CNS Depressants

Central nervous system (CNS) depressants belong to a class of medication that helps slow down brain activity, making them useful in treating many known psychological conditions such as anxiety, panic attacks, sleep disorders, seizures, stress, and pain management. CNS depressants function by affecting the neurotransmitter known as gamma-aminobutyric acid (GABA), which causes effects such as relaxation, drowsiness, and decreased inhibition. There are three types of CNS depressants currently available in the market today. These depressants include tranquilizers, sedatives, and hypnotics.

Drugs that are classified as CNS depressants are:

• Alcohol
• Most sleeping pills
• Opioids
• Barbiturates
• Benzodiazepines

The mechanism of CNS depressants may vary depending on the type of drug, but all variations slow down the user’s brain activity, leading to a lower level of awareness. Even though the substances within this drug class may vary, all CNS depressants share this one common trait. However, it is important to note that not all CNS medications are equally safe for consumption. Although doctors prescribe the safest drugs to their patients to avoid complications, all CNS depressants come with a potential risk of addiction. Adhering to the doctor’s prescription is crucial to prevent or minimize the risk of addiction.

Alcohol is one of the most widely consumed CNS depressants in the world. The sedative effects of alcohol on brain activity may vary depending on the type of alcohol, the amount consumed, and the rate of consumption. The early stages of alcohol consumption may induce a feeling of relaxing-high, caused by the chemical changes that take place in the brain. However, as the level of alcohol consumption rises, these effects may soon be replaced with negative effects such as aggression, depression, impaired co-ordination, high levels of anxiety, and stress. Prolonged consumption of alcohol may also contribute towards the development of dependency, tolerance, and addiction.

Benzodiazepines are CNS depressants generally used in the treatment of anxiety, convulsions, sleep disorders, and other acute stress responses. The most widely prescribed and abused benzos may include Valium, Ativan, and Xanax. Benzodiazepine’s function by slowing down the overactive brain and relieving severe mental stress felt by the individual. Although deemed safe for short-term treatment, long-term or illegal usage can contribute to the development of dependence, tolerance, and addiction. Patients may experience adverse withdrawal symptoms during cessation or a significant decrease in use.

Barbiturates or downers are a form of CNS depressants that help relieve tension, anxiety, and sleep disorders. The most widely prescribed barbiturates include Amytal, Luminal (Phenobarbital), Seconal, Mebaral, and Nembutal. Although initially considered a safe medication, issues with abuse, addiction, and overdose soon became evident following mass prescription. These medications induce feelings of euphoria and relaxation, even if administered in small doses. Due to the high abuse rates, barbiturates were soon replaced by benzodiazepines as they were perceived to be less addictive and less prone to cause an overdose.

Opioids are the most widely used prescription painkillers in the United States and much of the world. Some opioids, such as methadone, are also being used during the process of addiction treatment. Opioids can range from regulated prescribed medications like codeine and hydrocodone to illicit street drugs such as heroin. Although opioids differ immensely in strength, the effects induced and its capacity to form an addiction remains the same. Although opioids are known to be highly successful in treating pain, they are also some of the most dangerous and addictive medications in the world. The overdose of opioid claims the lives of tens of thousands of Americans each year.

This category of CNS depressant contains non-benzodiazepine sleeping aids like Ambien, Lunesta, and Sonata. These medications were primarily developed to cure sleep disorders. Sleeping pills are chemically distinct from other CNS depressants as they function contrastingly with the GABA neurotransmitter. Unlike other forms of CNS depressants, sleeping pills do not alleviate anxiety. These medications are considered to be less addictive than benzodiazepines. However, long-term usage of any prescription medication can lead to the development of dependence and tolerance.

Central nervous system depressants function by raising the production of the GABA neurotransmitter. This, in turn, slows down brain function and causes relaxation, drowsiness, and a variety of other effects, including:

• Dilated pupils
• Confusion or disorientation
• Impaired judgment
• Slowed pulse and breathing
• Sleepiness or fatigue
• Lowered blood pressure
• Loss of co-ordination
• Dizziness
• Difficulty concentrating
• Memory loss
• Relaxation and euphoria
• Difficulty urinating
• Slurred speech
• Reduced inhibitions
• Blacking out
• Slowed reaction time

Prolonged consumption of CNS depressants can lead to tolerance, dependence, and other side effects, depending on the type of drug used and the duration of use. Misusing the drug in higher doses for an extended period can intensify these side effects. Side effects of long-term CNS depressants may include:

• Chronic fatigue
• Depression
• Suicidal thoughts
• Sexual dysfunction
• Weight gain
• Physical dependence
• Addiction
• Hypersomnia

The predominant indicator of abuse is the usage of medications without medical supervision or against the prescribed medical criteria. Other signs of abuse may include:

• Decreased social activity or work productivity
• Consuming larger doses to boost intoxication
• Consuming someone else’s medication
• Mood swings
• Periods of apathy or depression
• Secretive or abnormal behavior
• Lack of motivation or energy
• Withdrawal symptoms when not using the drug
• Failing in attempts to discontinue taking the drugs
• Combining CNS depressants with other substances such as alcohol or opioids

Combining drugs to intensify each other’s effects is referred to as polydrug use. This practice can contribute to significant health complications and fatal overdose.

Misuse of prescription CNS depressants, also defined as a substance use disorder (SUD), can result in the formation of addiction in extreme cases. Long-term usage of prescription CNS depressants, even when consumed under the strict guidelines of a physician, can lead to the buildup of tolerance. During the stage of tolerance, patients will require higher doses of the drug to feel the desired effects as their body has grown immune to the initial doses. Patients who develop a dependence on the drug may experience symptoms of withdrawal during the abrupt cessation of consumption.

Another potential adverse effect of CNS depressant abuse is an overdose. Excessive use of depressants may contribute to respiratory distress, seizures, and even death. The combination of CNS depressants with other forms of medications or substances that are also depressants can lead to a decrease in heart rate and respiration that could end in a fatal overdose. This possibility is often compounded as CNS depressants are used to compensate for the effects of stimulant drugs like Adderall or cocaine. In fact, it is highly risky to mix several CNS depressants as the likelihood of an overdose is dramatically magnified.

The discontinuation of CNS depressants after the formation of dependence can contribute to symptoms of withdrawal. This is caused by the medication’s ability to influence brain chemistry and decrease activity. Withdrawal symptoms usually begin 12 to 24 hours since the last dose and are most serious between 24 to 72 hours after the last dosage. This stage of withdrawal is referred to as acute withdrawal. Withdrawal symptoms generally tend to disappear after this period. Symptoms that last longer are known as post-acute withdrawal syndrome (PAWS).

Patients undergoing benzodiazepine or barbiturate withdrawal may also experience a rebound reaction in which the disorder they were initially treating reappears stronger than before. For example, patients who are prescribed Xanax for anxiety will endure intense anxiety during withdrawal. Due to the intensity of CNS depressant withdrawals, patients are highly advised to seek medical assistance if they wish to cease consumption.

Withdrawal symptoms of CNS depressants may include:

• Insomnia
• Vomiting
• Shaking
• Excessive sweating
• Irritability
• Changes in perception
• Hallucinations
• Anxiety
• Restlessness
• Increase blood pressure
• Panic attacks
• Nausea
• Body tremors
• Seizures
• Depression
• Muscular pain or stiffness
• Weakness
• Heart palpitations
• Stress
• Memory issues
• Hypersensitivity to sound & light
• Pains & aches
• Tension

Withdrawal from CNS depressants can have life-threatening complications. These risks are heightened when an individual attempt to quit on their own.

Treatment for CNS depressant abuse and addiction begins with the initial stage of detoxification. This process helps patients gradually flush all traces of the drug from their bodies. Detoxification is generally carried out at a medical facility to ensure the safety of the patient. After the completion of detoxification, the patient will receive further treatment at an inpatient or outpatient recovery facility. These treatment facilities provide services such as therapy, counseling, and introduction to support groups to help patients address the psychological dependence on the drug. Patients with severe addiction and co-occurring disorders are required to seek treatment at an inpatient treatment facility. Treatment provided at these centers and the duration of treatment may vary from patient to patient.

Therapy such as cognitive-behavioral therapy (CBT) is especially effective in the management of CNS depressant abuse. This form of therapy helps improve a patient’s perspective, desires, and attitudes while also strengthening their capacity to deal with temptations and triggers. After the successful completion of an inpatient or outpatient treatment program, it is vital to continue with treatment with aftercare programs to avoid relapses and prolong recovery.