Psychological and Psychiatric Consequences of Sedatives, Hypnotics, and Anxiolytics

Abstract

The use of substances to induce sedation has a long history, even when alcohol is not considered. As early as the mid 19th century, production of agents designed for this purpose began with the introduction of bromide. Paraldehyde, chloral hydrate, urethan, and sulfonyl were also introduced prior to the beginning of the 20th century. Barbiturates dominated the early part of this century after their introduction in 1903, and up to 50 compounds in this class were eventually brought to market (Allgulander, 1986; Janicak, Davis, Preskorn, & Ayd, 1993). The benzodiazepines became available in the 1960s and their use and popularity grew steadily over the next 20 years. The benzodiazepines have now largely replaced barbiturates and other sedatives introduced around mid-century, such as methaqualone, meprobamate, ethchlorvynol, and glutethimide, for most therapeutic uses (Rosenbaum & Gelenburg, 1991; Smith & Seymour, 1991; Sternbach, 1993). This has been due largely to their relative safety (high lethal-therapeutic ratio) and an initial perception that they had a lower potential for misuse and physical dependence. It gradually became clear, however, that a dependence syndrome can be produced in some individuals within a short period of time. As these medications have been prescribed more liberally, there has been significant public concern about their level of use and misuse in society (Lader, 1991; Smith & Seymour, 1991).