Benzodiazepine psychological effects

Medications for symptomatic relief from vertigo consist of antiemetics, benzodiazepines and antihistamines. They are all mostly aimed at the psychological consequences of dizziness and can all have highly unfavourable side effects, for example, sedation, anticholinergic effects and insomnia. The psychological consequences of dizziness in elderly should rather be treated with information about the condition, supportive help actions and increased social activities, than with drugs. 

The ideal animal model for any human chnical condition must fulfill three criteria (McKinney and Bunney 1969) (1) pharmacological treatments known to be effective in patients should induce comparable effects in the animal model (predictive validity) (2) the responses or symptoms observed in patients should be the same in the animal model (face validity) (3) the imderlying rationale should be the same in both humans and animal models (construct validity). In other words, the ideal animal model for anxiety has to respond to treatment with anxiolytics such as benzodiazepines with reduced anxiety it has to display defense behavior when confronted with a threatening stimulus the mechanisms underlying anxiety as well as the psychological causes must be identical. 

The efficacy of beta-blockers in the symptomatic relief of anxiety in adults has been established in over a dozen controlled trials (Neppe, 1989). In a number of countries, beta-blockers have been licensed for the treatment of anxiety disorders. Somatic manifestations of anxiety such as palpitations, diaphoresis, and tremor, rather than core psychological symptoms, were particularly responsive to beta-blocker treatment. In comparative trials that included patients with severe anxiety and panic attacks, the antianxiety effect of beta-blockers was, however, somewhat less powerful than that of benzodiazepines (Lader, 1988), with the exception of a small trial that compared alprazolam to propranolol (Ravaris et ah, 1991). Head-to-head comparisons of beta-blockers and selective serotonin reuptake inhibitors (SSRIs) are lacking. Performance and stress-related anxiety that may affect public performers, such as musicians or people taking an examination or giving a speech, seems to be particularly suited for beta-blocker treatment (Lader, 1988). Beta-blockers may be given on an as-required basis 1-2 hours before the stressful situation. 

Because long-term exposure to high-dose benzodiazepines may place some patients at risk for physical and psychological dependence, we recommend the use of antidepressants for the treatment of panic disorder. For most patients, SSRIs should be considered first-line agents. The choice should be based on the factors discussed in Chapter 2. MAOls are usually reserved for patients whose symptoms have not responded to SSRIs and TCAs. A major caveat is that patients with panic disorder initially may be highly sensitive to the stimulant effect of small doses of antidepressants. For highly anxious patients with panic disorder, treatment may be... 

Nonbenzodiazepine anxiolytic. Busprione (Bu-Spar) is the first in a class of drugs that specifically work as anxiolytics. In addition to exerting no sedative effect, this medication poses few of the disadvantages associated with the benzodiazepines—such as physical or psychological dependency—and does not significantly interact with most other compounds. 

Flunitrazepam (Rohypnol), also known as roofies, is a benzodiazepine with physiological effects similar to diazepam (Valium), although it is about 10 times more potent. The drug produces sedative-hypnotic effects that include muscle relaxation and amnesia it can also produce physical and psychological dependence. It is illegal and not approved for use in the United States. 

The pharmacological properties of these drugs are dealt with in Chapter 5, and therefore only their propensity to cause physical and psychological dependence is considered here. Because of their lack of efficacy, and particularly because of their toxicity, barbiturates should never be used now as anxiolytic or sedative drugs. For this reason, emphasis is placed here on the benzodiazepines, which are not only effective but also relatively safe. Nevertheless, problems have arisen regarding their ability to cause dependence, and so this aspect of their pharmacology must be considered. 

An additional psychotropic medication that may be worth considering specifically for GAD is buspirone. One major benefit of buspirone can be found in the virtual absence of dependence and abuse liability. Although it is not effective for the acute relief of anxiety or panic disorders (anxiolytic effects may take up to a week to be established), buspirone may be indicated for patients with a history of alcohol abuse or among those who fear physiologic and psychological dependence with benzodiazepines. 

Patient education should include the anticipated length of drug therapy, potential side effects, and consequences of the ingestion of alcohol and other CNS depressants. Patients should understand that benzodiazepines provide symptomatic rehef hut do not solve underlying psychological problems. Patients should he instructed not to decrease or discontinue benzodiazepine usage without contacting their prescriber. 

---