Parental alcoholism as a risk factor in benzodiazepine abuse: a pilot study

Article Abstract:

Earlier studies indicated that alcoholics are at higher risk for benzodiazepine abuse than non-alcoholics. Benzodiazepines are a group of psychotropic drugs, including tranquilizers and hypnotics, prescribed to treat anxiety or sleep disorders. In a prior experiment conducted by the authors, it was found that the dosages of the tranquilizer alprazolam, a benzodiazepine, created distinctly different mood effects in alcoholics when compared with non-alcoholics. The plasma levels of drug concentration of the two groups were not significantly different. Therefore, the different effects of the drug could not be explained pharmacologically. To further investigate groups at higher risk for abuse, a control group of 12 was compared with a group of 12 adult sons of alcoholics. The criteria for defining alcoholism in DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, third edition, revised) were used. The final analysis did not include three of the subjects because they were classified as alcohol dependent. None of the subjects reported any drug usage for the prior year and all consumed comparable amounts of alcohol. Each group was given a 1.0-mg oral dose of alprazolam and euphoria reactions were measured by the Addiction Research Center Inventory-MBG Scale. Of the adult sons of alcoholics, nine of the 12 indicated an increased state of euphoria. Only two of the control subjects had a reaction to the drug. Blood samples were taken and similar concentrations of the drug were found in both groups. These measurements did not account for the differences of reaction in the two groups. It was concluded that adult sons of alcoholics are at higher risk for alprazolam abuse than individuals without a family history of alcoholism. Although these results should still be considered preliminary, it is possible that alprazolam may serve as a marker of high risk for developing alcoholism. Further study was recommended to clarify this hypothesis. It is also recommended that caution be taken in prescribing benzodiazepines to patients with a family history of alcoholism.

Research, Risk factors, Genetic aspects, Alcoholism, Benzodiazepine abuse

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Controlled discontinuation of benzodiazepine treatment for patients with panic disorder

Article Abstract:

Panic disorder is a chronic mental illness characterized by discrete periods of intense, inexplicable fear, accompanied by symptoms such as shortness of breath, dizziness, palpitations, trembling, and fear of dying or going crazy. The most common treatment for panic is the long-term use of one of the benzodiazepines. Benzodiazepines are a class of antianxiety drug which provide general sedative action. Different benzodiazepines have different rates of metabolic processes (absorption and distribution in the body). Drugs which metabolize quickly, such as alprazolam, usually result in immediate withdrawal reactions, while those which metabolize slowly (e.g., diazepam) usually do not cause immediate withdrawal symptoms after discontinuation. Both alprazolam and diazepam are commonly prescribed to treat panic disorder. To compare the effects of discontinuing treatment of alprazolam and diazepam, 24 women and 26 men (average age of 39 years) with panic disorder who had responded well to the administration of alprazolam, diazepam or an inert placebo for eight months, were gradually withdrawn from medication. Physical and psychiatric ratings were monitored throughout the dose reduction and discontinuation phase. The discontinuation study consisted of two weeks without medication and was completed by 36 percent of those taking alprazolam, 42 percent of those taking diazepam, and 67 percent of those taking placebo. Anxiety symptoms were rated as severe or extreme during discontinuation by 68 percent of those taking alprazolam, 26 percent of those taking diazepam, and 17 percent of those taking placebo. Sixty percent of those taking alprazolam, versus 26 percent of those taking diazepam, reported a rebound of anxiety symptoms which were worse than the original symptoms. Findings suggest that short-acting benzodiazepines lead to more intense distress, rebound panic and anxiety symptoms following discontinuance than longer-acting benzodiazepines. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Drug therapy, Panic disorders, Panic disorder, Drug withdrawal symptoms, Substance withdrawal syndrome

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Insights into the structure and function of GABA-benzodiazepine receptors: ion channels and psychiatry

Article Abstract:

Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter of the brain. Inhibitory neurons that employ GABA are found throughout the central nervous system. Effects of different classes of drugs on the GABA complex strongly suggest that this system is involved in psychiatric disease states and symptoms. GABA receptors are sites of action for potentiating compounds such as barbiturates, benzodiazepines, steroid anesthetics and alcohol. Although the mechanisms vary, these compounds promote the direct opening of chloride-selective GABA ion channels in a dose-dependent manner. It is now known that benzodiazepines do not directly change chloride channel properties, but rather influence GABA to open the channel. Thus, the degree of benzodiazepine effects depends on GABA concentrations. It is unlikely that GABA is the only transmitter system involved in the etiology of anxiety. However, the actions of sedative-hypnotics on the GABA complex make these proteins the likeliest sites of pathology in certain anxiety states. Since GABA enhances the actions of alcohol and sedatives, it is now presumed to be involved in various forms of substance abuse which may have genetic underpinnings. Complex relationships between depression, anxiety and the role of GABA receptors present important avenues for future exploration. Advances in biophysics have provided new and important insights into the interactions between GABA receptors and many psychopharmacological agents, which are likely to lead to a clearer understanding of disease states and drug effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, GABA

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