache. Life was good, except for her stressful job.

Then one day Cheryl felt a tightness in her chest and had difficulty breathing. Her heart began to race. Her palms were sweaty and her hands were shaking. She was overcome with worry, but didn’t know what she was worried about.

Cheryl went to her doctor who listened to her story and told her that she was experiencing an anxiety attack. The visit lasted less than 15 minutes and at the end of the visit he handed her a prescription for Ativan.

The tranquilizer worked exactly as expected initially. Within a few days Cheryl was more relaxed, and she was sleeping better. Sometimes she slept so soundly that she woke up feeling groggy the next morning. But that passed. Even the stress of work was easier to handle. Both Cheryl and her doctor were relieved.

For the next two years Cheryl continued to use Ativan on and off as needed. She never abused it, and never used more than her prescription. For two years her doctor kept on prescribing Ativan with little reassessment. As time went on Cheryl started using it a little more often. Eventually she was taking a tranquilizer almost every day. Sometimes her family doctor would simply renew the prescription over the phone. Cheryl was just happy that the anxiety attacks had gone.

By the end of the third year Cheryl was concerned, and approached her doctor. Was Ativan addictive she wondered? He assured her it was not. But Cheryl had her doubts and she persuaded her doctor to take her off the drug. One week later, Cheryl was hit with a series of anxiety attacks. She felt a little guilty that she questioned her doctor, and he immediately restarted her on Ativan.

What Cheryl didn’t know was that the anxiety attacks may have been avoided if she had been tapered off the drug correctly. In fact suddenly stopping tranquilizers can be dangerous.

There is a significant risk of seizure, strokes, heart attacks, or hallucinations if you stop tranquilizers suddenly.

Two years later, still not convinced that this was the harmless drug her doctor said it was, Cheryl took herself off the tranquilizers. The withdrawal was rough. Cheryl experienced all kinds of symptoms, including anxiety, mood swings, and poor concentration.

Her husband started to lose patience. But she persisted. Then one day, her boss told her that she had to take on more responsibilities at work. Cheryl tried to explain that she was going through a difficult time and that she wasn’t sure she could take on more stress right now. But her boss said that the company was restructuring and Cheryl’s job might be on the line.

Despite all that stress, Cheryl managed to remain off the pills and get through the withdrawal. But during that time she didn’t dare see her doctor once, because she was afraid that if he made the slightest suggestion she would lose her resolve and go back on Ativan.

Cheryl managed to stay off tranquilizers for a whole year, and was feeling stronger all the time. Given enough time we know she would have done well. It takes about 2 years for patients to fully recover from the effects of tranquilizers. But Cheryl’s mother fell ill and Cheryl took on the responsibility of her medical care.

One night, Cheryl suddenly woke up with her heart pounding in her chest. She had difficulty breathing, and she thought she was going to die. She went to the emergency room, and after a full examination was told that there was nothing wrong with her. She had experienced another anxiety attack.

The emergency room sent a follow up letter to her family doctor who booked an appointment to see Cheryl. He said he wanted to refer Cheryl to a psychiatrist.

The psychiatrist explained that Cheryl had a chemical imbalance, and that this was the cause of her anxiety. He said that it was not uncommon, and there was an effective treatment for it. He assured her that it was not addictive, and his very words were, “You can take this medication for the rest of your life.” Then the psychiatrist did something that set Cheryl back another five years. He wrote her a prescription for Ativan.

Now events started to happen a little more quickly. The Ativan wasn’t as effective as it had been in the past, and there were days when Cheryl needed more than her usual dose. The psychiatrist agreed that on bad days Cheryl could take 1 or 2 more pills to deal with her anxiety. By the end, Cheryl was being prescribed 4 times her initial dose. But at each visit her psychiatrist reassured her that she was doing well. Gradually, he spent less and less time with her since the Ativan was working. Some visits consisted of him just writing a prescription.

Cheryl had become dependent on tranquilizers. The more she took them, the more her brain adapted to them, and the more she needed. Whenever she tried to slow down, her withdrawal symptoms forced her to start up again.

The irony of tranquilizers is that they’re prescribed for anxiety and sleep. But the longer you take them the more they increase your anxiety and disturb your sleep.

The doctors had said that Cheryl could take these pills for the rest of her life. And sure enough it was coming true. Tranquilizers are the perfect addictive drug. The longer you take them — the more you need them.

After a while Cheryl began to experience new symptoms. She started feeling depressed. Initially she had a hard time describing it. She was less interested in things. She didn’t have as much energy as she normally did, and she wasn’t as happy. She complained to her psychiatrist who eventually decided to start Cheryl on an antidepressant. But he continued to prescribe the tranquilizer.

Most addictive drugs if taken long enough can cause depression. It is quite common with tranquilizers. Cheryl had been given a tranquilizer that caused depression, and now she was taking an antidepressant to counteract the tranquilizer.

Ten years had passed in one person’s life. What started out as anxiety, probably brought on by work stress, had gradually escalated into dependence and depression.

Finally, it was Cheryl herself who took the initiative and sought help to come off her drugs. She was gradually tapered off her Ativan, and counseled on post-acute withdrawal. Her withdrawal was uncomfortable, but with support she managed to get through it.

Cheryl completed her taper, went through withdrawal, and is now living a better life. Her symptoms disappeared after about two years. She will now happily tell you that she feels better than she’s felt in years, and that it’s good to no longer be dependent on tranquilizers.

Why are benzodiazepines still prescribed? If they’re that awful why do doctors still use them? Because they can be helpful if taken for a short time. Some people need them to deal with unusually stressful situations. But if you take them for longer than a few weeks or months, your body will adapt to them, your anxiety level will rise, and you will need more of them over time.

Potential Symptoms of Long-term Use

The longer you use tranquilizers and sleeping pills the more anxious you become. In the beginning they help you relax and fall asleep. But after a few months they have the opposite effect.(1)

One of the most disturbing symptoms of long-term benzodiazepine use is depersonalization. It means not feeling quite real. It’s impossible to describe unless you’ve experienced it, but tranquilizer patients often say things like “I don’t feel quite real,” or “my arms don’t feel connected to my body,” or “when I’m in a group of people I somehow feel outside of myself.” All bizarre descriptions that mean the person is experiencing depersonalization.

Depersonalization is usually worse during post-acute withdrawal. I have known patients who thought they were going crazy because they had depersonalization, when in fact they were experiencing typical tranquilizer withdrawal. The depersonalization will go away eventually, but it can take many months. Of course, you should always see a doctor if you have any unusual symptoms – preferably one who is familiar with addictions.

Benzodiazepine Tapering

There is an excellent website on tranquilizers and tapering off tranquilizers. It is Benzodiazepine Addiction, Withdrawal&Recovery (benzo.org.uk). This site contains taper schedules from the “Ashton Manual”, written by Professor Heather Ashton, a world authority on benzodiazepine post-acute withdrawal.

Benzodiazepine Post-Acute Withdrawal Symptoms

  • Anxiety
  • Mood swings
  • Depersonalization
  • Poor concentration
  • Social isolation
  • Low energy
  • Disturbed sleep

Post-acute withdrawal gradually gets better over two years. Your symptoms should show gradual improvement. Measure your progress month to month. If you measure your progress day to day, or week to week, you’ll often have one week that will be worse than the week before. But if you measure your progress month to month you should see steady improvement. If you take care of yourself, and you’re patient, you can get through this.

Look at the post-acute withdrawal page to learn more about those symptoms and how to deal with them.

Recovery and Relapse Prevention Strategies

If you have decided that you are addicted, this is your opportunity to change your life. Learn more about recovery skills and relapse prevention strategies in the following pages. You can recover from addiction and be happier.

Last Modified:December 4, 2019

Sedative-hypnotic drug

Sedative-hypnotic drug, chemical substance used to reduce tension and anxiety and induce calm (sedative effect) or to induce sleep (hypnotic effect). Most such drugs exert a quieting or calming effect at low doses and a sleep-inducing effect in larger doses. Sedative-hypnotic drugs tend to depress the central nervous system. Since these actions can be obtained with other drugs, such as opiates, the distinctive characteristic of sedative-hypnotics is their selective ability to achieve their effects without affecting mood or reducing sensitivity to pain.

Diazepam (Valium) is a benzodiazepine drug that is commonly used to reduce symptoms of anxiety.U.S. Drug Enforcement Administration

For centuries alcohol and opium were the only drugs available that had sedative-hypnotic effects. The first substance introduced specifically as a sedative and as a hypnotic was a liquid solution of bromide salts, which came into use in the 1800s. Chloral hydrate, a derivative of ethyl alcohol, was introduced in 1869 as a synthetic sedative-hypnotic; it was used notoriously as “knock-out” drops. Paraldehyde was introduced into clinical medicine in the 1880s and was followed by the synthesis of barbital in 1903. Phenobarbital became available in 1912 and was followed, during the next 20 years, by a long series of other barbiturates. In the mid-20th century new types of sedative-hypnotic drugs were synthesized, chief among them the benzodiazepines (the so-called minor tranquilizers).

Barbiturates were extensively used as “sleeping pills” throughout the first half of the 20th century. They also were used to reduce voluntary inhibition during psychiatric examinations (for which they have sometimes been dubbed “truth serums”). Among the most commonly prescribed kinds were phenobarbital, secobarbital (marketed under Seconal and other trade names), amobarbital (Amytal), and pentobarbital (Nembutal). When taken in high-enough doses, these drugs are capable of producing a deep unconsciousness that makes them useful as general anesthetics. In still higher doses, however, they depress the central nervous and respiratory systems to the point of coma, respiratory failure, and death. Additionally, the prolonged use of barbiturates for relief of insomnia leads to tolerance, in which the user requires amounts of the drug much in excess of the initial therapeutic dose, and to addiction, in which denial of the drug precipitates withdrawal, as indicated by such symptoms as restlessness, anxiety, weakness, insomnia, nausea, and convulsions. Analysis of electroencephalographic (EEG) patterns during barbiturate-induced sleep has further revealed that the use of some of these drugs produces sleep disruption.

The use of barbiturates declined after the development in the 1950s of the benzodiazepines. The latter are more effective in relieving anxiety than in inducing sleep, but they are superior to barbiturates because of the reduced dangers they present of tolerance and addiction and because they are much less likely to injuriously depress the central nervous system when used at high doses. They also require a much smaller dosage than barbiturates to achieve their effects. The benzodiazepines include chlordiazepoxide (Librium), diazepam (Valium), alprazolam (Xanax), oxazepam (Serax), and triazolam (Halcion). They are, however, intended only for short- or medium-term use, since the body does develop a tolerance to them and withdrawal symptoms (anxiety, restlessness, and so on) develop even in those who have used the drugs for only four to six weeks. The benzodiazepines are thought to accomplish their effect within the brain by facilitating the action of the neurotransmitter gamma-aminobutyric acid, which is known to inhibit anxiety.

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Antipsychotic drugs (major tranquilizers), tricyclic antidepressants, and antihistamines can also induce drowsiness, though this is not their primary function. Most over-the-counter sleeping aids use antihistamines as their active ingredient.

Alcoholic beverages in particular are only of modest benefit in inducing sleep. On frequent exposure to alcohol, the nervous system adapts to the drug, and this results in early-morning awakening.

Sedatives

Symptoms of Use

Barbiturates and benzodiazepines have the potential for abuse and should be used only as prescribed. During the first few days after taking a prescribed CNS depressant, a person usually feels drowsy and uncoordinated; however, this typically diminishes. If one uses these drugs long term, the body will develop tolerance, and larger doses will be required to achieve the same initial effects.

In addition, continued use can lead to physical dependence and—when use is lessened or stopped—withdrawal symptoms. Because all CNS depressants work by slowing the brain’s activity, when an individual stops taking them, the brain’s workings can rebound and race out of control, possibly resulting in seizures and other harmful consequences. Although withdrawal from benzodiazepines can be a difficult experience, it is rarely life threatening, whereas withdrawal from prolonged use of other CNS depressants can have life-threatening complications. Therefore, someone who is thinking about discontinuing CNS depressant therapy or who is suffering withdrawal from a CNS depressant should speak with a physician or seek medical assistance.

At high doses or when they are abused, many of these drugs can cause unconsciousness or even death.

Side Effects

When taking sedatives of any kind, activity of the central nervous system becomes slowed down. Small doses relieve tension; large doses increase the risk of other undesirable side effects. These include:

  • staggering
  • blurred vision
  • impaired perception of time and space
  • slowed reflexes and breathing
  • reduced sensitivity to pain
  • impaired thinking
  • slurred speech

Overdoses cause unconsciousness, coma, and death. Accidental overdoses may occur when children swallow pills or when adults with increased tolerance are unsure of how many to take.

CNS depressants should be used with other medications only under a physician’s supervision. Typically, they should not be combined with any other medication or substance that causes CNS depression, including prescription pain medicines, some over-the-counter cold and allergy medications, or alcohol. Using CNS depressants with these other substances—particularly alcohol—can slow breathing, or slow both the heart and respiration, possibly resulting in death.

Other health risks of sedative use include:

  • anemia
  • depression
  • impairment of liver function
  • chronic intoxication (headache, impaired vision, slurred speech)

Babies of chronic users may have difficulty with breathing and feeding, disturbed sleep patterns, sweating, irritability, and fever.

Sedative Tolerance and Withdrawal

Very significant levels of physiological dependence marked by both tolerance and withdrawal can develop in response to the sedatives. The timing and severity of withdrawal issues will differ depending on the specific substance.

A physical symptom of dependence is tolerance, meaning higher levels are needed to achieve the same calming effect.

Symptoms of psychological dependence include needing the drug to function and being obsessed with obtaining the drug.

Symptoms of withdrawal include:

  • restlessness
  • insomnia
  • anxiety
  • seizures
  • in rare cases, death

To be clinically diagnosed with having a Sedative, Hypnotic, or Anxiolytic Use Disorder, there must be a problematic pattern of impairment or distress, with at least two of the following symptoms within the previous 12-month period:

  • Taking larger dosages and/or taking the drugs for a longer period of time than intended
  • Desiring to reduce or control sedative, hypnotic, or anxiolytic drug use, or making unsuccessful attempts to do so
  • Spending large amounts of time procuring or using the sedative, hypnotic, or anxiolytic, or recovering from the effects of the sedative, hypnotic, or anxiolytic drug
  • An overwhelming desire or urge to use the sedative, hypnotic, or anxiolytic
  • Frequent absences from job or school, or the inability to maintain obligations for one’s job, school, or home life due to sedative, hypnotic, or anxiolytic drug use
  • Continued sedative, hypnotic, or anxiolytic drug use in the face of social/interpersonal problems that result from, or are made worse by, the use of the drug
  • Sedative, hypnotic, or anxiolytic use is prioritized to such an extent that social, occupational, and recreational activities are either given up completely or reduced drastically
  • Sedative, hypnotic, or anxiolytic use even in situations where it is physically hazardous
  • Use of the sedative, hypnotic, or anxiolytic drug continues even when the individual knows the physical and psychological risks
  • Tolerance, as defined by either of the following:
    • Considerable increases in the amount of the sedative, hypnotic, or anxiolytic drug to achieve the desired effect
    • The same use of the sedative, hypnotic, or anxiolytic drug no longer results in the desired effect
  • Withdrawal, as defined by either of the following
    • The individual displays withdrawal symptoms and characteristics of the sedative, hypnotic, or anxiolytic drug
    • Symptoms of withdrawal diminish with use of the sedative, hypnotic, or anxiolytic drug, or the drug is used to relieve or avoid symptoms of withdrawal

The tolerance and withdrawal criteria are not met if an individual is taking sedatives, hypnotics, or anxiolytics under medical supervision.

DEPRESSANTS

Sometimes called “downers,” these drugs come in multicolored tablets and capsules or in liquid form. Some drugs in this category, such as Zyprexa, Seroquel and Haldol, are known as “major tranquilizers” or “antipsychotics,” as they are supposed to reduce the symptoms of mental illness. Depressants such as Xanax, Klonopin, Halcion and Librium are often referred to as “benzos” (short for benzodiazepines1). Other depressants, such as Amytal, Numbutal and Seconal, are classed as barbiturates—drugs that are used as sedatives and sleeping pills. Some of the well-known brand and street names can be found here.

depressants: short-term effects

  • Slow brain function
  • Slowed pulse and breathing
  • Lowered blood pressure
  • Poor concentration
  • Confusion
  • Fatigue2
  • Dizziness
  • Slurred speech
  • Fever
  • Sluggishness
  • Visual disturbances
  • Dilated pupils
  • Disorientation, lack of coordination
  • Depression
  • Difficulty or inability to urinate
  • Addiction

Higher doses can cause impairment of memory, judgment and coordination, irritability, paranoia,3 and suicidal thoughts. Some people experience the opposite of the intended effect, such as agitation or aggression.

Using sedatives (drugs used to calm or soothe) and tranquilizers with other substances, particularly alcohol, can slow breathing and the heart rate and even lead to death.

(Photo credit: Stockxpert)

depressants: long-term effects

Tolerance to many depressants can develop rapidly, with larger doses needed to achieve the same effect. The user, trying to reach the same high, may raise the dose to a level that results in coma or death by overdose.

Long-term use of depressants can produce depression, chronic fatigue, breathing difficulties, sexual problems and sleep problems. As a dependency on the drug increases, cravings, anxiety or panic are common if the user is unable to get more.

Withdrawal symptoms include insomnia, weakness and nausea. For continual and high-dose users, agitation, high body temperature, delirium, hallucinations and convulsions can occur. Unlike withdrawal from most drugs, withdrawal from depressants can be life-threatening.

These drugs can also increase the risk of high blood sugar, diabetes, and weight gain (instances of up to 100 pounds have been reported).

In a study conducted by USA Today, based on Food and Drug Administration data over a four-year period, antipsychotics (a type of depressant) were the prime suspects in forty-five deaths caused by heart problems, choking, liver failure and suicide.

“I have overdosed twice off of prescription pills (Zyprexa) and had a close friend die of the same drug….There is no worse feeling than knowing that your friend is dead because you gave him pills you knew relatively little about.” —Linda

Is Alcohol a Depressant?

Drinking profoundly alters an individual’s mood, behavior, and neuropsychological functioning. For many people, alcohol consumption is a means of relaxation; however, the effects of alcohol and hangovers can actually induce anxiety and increase stress. Alcohol is classified as a Central Nervous System depressant, meaning that it slows down brain functioning and neural activity. Alcohol does this by enhancing the effects of the neurotransmitter GABA.

Alcohol can depress the central nervous system so much that it results in impairment such as slurred speech, unsteady movement, disturbed perceptions, and an inability to react quickly. Mentally, alcohol reduces an individual’s ability to think rationally, lessens inhibitions, and distorts judgment. If an individual consumes too much alcohol too rapidly, they can depress the central nervous system to a point of respiratory failure, coma, or death.

Alcohol encompasses both stimulating and sedative effects. Although clinically categorized as a depressant, the amount of alcohol consumed and a person’s individual reaction determines the type of effect he or she will experience. Most people drink for the initial stimulant effect, to “loosen up” and reduce social inhibitions. However, if a person consumes more than the body can handle or has a higher tolerance, he or she will then begin to experience alcohol’s sedating effects such as cognitive impairment. Some individuals actually drink primarily for alcohol’s sedative effects, such as anxiety reduction. Some studies suggest that most people initially drink alcohol to experience stimulation and associated positive effects, but after becoming dependent or developing an addiction, they switch to drink primarily to experience the anxiety associated with the sedative effects. Drinking slowly is more likely to lead to a desire for more sedative effects, while drinking rapidly tends to increase stimulation effects.

Some researchers believe that people who don’t respond to alcohol’s sedative effects as strongly as others are at a heightened risk of developing an alcohol use disorder. They drink more to compensate for the fact that they don’t immediately feel anything, increasing their chances of experiencing the negative side effects. Alcohol overdose, or alcohol poisoning, can cause even more severe depressant effects, including: inability to feel pain, toxicity, unconsciousness, slow and irregular breathing, cold, clammy, and blue skin, and possibly even death. These reactions additionally depend on how much an individual consumes and how quickly.

How Depressants Effect the Mind and Body

Alcohol impacts the brain in a variety of ways. The substance binds to receptors for gamma-aminobutyric acid (GABA), which is a neurotransmitter responsible for producing feelings of calmness and sedation, as well as the depression of the central nervous system that causes suppression of breathing and heart rate. Alcohol also inhibits glutamate, resulting in memory loss and other impaired brain functionality. In addition to effecting GABA and glutamine, alcohol releases dopamine – the neurotransmitter chemical responsible for pleasure and reward. This causes people to drink even more in an attempt to increase those feel good feelings that dopamine produces.

However, as more alcohol is consumed, more depressant effects will develop. As an individual continues drinking and more alcohol enters the system, it impairs judgement, vision, and alertness; dulls the senses; affects concentration; and slows down reaction time.

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Side Effects of Alcohol and Other Depressants

In addition to alcohol, there are many other depressant drugs. Sometimes referred to as “downers,” these are medications that are regularly prescribed to reduce symptoms of anxiety, panic, and sleep disorders due to their tranquilizing effects. The most common depressants include:

  • Xanax
  • Valium
  • Halcion
  • Ativan
  • Klonopin
  • Librium

Abusing depressant medications and alcohol can result in both short-term and long-term effects, some of which can be irreversible. While many people use depressants because of the relaxing effects that these substances temporarily create, the severity of the negative effects far outweigh any positive associations. Side effects of depressant abuse include:

  • Low blood pressure
  • Slowed heart rate
  • Fatigue
  • Light-headedness
  • Dizziness
  • Slurred speech
  • Depression
  • Unconsciousness
  • Vomiting
  • Impaired motor skills
  • Slowed breathing
  • Nausea
  • Low blood pressure
  • Seizures
  • Death

There are a number of non-physical effects of depressant abuse as well. Many depressant abusers experience problems with finances, employment, friends, and family. Additionally, the effects that alcohol induces can easily put others at risk and in danger, such as driving under the influence, participating in unprotected sex, and engaging in physical altercations.

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Finding Treatment for Alcohol and Depressants

If you or someone you know is struggling with an addiction to alcohol or another depressant, know that you are not alone and that there are treatment options available. Treatment facilities across the country are waiting to provide you or your loved one with the best possible care so that you can reclaim your life without substance abuse. Contact a treatment expert today, and get started on your journey to recovery.

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