Sedative drugs, combined prescribing

Lithium is rarely used as the only treatment for acute mania, a practical acknowledgment of its limitations. If it is used at all it is combined with a neuroleptic and other sedatives are frequently prescribed as well. Trials comparing effects of lithium and carbamazepine in acute mania reveal that substantial doses of benzodiazepines or barbiturates were used in addition to the study drugs (Freeman et al. 1992 Small et al. 1991). However the belief in lithium s specificity for manic depression means it is still deemed an effective treatment and it is still recommended for mild to moderate cases of mania (National Institute for Clinical Excellence 2006). 

Drug interactions also may cause problems with different nonprescribed drugs or combinations of prescribed and nonprescribed drugs. The most common examples are mixing drugs that depress the central nervous system. For example, as we said earlier, alcohol and the barbiturates may be lethal in enhancing the sedative effects of each. This drug combination has caused many intentional and accidental deaths. 

The benzodiazepines (BZDs), which were introduced nearly 40 years ago, were hailed as a breakthrough because they have fewer of the drawbacks of prior anxiolytics and sedative-hypnotics, are effective in a range of disorders, and are safe in combination with most drugs (except other sedatives), as well as alone in overdose, and are generally mild in terms of side effects. For these reasons, BZDs quickly became, and remain, among the most widely prescribed drugs worldwide. 

In reality psychiatric patients are often prescribed a whole cocktail of drugs, often at high doses. Many take a combination of neuroleptics, so-called mood stabilisers and benzodiazepines, all of which have sedative effects that dampen down and restrict nervous system activity in different ways. A British government report published in 2007 suggested that up to one in three psychiatric patients was being overtreated with drugs... 

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