Advertisement

Central Nervous System (CNS) Depressants

  • Marc A. Schuckit
Part of the Critical Issues in Psychiatry book series (CIPS)

Abstract

The central nervous system (CNS) depressant drugs include a variety of medications, such as hypnotics, most antianxiety drugs (also called minor tranquilizers),and alcohol.1 As discussed in greater depth in Section 2.1.1.4.4, a new group of nonbenzodiazepine antianxiety drugs have appeared in recent years, but these are not CNS depressants. The general anesthetics are not presented here, as time and space constraints forced me to limit the discussion to the substances most clinically important in drug abuse. One anesthetic agent, phencyclidine (PCP), is abused as a hallucinogen and is discussed in Chapter 9.

Keywords

Clinical Psychiatry Withdrawal Syndrome Toxic Reaction Anterograde Amnesia Paradoxical Reaction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Harvey, S. C. Hypnotics and sedatives. In A. G. Gilman, L. S. Goodman, T. W. Rall, and F. Murad (Eds.), The Pharmacological Basis of Therapeutics ( 7th ed. ). New York: Macmillan, 1985, pp. 339 - 371.Google Scholar
  2. 2.
    Jaffe, J. H. Drug addiction and drug abuse. In A. G. Gilman, L. S. Goodman, T. W. Rall, and Murad, F. (Eds.), The Pharmacological Basis of Therapeutics ( 7th ed. ). New York: Macmillan, 1985, pp. 532 - 581.Google Scholar
  3. 3.
    National Clearing House for Drug Abuse Information. The CNS Depressant Withdrawal Syndrome and Its Management: An Annotated Bibliography: 1950-1983. Rockville, Maryland: National Institute on Drug Abuse, 1975.Google Scholar
  4. 4.
    Sapira, J. D., and Cherubin, C. E. Drug Abuse: A Guide for the Clinician. Amsterdam: Excerpta Medica; New York: American Elsevier, 1975.Google Scholar
  5. 5.
    Covi, L., Lipman, J. H., Pattison, J. H., et al. Length of treatment with anxiolytic sedatives and response to their sudden withdrawal. Acta Psychiatrica Scandinavica 49: 51 - 64, 1973.PubMedCrossRefGoogle Scholar
  6. 6.
    Buston, U., Sellers, E. M., Naranjo, C. A., et al. Withdrawal reaction after long-term therapeutic use of benzodiazepines. New England Journal of Medicine 315: 854 - 859, 1986.CrossRefGoogle Scholar
  7. 7.
    Goodman, W. K., Charney, D. S., Price, L. H., et al. Ineffectiveness of clonidine in the treatment of the benzodiazepine withdrawal syndrome: Report of three cases. American Journal of Psychiatry 143: 900 - 903, 1986.PubMedGoogle Scholar
  8. 8.
    Schneider, L. S., Syapin, P. J., and Pawluczyk, S. Seizures following triazolam withdrawal despite benzodiazepine treatment. Journal of Clinical Psychiatry 48: 418 - 419, 1987.PubMedGoogle Scholar
  9. 9.
    Rickels, K., Case, W. G., Schweizer, E. E., et al. Low-dose dependence in chronic benzodiazepine users: A preliminary report on 119 patients. Psychopharmacology 22: 407 - 416, 1986.Google Scholar
  10. 10.
    Campbell, R., Schaffer, C. B., and Tupin, J. Catatonia associated with glutethimide withdrawal. Journal of Clinical Psychiatry 44: 32 - 33, 1983.PubMedGoogle Scholar
  11. 11.
    Falco, M. Methaqualone misuse: Foreign experience and United States drug control policy. International Journal of the Addictions 11: 597 - 610, 1976.PubMedGoogle Scholar
  12. 12.
    Kay, D. C. Blackburn, A. B., Buckingham, J. A., and Karacan, I. Chapter 4: Human pharmacology of sleep. In R. I. Williams and I. Karacan (Eds.), Pharmacology of Sleep. New York: Wiley, 1976, pp. 419 - 428.Google Scholar
  13. 13.
    Schuckit, M. A. Anxiety treatment: A commonsense approach. Postgraduate Medicine 75: 52 - 63, 1984.PubMedGoogle Scholar
  14. 14.
    Raskind, M. A., and Eisdorfer, C. When elderly patients can’t sleep. Drug Therapy, August 1977, pp. 44 - 50.Google Scholar
  15. 15.
    Dement, W. C. Some Must Watch While Others Sleep: The Portable Stanford. Stanford, California: Stanford Alumni Association, 1972.Google Scholar
  16. 16.
    Greenblatt, D. J., and Shader, R. I. Benzodiazepines in Clinical Practice. New York: Raven Press, 1974.Google Scholar
  17. 17.
    Greenblatt, D. J., Harmatz, J. S., Zinny, M. A., and Shader, R. I. Effect of gradual withdrawal on the rebound sleep disorder after discontinuation of triazolam. New England Journal of Medicine 317: 722 - 728, 1987.PubMedCrossRefGoogle Scholar
  18. 18.
    Greenblatt, D. J., Shader, R. I., Franke, K., et al. Pharmacokinetics and bioavailability of intravenous, intramuscular, and oral lorazepam in humans. Journal of Pharmaceutical Sciences 68: 5763, 1979.CrossRefGoogle Scholar
  19. 19.
    Tallman, J F, Paul, S. M., Skolnick, P., et al. Receptors for the age of anxiety: Pharmacology of the benzodiazepines. Science 207: 274 - 281, 1980.PubMedCrossRefGoogle Scholar
  20. Darragh, A., Scully, M., Lambe, R., et al. Investigation in man of the efficacy of a benzodiazepine antagonist, Ro 15-1788. Lancet 1:8-10,1981.Google Scholar
  21. 21.
    Massotti, M., Guidotti, A., and Costa, E. Characterization of benzodiazepine and y-aminobutyric acid recognition sites and their endogenous modulators. Journal of Neuroscience 1: 409 - 418, 1981.PubMedGoogle Scholar
  22. 22.
    Skolnick, P., Moncada, V., Barker, J. L., et al. Pentobarbital: Dual actions to increase brain benzodiazepine receptor affinity. Science 211: 1448 - 1450, 1981.PubMedCrossRefGoogle Scholar
  23. 23.
    Britton, K. T., Ehlers, C. L., and Koob, G. F. Is ethanol antagonist Ro 15-4513 selective for ethanol? Science 239: 648 - 649, 1988.PubMedCrossRefGoogle Scholar
  24. 24.
    Schuckit, M. A. New frontiers in the treatment of anxiety. Internal Medicine (Special Issue):42-49,1985.Google Scholar
  25. 25.
    Wheatley, D. Zopiclone: A non-benzodiazepine hypnotic controlled comparison to temazepam in insomnia. British Journal of Psychiatry 146: 312 - 314, 1985.PubMedCrossRefGoogle Scholar
  26. 26.
    Rickels, K. Recent advances in anxiolytic therapy. Journal of Clinical Psychiatry 42: 40 - 44, 1981.PubMedGoogle Scholar
  27. 27.
    Gershon, S., and Eison, A. S. Anxiolytic profiles. Journal of Clinical Psychiatry 44: 45 - 56, 1982Google Scholar
  28. 28.
    Eison, A. S., and Temple, D. L. Buspirone: Review of its pharmacology and current perspectives on its mechanism of action. American Journal of Medicine 80: 1 - 9, 1986.PubMedCrossRefGoogle Scholar
  29. 29.
    Uhlenhuth, E. H. Discussant presentation: Buspirone: A clinical review of a new, non-benzodiazepine anxiolytic. Journal of Clinical Psychiatry 43: 109 - 114, 1982.PubMedGoogle Scholar
  30. 30.
    Schweizer, E., and Rickels, K. Failure of buspirone to manage benzodiazepine withdrawal. American Journal of Psychiatry 143:1590-1592, 1986.Google Scholar
  31. 31.
    Riblet, L. A., Taylor, D. P., Eisan, M. S., and Stanton, H. C. Pharmacology and neurochemistry of buspirone. Journal of Clinical Psychiatry 43: 11 - 15, 1982.PubMedGoogle Scholar
  32. 32.
    Lader, M. Psychological effects of buspirone. Journal of Clinical Psychiatry 43: 62 - 67, 1982.PubMedGoogle Scholar
  33. 33.
    Moskowitz, H., and Smiley, A. Effects of chronically administered buspirone and diazepam on driving-related skills performance. Journal of Clinical Psychiatry 43: 45 - 49, 1982.PubMedGoogle Scholar
  34. 34.
    Cole, J. P., Hecht-Orzack, M., Bease, B., and Bird, M. Assessment of the abuse liability of buspirone in recreational sedative users. Journal of Clinical Psychiatry 43: 69, 1982.PubMedGoogle Scholar
  35. 35.
    Lader, M. Assessing the potential of buspirone dependence or abuse and effects of its withdrawal. American Journal of Medicine 82: 20 - 26, 1987.PubMedCrossRefGoogle Scholar
  36. 36.
    Roy-Byrne, P., and Katon, W. An update on treatment of the anxiety disorders. Hospital and Community Psychiatry 38: 835 - 843, 1987.PubMedGoogle Scholar
  37. 37.
    Mackinnon, G. L., and Parker, W. A. Benzodiazepine withdrawal syndrome: A literature review and evaluation. American Journal of Drug and Alcohol Abuse 9: 19 - 33, 1982.PubMedCrossRefGoogle Scholar
  38. 38.
    Busto, U. Patterns of benzodiazepine abuse and dependence. British Journal of Addictions 81: 8794, 1986.CrossRefGoogle Scholar
  39. 39.
    Mellinger, G. D., Baiter, M. B., and Uhlenhuth, E. H. Insomnia and its treatment. Archives of General Psychiatry 42:225-232, 1985.Google Scholar
  40. 40.
    Chaplin, S. Benzodiazepine prescribing. Lancet 1: 120 - 121, 1988.PubMedCrossRefGoogle Scholar
  41. 41.
    Cole, J. O., Haskell, D. S., and Orzack, M. H. Problems with the benzodiazepines: An assessment of the available evidence. McLean Hospital Journal 6: 46 - 74, 1981.Google Scholar
  42. 42.
    Blackwell, B. Benzodiazepines: Drug abuse and data abuse. Current Psychiatry Research 16: 1037, 1979.Google Scholar
  43. 43.
    Schuckit, M. Alcohol and drug interactions with antianxiety medications. American Journal of Medicine 82: 27 - 33, 1987PubMedCrossRefGoogle Scholar
  44. 44.
    Cohen, S. Valium: Its use and abuse. Drug Abuse and Alcoholism Newsletter 5:1-3, San Diego: Vista Hill Foundation, 1976.Google Scholar
  45. 45.
    Nicholi, A. M. The nontherapeutic use of psychoactive drugs. New England Journal of Medicine 308: 925 - 933, 1983.PubMedCrossRefGoogle Scholar
  46. 46.
    Smart, R. G., Adlaf, E. M., and Goodstadt, M. S. Alcohol and other drug use among Ontario students: An update. Canadian Journal of Public Health 77: 57 - 58, 1986.Google Scholar
  47. 47.
    Smart, R. G., Goodstadt, M. S., Adlaf, E. M., et al. Trends in the prevalence of alcohol and other drug use among Ontario students: 1977-1983. Canadian Journal of Public Health 76: 157 - 161, 1985.Google Scholar
  48. 48.
    Brophy, J. J. Suicide attempts with psychotherapeutic drugs. Archives of General Psychiatry 17: 652 - 657, 1967.CrossRefGoogle Scholar
  49. 49.
    Diaz, J. Phenobarbital: Effects of long-term administration on behavior and brain of artifically reared rats. Science 199: 90 - 91, 1978.PubMedCrossRefGoogle Scholar
  50. 50.
    Regestein, Q. R., and Reich, P. Agitation observed during treatment with new hypnotic drugs. Journal of Clinical Psychiatry 46: 280 - 283, 1985PubMedGoogle Scholar
  51. 51.
    Schuckit, M. A., Irwin, M., and Brown, S. The history of anxiety symptoms among 171 primary alcoholics. Journal of Studies on Alcohol (in press).Google Scholar
  52. 52.
    Lewis, D. C., and Senay, E. C. Treatment of Drug and Alcohol Abuse. New York: Career Teaching Center, 1981.Google Scholar
  53. 53.
    Setter, J. G. Emergency treatment of acute barbiturate intoxication. In P. G. Bourne (Ed.), A Treatment Manual for Acute Drug Abuse Emergencies. Washington, D.C.: U.S. Government Printing Office, 1974, pp. 49 - 62.Google Scholar
  54. 54.
    Risch, S. C., Groom, G. P., and Janowsky, D. S. Interfaces of psychopharmacology and cardiology: Part H. Journal of Clinical Psychiatry 42: 47 - 59, 1981.PubMedGoogle Scholar
  55. 55.
    Diagnosis and Management of Reactions to Drug Abuse. New Rochelle, New York: The Medical Letter, 1977.Google Scholar
  56. 56.
    Lorch, J. A. Haemoperfusion for acute intoxication with hypnotic drugs. Lancet 1: 1116, 1979.Google Scholar
  57. 57.
    Allen, M. D., Greenblatt, D. K., and Lacasse, Y. Pharmacokinetic study of lorazepam overdosage. American Journal of Psychiatry 137: 1414 - 1415, 1980.PubMedGoogle Scholar
  58. 58.
    Boldy, D. A. R., Heath, A., Ruddock, S., Vale, J. A., and Prescott, L. F. Activated charcoal for carbamazepine poisoning. Lancet 1: 1027, 1987.PubMedCrossRefGoogle Scholar
  59. 59.
    Editorial: Repeated oral activated charcoal in acute poisoning. Lancet 1:1013-1016,1987.Google Scholar
  60. 60.
    Nutt, D., and Costello, M. Flumazenil and benzodiazepine withdrawal. Lancet 2: 463, 1987.CrossRefGoogle Scholar
  61. 61.
    Fraser, A. A., and Ingram, I. M. Lorazepam dependence and chronic psychosis. British Journal of Psychiatry 147: 211, 1987.CrossRefGoogle Scholar
  62. 62.
    McLellan, A. T., Woody, G. E., and Brien, C. P. Development of psychiatric illness in drug abusers. New England Journal of Medicine 301: 1310 - 1314, 1979.CrossRefGoogle Scholar
  63. 63.
    Pomara, N., Stanley, B., Block, R., et al. Increased sensitivity of the elderly to the central depressant effects of diazepam. Journal of Clinical Psychiatry 46: 185 - 187, 1985.Google Scholar
  64. 64.
    Bergman, H., Borg, S., and Holm, L. Neuropsychological impairment and exclusive abuse of sedatives or hypnotics. American Journal of Psychiatry 137: 215 - 217, 1980.PubMedGoogle Scholar
  65. 65.
    Scharf, M. Comparative amnestic effect of benzodiazepines. Journal of Clinical Psychiatry 49: 134137, 1988.Google Scholar
  66. 66.
    Raskind, M., and Eisdorfer, C. Psychopharmacology of the aged. In L. L. Simpson (Ed.), Drug Treatment of Mental Disorders. New York: Raven Press, 1976, pp. 123 - 131.Google Scholar
  67. 67.
    Ashton, H. Benzodiazepine withdrawal: Outcome in 50 patients. British Journal of Psychiatry 82:665-671, 1987.Google Scholar
  68. 68.
    Rickels, K., Fox, I. L., Greenblatt, D. J., et al. Clorazepate and lorazepam: Clinical improvement and rebound anxiety. American Journal of Psychiatry 145: 312 - 317, 1988.PubMedGoogle Scholar
  69. 69.
    Jurgens, S. M., and Morse, R. M. Alprazolam dependence in seven patients. American Journal of Psychiatry 145: 625 - 627, 1988.Google Scholar
  70. 70.
    Fyer, A. J., Liebowitz, M. R., Gorman, J. M., et al. Discontinuation of alprazolam treatment in panic patients. American Journal of Psychiatry 144: 303 - 308, 1987.PubMedGoogle Scholar
  71. 71.
    Vinogradov, S. Clonidine therapy in withdrawal from high dose alprazolam. American Journal of Psychiatry 143:1188, 1986.Google Scholar
  72. 72.
    Stewart, R. B., Salem, R. B., Springer, P. K. A case report of lorazepam withdrawal. American Journal of Psychiatry 137: 1113 - 1114, 1980.PubMedGoogle Scholar
  73. 73.
    Nagy, B. R., and Dillman, C. E. Case report of unusual diazepam abstinence syndrome. American Journal of Psychiatry 138: 694 - 695, 1981.Google Scholar
  74. 74.
    Preskom, S. H., and Denner, L. J. Benzodiazepines and withdrawal psychosis. Journal of the American Medical Association 237: 36 - 38, 1977.CrossRefGoogle Scholar
  75. 75.
    Wilder, A. Diagnosis and treatment of drug dependence of the barbiturate type. American Journal of Psychiatry 125: 758 - 765, 1968.Google Scholar
  76. 76.
    Smith, D. E., and Wesson, D. R. Phenobarbital technique for treatment of barbiturate dependence. Archives of General Psychiatry 24: 56-60, 1971.Google Scholar
  77. 77.
    Diagnosis and Management of Reactions to Drug Abuse,New Rochelle, New York: The Medical Letter, Vol. 19(3), Feb. 1977.Google Scholar
  78. 78.
    Grant, I., Adams, K. M., and Reed, R. Subacute organic mental disorders. In I. Grant (Ed.), Neuropsychiatric Correlates of Alcoholism. Washington, DC: APA Press, 1986, pp. 37 - 60.Google Scholar
  79. 79.
    Grant, I., and Judd, L. L. Neuropsychological and EEG disturbances in polydrug users. American Journal of Psychiatry 133 (9): 1039 - 1042, 1976.Google Scholar
  80. 80.
    Wolkowitz, O. M., Weingartner, H., Thompson, K., and Pickar, D. Diazepam-induced amnesia: A neuropharmacological model of an organic amnestic syndrome. American Journal of Psychiatry 144: 25 - 29, 1987.Google Scholar
  81. 81.
    Kumar, R., Mac, D. S., Gabrielli, W. F., and Goodwin, D. W. Anxiolytics and memory: A comparison of lorazepam and alprazolam. Journal of Clinical Psychiatry 48: 158 - 160, 1987.PubMedGoogle Scholar
  82. 82.
    Scharf, M. B. Anterograde amnesia with oral lorazepam. Journal of Clinical Psychiatry 44: 36 2364, 1983.Google Scholar
  83. 83.
    Ray, W. A., Griffin, M. R., Schaffner, W., et al. Psychotropic drug use and the risk of hip fracture. New England Journal of Medicine 316: 363 - 369, 1987.PubMedCrossRefGoogle Scholar
  84. 84.
    Castillo-Ferrando, J. R. Digoxin levels and diazepam. Lancet 2: 368, 1980.PubMedCrossRefGoogle Scholar
  85. 85.
    Desmond, P. V., Patwardhan, R. V., Schenker, S., et al. Cimetidine impairs elimination of chlordiazepoxide (Librium) in man. Annals of Internal Medicine 93:266-268, 1980.Google Scholar
  86. 86.
    Schuckit, M. A. Alcohol and drug interactions with antianxiety medications. American Journal of Medicine 82:27-34, 1987.Google Scholar
  87. 87.
    Abernethy, D. R., Greenblatt, D. J., Divoli, M., et al. Impairment of diazepam metabolism by low-dose estrogen-containing oral-contraceptive steroids. New England Journal of Medicine 306:791 792, 1982.Google Scholar
  88. 88.
    Jick, H., Holmes, L. B., Hunter, J. R., et al. First-trimester drug use and congenital disorders. Journal of the American Medical Association 246: 343 - 346, 1981.PubMedCrossRefGoogle Scholar
  89. 89.
    Laegried, L. Abnormalities in children exposed to benzodiazepines in utero. Lancet 1: 108 - 109, 1987.CrossRefGoogle Scholar
  90. 90.
    Kellogg, C. K., Simmons, R. D., Miller, R. K., and Ison, J. R. Prenatal exposure in rats: Long-lasting functional changes in the offspring. Neurobehavioral Toxicology and Teratology 7: 483 - 488, 1985.Google Scholar
  91. 91.
    Gupta, C. Prenatal exposure to phenobarbital permanently decreases testosterone and causes reproductive dysfunction. Science 216: 640 - 642, 1982.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Marc A. Schuckit
    • 1
  1. 1.San Diego School of Medicine, Veterans Administration HospitalUniversity of CaliforniaSan DiegoUSA

Personalised recommendations