As noted above, barbiturates were once widely used as a sedative hypnotic, but recently, with the exception of certain specialized uses, they have been replaced by safer benzodiazepines. High-speed barbiturates are still used for anesthesia, and are also used to relieve convulsions during critical situations and prevent attacks of certain types of epilepsy.
Tolerance, Dependence and Side Effects
The main reasons for the rejection of barbiturates in practical medicine are dependence and tolerance to barbiturates. Tolerance to many effects of barbiturates develops very quickly. The dose may cause sleep in the first period, but the constant use of such a dose will not have the desired effect, leading to an increase in the dose needed to achieve the desired effect. With a constant increase in the dose of the drug, the patient who decides to abandon barbiturates will experience withdrawal syndrome. Symptoms of refusal from barbiturates are similar to symptoms of refusal from alcohol. They manifest themselves in chills, sweating, agitation and, in some cases, signs of delirium tremens. Convulsions and seizures also often occur when barbiturates are rejected. The dangers of refusing barbiturates depend on the scale of their use. Mild symptoms, such as reciprocal insomnia and anxiety, can appear after a short course of treatment with barbiturates, while life-threatening convulsions are caused by prolonged use.
Many people were dependent on barbiturates, using them only as prescribed by a doctor. Suppose someone is in crisis after the death of a spouse or other loved one. The doctor may prescribe a sleeping pill to give a person the opportunity to rest normally during a crisis. After several weeks, the patient may already feel an emotional readiness to sleep without a drug, but during the first night after giving up the drug, he may experience great difficulties with sleep, because One of the features of abstinence syndrome in case of refusal from barbiturates is insomnia response. It often happens that after prolonged use of barbiturates, abstinence leads to insomnia, even those who have not suffered from it before.
A similar problem affects the type of sleep in which a person remains during the action of barbiturates and after prolonged use of sleeping pills. Barbiturates do cause sleep, but, like alcohol, they reduce the amount of time spent in the REM stage of sleep or the stage of rapid eye movements (Rapid eye movement / REM /). This may partly explain the “hangover”, as evidenced by patients taking barbiturates as a sleeping pill. Even if a person will sleep for a sufficient amount of hours, such a dream will not be “quality”. A further problem of a person who is trying to fall asleep without pills after using drugs can be the problem of the PEM-effect response. That is, the person will spend more time in the REM stage of sleep than usual.
Often the response PEM-effect is accompanied by vivid dreams and nightmares with sleepwalking. Thus, after giving up barbiturates, even if a tired patient falls asleep without a drug, he wakes up early in the morning and is unable to return to sleep. Other factors can also influence here, but it is clear that, once developed, dependence on sleeping pills can be overcome only after a considerable period of time. All these factors give an idea of why dependence on such sleeping pills as barbiturates develops so often. This dependence is one of the reasons for limiting the use of certain depressants for the treatment of insomnia.
An additional problem associated with barbiturates is the risk of a fatal overdose of the drug. The lethal dose of many barbiturates is not much different from the dose that causes sleep. Also, this problem is very relevant when barbiturates are taken along with alcohol or other depressants, as they reinforce the influence of each other. Barbiturates were often prescribed to depressed patients, because sleep disorders are also signs of clinical depression. Since there is a risk of attempted suicide on the part of some patients who are in serious depression, barbiturates prescribed by a doctor increase the likelihood of success of such attempts. Barbiturates very often appear in suicide cases, including the notorious case of Merelin Monroe.
Barbiturates (especially high-speed barbiturates) cause a state of euphoria, similar to alcohol intoxication. As a result, barbiturates appeared on the street as intoxicating drugs in the 1950s, 1960s. It is assumed that in 1969 alone, five billion doses were sold on the black market! Obviously, barbiturates led to social problems, so the search for a safer drug to combat drugs voshnom state and insomnia.