Caution surrounding Psychotropics

Effect size of antidepressants for anxiety = 1.2

Effect size of antidepressants for depression = 0.7



Benzos are very common sedatives. In general population, 8% have used benzos in the past year; 2% have used them for over a year.



Types of benzodiazepines

The big difference of benzodiazepines is length of action.


down-regulation of GABAA receptors occurs a lot

acts on the GABAA receptor





should be given for at most weeks or months due to potential for dependence and side effects.




Side Effects

long term use can result in cognitive decreases


Adverse Drug Reactions

Overdose: give flumazinil



There are varying effects of alcohol on benzo concentrations.

Synergistic pharmacological interactions occur.



Overuse, misuse, abuse

specific tricky drugs:





Symptoms of BZD withdrawal syndrome:


risk factors:

lose dose: tachycardia, hypertension, insomnia

high dose: seizures, psychosis


Stopping Treatment

To stop treatment, in general you should taper off with all psychotropics.

Go really slow at the end of the taper (asymptotic)

get patient involved in drafting the schedule

have a treatment plan for break-through emergence of symptoms (PRNs)

switch to long-acting BZP prior to taper (ie clonazapam or diazepam)


Benzo agonists

facilitate GABA action: zolpidem, zaleplon, eszopiclone

antagonists: used in overdose: flumazenil

inverse agonists: act as negative allosteric modulators of GABA receptors



Mechanism of action

Benzodiazepines bind to chloride channels in neurons, causing conformational changes that increase GABA binding and subsequent chloride channel opening. This leads to hyperpolarization and inhibits CNS activity.






  • onset
  • hypnotic utility
  • abuse potential
  • lipophilicity
  • duration of effect
  • onset/offset of effect
  • half-life
  • dosing frequency
  • risk of accumulation
  • withdrawal syndrome
  • hepatic metabolism
  • specific populations: elderly, hepatic impairment


Phase I capacity decreases with age, meaning half life will be increased in the elderly.

Non-phase I metabilized drugs: lorazepam, o, tamazapam




A sedative-hypnotic




adverse effects