Sedatives – An Overview

The first thing that comes into our mind when we hear the word ‘sedative’ , is someone completely drugged, unconscious, possibly forced by some mafia goons, or; drug addicts as shown in movies. Well, we are not to blame because we were conditioned to believe so. However, there are a range of drugs called sedatives from the most common alcohol to medically prescribed sedatives to local street drugs.

In ancient times, alcohol was indeed used to ease tension or stress, reduce anxiety, etc. Alcohol still remains one of the most abused sedative. But, is that it? Is alcohol and it’s produced effects all a sedative is about? Absolutely not.

What are Sedatives?

Sedatives are drugs that subdues the excitement of the Central Nervous System (CNS) and causes relaxation without inducing sleep, although drowsiness may be produced. This results in deceleration of the physical and mental processes of the human body. Sedatives are used as drugs to alleviate anxiety and sleep disorders when prescribed by doctors. It is also used as a component of general anaesthesia.

Sedatives are controlled drugs, regulated by the Nation’s drug department and it is not to be sold or procured Over-the-Counter (OTC). This is so because sedatives are highly addictive drugs that can be misused by people. When taken in high dosages it can lead to changes in gait, slurred speech, blurred vision, poor judgement and slow down of reflexes. In case of overdose or mixing with another drug, sedatives can be lethal (Jewell, 2019). https://www.healthline.com/health/sedatives

How does it work?

Sedatives are mostly classified according to it’s impact internally on the human body. There are a diverse group of drugs that comprises of the ability to lower the activity of the CNS and diminish the brain’s level of awareness. Since there is a structural difference in between different sedatives, attributing the mechanism of action to a single receptor or part is difficult. However majority of them affect the neurotransmitter- gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter, which regulates several cortical functions in the body. It is also known to regulate anxiety by reducing the neuronal excitability in the CNS (Mestrovic, 2018).

Therefore, although each sedative acts in its specified way, they end effect is the same as that of producing ease and relaxation by making the GABA work overtime. Once the sedative enters the body, the absorption occurs immediately through the gut or the gastrointestinal tract. Once absorbed into the small intestine and procured it’s desired effects, it prepares for elimination from the body. The sedatives are usually metabolised into active components, and is expelled mostly by hepatic metabolism, i.e., through liver (Mestrovic, 2018). https://www.news-medical.net/health/What-are-Sedatives.aspx

Types of Sedatives

Sedatives are available in many types as discussed above. The most legitimate type being prescribed medical drugs. In early days,  research for other sedatives other than alcohol began. Bromides were discovered in 1826 and used until the toxic effects of the drug came into the picture. Then came the most commonly prescribed sedatives, which are, barbiturates & benzodiazepenes.

• Barbiturates: Mostly used upto the 1960s, they are basically hypnotics and sedatives which causes general suppression of most neuronal activity, thus they are considered nonselective, i.e., it cannot suppress the neurons responsible for a particular function singularly. Therefore, when used, it could lead to a certain degree of impairment in the cognitive functioning. Due to this serious effect, barbiturates had to be replaced by benzodiazepene, which is a a selective sedative (Mestrovic, 2018).
• Benzodiazepene: After 1960s, benzodiazepene came into being, which is a selective sedative, i.e., it selectively affects the neurons that have receptors for GABA. Therefore when benzodiazepene enters the body, it increases the activity of GABA, causing relaxation and inhibition of neuronal excitability. These drugs are very addictive and hence the intake has to be monitored by the physician. These drugs tend to develop tolerance in the body, i.e., once the individual starts taking these drugs in a particular dosage for their symptoms, the dosage will have to be increased further overtime to produce same effect as in the beginning (Mestrovic, 2018). https://www.news-medical.net/health/What-are-Sedatives.aspx

Other types of sedatives are-

• Non-benzodiazepine
• Anti-histamines
• Herbal sedatives
• Opioid sedatives
• Anaesthetics, etc.

Dependency or abuse

Since sedatives activates GABA, it relaxes your body and reduces fear and anxiety. According to dosages, it can create euphoria or feeling ‘high’. To achieve this, individuals tend to use sedatives for recreational purposes or use higher doses than prescribed. Alcohol is a classic example for abuse along with narcotics.

Benzodiazepene is one of those drugs commonly abused, although it creates less euphoria, tolerance or sleep as compared to barbiturates. However tolerance and withdrawal symptoms can be developed due to chronic use of the drug.

Withdrawal symptoms are the first sign to one’s dependency. They are nothing but the way one’s body responds to absence of sedatives which may involve discomfort in physical and psychological processes, unexplainable pain, sleep disturbances, etc.

Common withdrawal symptoms include:

• Inability to sleep
• Irritability and restlessness
• Increased anxiety
• Muscle Spasm
• Headache
• Body pain
• Hyperventilation & hypersensitivity, etc

Side-effects

Sedatives can have a series of side effects when used for longer period of time. Hence it is very important for doctors to prescribe the drugs accordingly. However if due to certain conditions, the individual takes sedatives longer, it can lead to both short-term and long-term side effects.

Short-term side effects include:

• Impaired reflexes
• Blurred vision
• Slurred or incomprehensible speech
• Drowsiness
• Giddiness
• Difficulty in visuo-spatial perception
• Poor attention and concentration
• Increased threshold of pain reflexes

Long term side effects include:

• Increased anxiety
• Depressive symptoms such as anhedonia, fatigue, forgetfulness, hopelessness, helplessness & worthlessness, suicidal thoughts, etc
• In certain cases, amnesia is possible
• Liver damage or failure
• Addiction to sedatives  (Jewell, 2019). https://www.healthline.com/health/sedatives

Treatment

This might be ironic, since we are talking about treatment for a drug that was supposed to be a treatment option. However, long-term usage, overdose or dependency, etc. of sedatives can be harmful to the body. Both the physician and the patient must be cautious about the administration or consumption of sedatives. Some necessary cautions to be taken while under medically prescribed sedative are:

1. Stay away from alcohol: mixing of two types of sedatives can lead to life-threatening effects
2. Try alternative drugs
3. Consult a doctor before taking any other medication.
4. Do not take sedatives if you are pregnant unless prescribed
5. Don’t use any other street drugs or smoke marijuana
6. Try to maintain a healthy life style through proper diet, exercise, etc.
7. Undergo psychotherapy for anxiety or related symptoms (Jewell, 2019). https://www.healthline.com/health/sedatives