Psychiatry medications

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1. Benzodiazepines (-azepam, -azolam):

   • Mechanism: Increase frequency of GABAA​ Cl- channel opening.
   • Risk: High tolerance, physical dependence, abuse.
   • Withdrawal: Life-threatening (anxiety, insomnia, seizures). Requires slow taper.
   • Antidote (Overdose): Flumazenil (can precipitate withdrawal).

2. Barbiturates (-barbital):

   • Mechanism: Increase duration of GABAA​ Cl- channel opening.
   • Risk: Very high dependence, abuse, narrow therapeutic index (respiratory depression).
   • Withdrawal: Life-threatening (like BZDs, potentially worse).

3. Stimulants (Methylphenidate, Amphetamines):

   • Mechanism: Increase Dopamine (DA) / Norepinephrine (NE).
   • Risk: High abuse potential, psychological dependence.
   • Withdrawal: Significant but not typically life-threatening (“crash” - depression, fatigue, hypersomnia).

4. Z-drugs (Zolpidem, Zaleplon, Eszopiclone):

   • Mechanism: Selective GABAA​ (alpha-1) agonists.
   • Risk: Lower than BZDs, but tolerance, dependence, and withdrawal can occur.
   • Use: Insomnia.

Key Distinction:

• Antidepressant Discontinuation Syndrome (SSRIs/SNRIs): Abrupt stop causes flu-like symptoms, insomnia, sensory issues (“FINISH”). Not true dependence/addiction. Requires tapering.