TRANQUILIZERS

Stress is not an invention of the twentieth century. We have suffered from its effects since man first dodged dinosaurs. Fear, guilt, and worry accompany our passage through life, and over the centuries we have sought various means of alleviating our mental anguish.

Tranquilizers are an invention of the twentieth century, the latest means of dulling our minds to pain. Use of these mood changing mind-altering drugs is not only accepted but often encouraged by. the public and the medical community alike. As a result, one out of six Americans is a regular tranquilizer user. Anti-anxiety drugs account for 250 million prescriptions a year, over sixty doses for each man, woman, and child in the United States. Only alcohol, nicotine, and aspirin rank higher than tranquilizers as "abused drugs." Almost 30 percent of all American women, with highest consumption in the age bracket from thirty to fifty-nine, attempt to erase their problems with mood-changing drugs. Tranquilizer misusers far outnumber abusers of illicit drugs, with minor tranquilizers accounting for 15 to 25 percent of annual hospital admissions. In spite of this,' some doctors still scribble prescriptions for, a "panacea" rather than investigate other avenues of treatment, perhaps in response to patients' demands or to the expensive, effective, and misleading advertising by drug companies. Undoubtedly helpful to those with genuine psychiatric problems, tranquilizers are too often prescribed for hypochondriacs and normal, healthy people.

A central-nervous-system depressant, tranquilizers may be divided into several categories: benzodiazepines, meproai bamate, methaqualone, phenobarbital, phenothiazines, and tri-cyclic anti-depressants.

Benzodiazepines, which include Valium, Librium, Dalmane, and Serax, are considered minor tranquilizers Safest of the anti-anxiety agents, they are long-acting, thereby necessitating less frequent use. Potential for overdose and addiction is small, but possible, with heavy, prolonged use Pharmacologically similar, Valium and Librium are the most widely prescribed drugs in the United States.

Meprobamates include Miltown and Equanil. The first of the minor tranquilizers when marketed in 1955, it was considered a mild, safe, nonaddictive anxiety-reliever. Users discovered its euphoric, barbiturate-like effects and "Mil town" became a household word. The high addiction and overdose potential of the drug was not realized until later.

Methaqualones include Quaaludes, Sopors, Mandrax, Parest, and Somnifac. A nonbarbiturate sedative-hypnotic like meprobamate, it was once considered safe and non-habit forming Methaqualone's high addiction and overdose potential has now been established (see Methaqualone).

Phenobarbitals include tranquilizers such as Luminal. It is less expensive than most tranquillizers and has a low overdose addiction potential when used for short periods. The drug acts as a muscle relaxant without the sedative effects of other barbiturates. Long-term use may result in barbiturate withdrawal (see Barbiturates).

Phenothiazines include Thorazine, Stelazine, Compazine, and Mellaril -all considered "major" tranquilizers or antipsychotics used in the treatment of schizophrenia and other psychotic states. While addiction potential is low, overdose potential is moderate. Jaundice and Parkinson-like symptoms may appear as side effects. Some feel these drugs are over   prescribed and should be used only in° severe cases. Controversy also exists concerning their use in the treatment of trips caused by drugs such as LSD.

Tri-cyclic anti-depressants such as Elavil and Triavil are anti-depressant mood elevators with a moderately high overdose addiction rate. Although widely prescribed, some say they are generally ineffective and should be used only for severe psychiatric disorders.

The distinction between "minor" and "major" tranquilizers is a chemical one; it does not indicate differences between their degrees of potency. Most users of minor tranquilizers feel their use is therapeutic, rather than al, helping them smooth out the rough edges of life. Availability of tranquilizers further adds to their acceptability. Whether ingested in tablets or capsules every three to six hours, or injected as part of a medical procedure, tranquilizers are considered legitimate pharmaceutical aids.

Tranquilizers are indicated for sedation in the fields of dentistry, neurology, cardiology, obstetrics and gynecology, orthopedics, pediatrics, dermatology, plastic surgery and psychiatry. Controversy exists over their use in the treatment of alcoholism and in amphetamine, heroin, and barbiturate withdrawal, although they have been effective in many cases. When used judiciously, they are valuable as a sedative, antianxiety agent, anti-convulsant, muscle relaxant, and sleeping aid.

Acting on the limbic system of the brain, tranquilizers depress the central nervous system by affecting the connection between the sensory and motor pathways. As the skeletal muscles relax, anxiety and tension disappear into a peaceful, calm state. The resulting euphoria may affect coordination, speech, libido, and attention span, reduce aggression, and in duce sleep. Depending on tranquilizer, dosage, and the attitude and personality of the patient, this sedative effect may be short-term, lasting a few hours, followed by deterioration into a state of agitation or depression. This can create a cycle of sedation-agitation and may' lead to psychological dependence.

Tranquilizer effects, both adverse and therapeutic, are generally less extreme than those of barbiturates. Tolerance may develop within a few weeks if the drug is continually kept in the bloodstream by three-times-a-day ingestion. Side effects may include apathy, low blood pressure, blurred vision rashes, disorientation, confusion, muscle weakness, head aches, upset stomach, fainting, lack of coordination, dizziness; menstrual, bladder, and ovulary irregularities;: anxiety, and hallucinations. Some users experience stimulation rather than sedation, which results in hyperex citability, insomnia, hostility, and rage. Large doses can lead to tremors, loss of muscular coordination, and convulsions With time and heavy dosage, habituation, psychological dependence, and withdrawal symptoms may occur.

Tranquilizers can kill when potentiated by other central nervous-system depressants such as alcohol, barbiturates, opiates, hypnotic-sedatives, and synthetic narcotics. Accidental poisoning or suicide is almost impossible with tranquilizer unless the drug is combined with anon depressant.

Alcohol and tranquilizers have a synergistic effect on eachother, creating an additive result when they are together. Since the liver processes alcohol first, the tranquilizer must wait its turn, circulating through the system many times over, damaging organs with each visit. Body func tions, including breathing, heartbeat, and mum - ad reasoning powers, slow down and may eventually stop, causing death.

In addition to alcohol, minor tranquilizers should not be used with anti-depressants or antihistamines and may decrease the effectiveness of birth-control pills; Major tranquilizers should be avoided when using anti-depressants, antihistamines,   barbiturates,   other   tranquilizers   and sedatives, blood-pressure medication, or diuretics. These sub stances, along with anti-convulsants, anti-coagulants, and MAO inhibitors, should also be avoided in combination with try-cyclic anti-depressants, which remain in the system for two weeks after their use is discontinued. All drugs should be temporarily avoided after the user has stopped taking tri-cyclics.

Since tranquilizers depress the central nervous system and relax muscles, they cause the user's reaction time to increase Operating machinery or power tools, driving a car, or riding a bike in traffic may all be hazardous to the health of the user, as alteration of vision and time, and- space judgment greatly multiplies the chance of accident.

Pregnant women should avoid use of tranquilizers, which penetrate the placental barrier. Birth defects, fetal death, congenital heart disease, and skeletal l abnormalities have all been attributed to use of the drug, which also infiltrates the mother's milk. The most publicized case of tranquilizer ;

danger to fetal development was that of Thalidomide, a non- barbiturate sleeping pill, originally thought harmless, which resulted in severe birth defects. Tranquilizers are also ranked third among drugs causing damage to the stomach lining, trailing only aspirin and alcohol.

Street tranquilizers are even more dangerous, since they are sometimes cut with unknown substances, or crudely manufactured in amateur laboratories, adding to the unpredictability of an already unpredictable drug. Tranquilizers' shelf lives with some pills becoming impotent while others become more toxic with the passage of time.

Addiction, both physical and psychological, may occur with prolonged heavy use. Self-medication is often the culprit when tranquilizers -are abused. The need to increase dosage to achieve the same effect signifies tolerance has set in.

An addictive personality may find the drug to be a  "legitimate" source to feed-his-habit, not realizing that withdrawal from tranquilizers maybe as difficult as from alcohol, opiates, or barbiturates. Sedative, users should take precautions. Do -not use tranquilizers for minor temporary problems or refill prescriptions without consulting your doctor. Do not use the drug over long periods of time, follow directions exactly, and do not self-medicate.

Prolonged medication-'should not be stopped abruptly.' Tranquilizer use must be gradually discontinued to avoid unpleasant withdrawal symptoms. A dependent user may experience such symptoms within four to eight hours after cessation. Hyperexcitability and anxiety, insomnia, 'respiration and pulse reductions, coordination impairment, -slurred' speech, nausea, vomiting, tremors, and convulsions may occur, depending on the drug's potency, the victim's metabolism, and the length and frequency of use.

Medical supervision is necessary for safe withdrawal from tranquilizers. Get the overdoser to a hospital, or, if he is conscious, induce vomiting. Do not force an unconscious person to throw up, but turn him on his side in case he does. Do not give him amphetamines or coffee. Keep` him awake and walking. Find out exactly what he took, how much, and what it looked like, if possible.

Tranquilizers are regulated under Schedule IV of the Controlled Substances Act. Prescriptions are not refillable more than five times within six months, and the drug's production and distribution 'must be recorded and supervised by manufacturers. Physicians and pharmacists are expected to keep records, and security precautions against theft must be taken.

One of the first tranquilizers was Sedobrol, a cube which made a sodium-bromide broth. Research on the drug rauwolfia produced many of the pioneer sedatives, followed by barbiturates in the thirties and nonbarbiturates in the 1950s. Discovery of , the benzodiazepines revolutionized the tranquilizer industry. Unlike their predecessors they relaxed users without sedating. Librium was discovered in 1960, instantly becoming the world's most widely prescribed drug until the introduction of Valium in 1963. Today, Valium remains the topselling drug, indicative of our obsession with anxiety (see Valium).

Less dangerous and sometimes more successful alternatives to tranquilizers are available, from massage and exercise to alleviate muscle tension, to non drug means of falling asleep. Depression is suppressed, not solved, by the use of tranquilizers; the anxiety problem still exists.

Rather than being the panacea of our time, tranquilizers should more likely be considered a psychiatric Band-Aid.