cion®) and estazolam (Prosom®) are prescribed for short-term treatment of sleep disorders. Usually, benzodiazepines are not prescribed for long-term use because of the high risk for devel- oping tolerance, dependence, or addiction.
Non-benzodiazepine sleep medications, such as zolpidem (Ambien®), eszopiclone (Lunesta®), and zaleplon (Sonata®), known as z-drugs, have a different chemical structure but act on the same GABA type A receptors in the brain as benzodi- azepines. They are thought to have fewer side effects and less risk of dependence than benzodiazepines.
Barbiturates, such as mephobarbital (Mebaral®), phenobarbi- tal (Luminal®), and pentobarbital sodium (Nembutal®), are used less frequently to reduce anxiety or to help with sleep problems because of their higher risk of overdose compared to benzodiazepines. However, they are still used in surgical pro- cedures and to treat seizure disorders.
How do CNS depressants affect the brain and body? Most CNS depressants act on the brain by increasing activity at recep- tors for the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). Although the different classes of depressants work in unique ways, it is through their ability to increase GABA signal- ing—thereby increasing inhibition of brain activity—that they produce a drowsy or calming effect that is medically beneficial to those suffering from anxiety or sleep disorders.
What are the possible consequences of CNS depressant
misuse? Despite their beneficial therapeutic effects, benzodiaz- epines and barbiturates have the potential for misuse and should be used only as prescribed. The use of non-benzodiazepine sleep aids, or z-drugs, is less well-studied, but certain indicators have raised concern about their psychoactive properties as well. During the first few days of taking a depressant, a person usually feels sleepy and uncoordinated, but as the body becomes accustomed to the effects of the drug and tolerance develops, these side effects begin to disappear. If one uses these drugs long term, he or she may need larger doses to achieve the therapeutic effects. Continued use can also lead to dependence and with- drawal when use is abruptly reduced or stopped. Because all sedatives work by slowing the brain’s activity, when an individ- ual stops taking them, there can be a rebound effect, resulting in seizures or other harmful consequences. Although withdrawal from benzodiazepines can be prob-
lematic, it is rarely life threatening, whereas withdrawal from prolonged use of barbiturates can have life-threatening complica- tions. Therefore, someone who is thinking about discontinuing a sedative or who is suffering withdrawal from CNS depressants should speak with a physician or seek immediate medical treat- ment.
Stimulants
What are stimulants? Stimulants increase alertness, attention, and energy, as well as elevate blood pressure, heart rate, and respiration. Historically, stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. But as their potential for misuse and addiction became apparent, the number of conditions treated with stimulants has decreased. Now, stimulants are prescribed for the treatment of only a few health conditions, including at- tention-deficit hyperactivity disorder (ADHD), narcolepsy, and occasionally treatment-resistant depression.
How do stimulants affect the brain and body? Stimulants, such as dextroamphetamine (Dexedrine®, Adderall®) and methylphe- nidate (Ritalin®, Concerta®), act in the brain on the family of monoamine neurotransmitter systems, which include norepi- nephrine and dopamine. Stimulants enhance the effects of these chemicals. An increase in dopamine signaling from nonmedical use of stimulants can induce a feeling of euphoria, and these medications’ effects on norepinephrine increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, and open up breathing passages.
What are the possible consequences of stimulant misuse? As with other drugs in the stimulant category, such as cocaine, it is possible for people to become dependent on or addicted to prescription stimulants. Withdrawal symptoms associated with discontinuing stimulant use include fatigue, depression, and disturbed sleep patterns. Repeated misuse of some stimulants (sometimes within a short period) can lead to feelings of hostil- ity or paranoia, or even psychosis. Further, taking high doses of a stimulant may result in dangerously high body temperature and an irregular heartbeat. There is also the potential for cardiovas- cular failure or seizures.
Cognitive Enhancers The dramatic increases in stimulant prescrip- tions over the last 2 decades have led to their greater availability
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AUGUST 2017 29
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