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International data shows that almost 25% to 33% population of the Western European and some Asian countries are dependent on sedative hypnotic and anxiolytics.

What is sedative hypnotic and anxiolytic (SHA) dependence?

Through the ages individuals have been depending on chemical substances which relieve stress, anxiety, tension and helps withstand the feeling of discomfort. Sedatives are medications that slow the normal brain function and are commonly prescribed for the individuals suffering from excitement and tension. Hypnotics induce sleep and anxiolytics reduces or prevents anxiety. Sedatives, hypnotics and anxiolytics play an important role in management of both medical illnesses and psychiatric disorders. Medications such as benzodiazepine, carbamate and barbiturate are commonly prescribed to treat anxiety, sleeplessness, spasticity (acting in spasms or jerkiness), convulsions and they also to aid in treating alcohol/drug withdrawal symptoms.

Occasionally individuals may develop dependence to these medications. Here, the individuals develop drug seeking behavior and consistently take excess medications. International data shows that almost 25% to 33% population of the Western European and some Asian countries are dependent on sedative hypnotic and anxiolytics.

Influence of drug dependence may be due to genetic predisposition, personal characteristics and social circumstances. Symptomatic sadness, emotional distress, which is relieved by the drug and a sense of social alienation, also leads to increased use and dependence. In hospitalized conditions, individuals suffering from back pain, or pain due to certain abnormalities of red blood cell or disorders of the nerve, require this medication on a regular basis for relief .Many individuals subsequently take medications continuously and become dependent.

How do I know if I have Sedative Hypnotic or Anxiolytic dependence?

Individuals who are constantly taking SHAs tend to become dependent upon these medications as time progresses. At times the dosage may need to be increased as smaller dosages do not relieve the symptoms. Withdrawal or decrease in the dosage of these medications can lead a wide range of symptoms including restlessness, disturbing dreams, frequent awakening, and feelings of tension in the mornings. These symptoms that occur when the administration of SHA medication is stopped or the dosage is reduced abruptly are commonly referred to as withdrawal symptoms and indicate dependence. Withdrawal symptoms may also include features such as sweating, increased pulse rate (>100 beats per minute), increased hand tremor, nausea or vomiting, loss of vision, deafness , auditory sensory loss ,scary images, anxiety, sleep disorder, hypotension, restlessness, blurred vision, sweating, and drowsiness occur.

Higher the dose of barbiturates and benzodiazepines leads to physical dependence or withdrawal syndrome. Severe dependence shows increased risk of complications further leading to death. Withdrawal syndrome occurs due to emotional and behavioral changes. The severity of withdrawal syndrome depends on the dose, duration and elimination rate of the medications administered.

How is Sedative Hypnotic or Anxiolytic dependence treated?

Sedatives, hypnotics and anxiolytic dependence are initially treated by reducing the dose and withdrawing the drug while monitoring the signs closely. Re-evaluating the individual treatment schedule and underlying psychological conditions is generally carried out. In some cases the individual may be switched over to long acting drugs such as flurazepam.clonazepam and diazepam. Individuals who suffer from severe withdrawal symptoms require hospitalization with intensive care. Life saving measures along with administration of adjunctive medication is also prescribed if necessary.

Recovery from SHA dependence occurs in four phases. During the acute phase the treatment focuses on alleviating symptoms associated with physiological withdrawal, since the SHA drugs can stay in the body for longer period even though the individual has stopped using of the drug. During the second phase the treatment is focused on changing the behavior. Early remission phase (state of absence of drug consumption) can last up to 12 months, and the sustained remission phase lasts as long as the individual stops from using or abusing these medications.

Close observation is needed for at least 72 to 96 hours in acute phase during withdrawal symptoms. Medication preferred in acute phase may include benzodiazepines to decrease unintended muscle movement, fall in blood pressure and heart rate Overdose of barbiturates are treated by administering sodium bicarbonate through veins to increase the rate of barbiturate excretion. Depending on the individual circumstances dialysis is also recommended. Psychological intervention such as counseling and behavioral therapy is also advised.

Is Sedative Hypnotic or Anxiolytic dependence harmful?

Continuous use of these drugs is found to develop dependence over these medications which can lead to withdrawal symptoms on stopping the consumption of these drugs. Studies have shown that about 20-100% of the individuals prescribed with benzodiazepines tend to develop physical and psychological dependence. Occasionally, drug seeking behavior is also seen in such individuals. The commonly noted withdrawal symptoms include: anxiety, convulsions, frequent alterations in emotional states or persistent depression. Consumption of higher dose of sedatives for prolonged duration can lead to problems such as poor memory, difficulty in thinking, slowing of speech and emotional disorders.

Read More: Barbiturates Abuse: Causes and Abuse Symptoms of Drugs Classified as Hypnotics and Sedatives

How can I prevent sedative hypnotic or anxiolytic dependence?

The sedative, hypnotic or anxiolytic drugs are commonly advised to treat high levels of stress, anxiety and tension. Always discuss with your healthcare provider about the possible side effects of drugs used to treat such conditions. The SHA drugs are generally prescribed in smaller doses initially with gradual increase in the dosage to attain the required concentration of the drug. The reverse order is followed when stopping wherein the dosage of the drug is gradually reduced to the lowest level before completely stopping the usage of the drug. Therefore it is highly necessary to strictly follow the instructions provided by the doctor regarding the use of these drugs. Try alternative options such taking measures such as organizing your work to reduce work related stress and improving interpersonal relations at home. Alternative therapies such as acupuncture, meditation, yoga, tai chi and others have also been noted to relieve the anxiety and tensions. Try these and gradually stop using the medications.

  • Ulrich John, Sebastian E Baumeister, Henry Volzke, Christian Meyer, Sabina Ulbricht, Dietrich Alte .Sedative, hypnotic, anxiolytic and opiod medicament use and its co-occurrence with tobacco smoking and alcohol risk drinking in a community sample.BMC Public Health 2007, 7:337 doi: 10.1186/1471-2458-7-337
  • Busto UE, Sellers EM. Anxiolytics and sedative/hypnotics dependence.Br J Addict. 1991, 86(12):1647-52