ベンゾジアゼピン系の睡眠薬抗不安薬に対する思いを精神科医が吐露します。24分動画

Good evening. I'm Takahiro Haga, a psychiatrist. Today, I'd like to talk in depth about benzodiazepine anti-anxiety medications. I'll be talking about them in detail again. Thank you for your attention. Today, rather than reviewing each of the so-called "whatever-pam" drugs like lorazepam (Xylonitrile/Alpha), alprazolam (Constan/Xanax), etizolam (Depas), ethyl loflazepate (Melax), and clonazepam (Rivotril), I'd like to clarify the nature of benzodiazepine anti-anxiety medications themselves, as I believe this is key to drug therapy. First of all, I'd like to assume that there are quite a lot of people who are seeing a psychiatrist, or whose family members are, who have been prescribed benzodiazepines. This is a topic that can easily become confusing, so let me clarify it. Sleeping pills are used to help you sleep, right? In other words, the time they work is while you're asleep. On the other hand, anti-anxiety drugs are not drugs that you want to work while you're asleep. Essentially, they're meant to work while you're awake. That's why benzos that work while you're awake are called anti-anxiety drugs, and benzos that work while you're asleep are called sleeping pills. Essentially, they're very similar as drugs. They just have different purposes. So what do anti-anxiety drugs do while you're awake? I explain it like this: Anti-anxiety drugs put you in a state where you're awake but slightly "half asleep." If "half" sounds like an exaggeration, 10%, 20%, or 30% is fine. In other words, they put only part of your brain to sleep a little. The reason is that some people find it too painful for their brains to be 100% awake. They're incredibly anxious, restless, and their thoughts are constantly racing. For these people, being "100% awake" is painful. So we slow down the brain's activity by 10%, 20%, 30%, etc. I think this is one of the essential aspects of benzodiazepine anti-anxiety drugs. This is what makes them different from, for example, antidepressants. Antidepressants increase BDNF and restore neuroplasticity, so in a sense, the idea of ​​making them effective 24 hours a day is often a good fit. Antipsychotics are also meant to work while you're awake. However, strong sedatives like risperidone, olanzapine, and quetiapine tend to cause drowsiness and fatigue when taken during the day. Therefore, rather than aiming for their effectiveness before bed, side effects often lead to them being postponed until before bed. In contrast, the basic idea behind anti-anxiety drugs is to make them work during the day. So, as a general rule, they're taken in the morning. Depending on the duration of action, some people take them only in the morning, others in the morning and evening, and for shorter-acting medications, three doses a day (morning, noon, and evening) may be necessary. Blood levels rise as you take the drug and then decline in a curve, so they're most effective when you first start taking them. That's why drugs that you want to work during the day are designed to have a daytime curve. From here on, there's an important issue I'd like everyone to think about: driving. Is it okay to drive while taking benzodiazepines? To be honest, it's a gray area. I say gray because, although that's a strong word, in a sense, they can create a state similar to drunk driving. The structure is similar: you drive while partially paralyzed. I've sometimes been told not to compare doctor-prescribed medications to alcohol. But there are similarities in the sense that they both impair some brain function. This is a fact. However, society doesn't run on idealism alone. For people living in rural areas, life can sometimes be impossible without a car. So, is it really possible to say with certainty that "if you take medication that makes you even a little sleepy, you should never drive?" In reality, it's difficult to say. Furthermore, there are people whose anxiety is so intense that 50% of their brains are controlled by anxiety. If such people were to drive without medication, only 50% of their brains would be available for driving. It's possible that even if medication makes you 30% sleepy, it's still better if you can devote the remaining 70% of your time to driving. So it really depends on the case. Of course, if someone is self-regulating or overdosing through personal imports, that's dangerous. Ideally, we'd like them to stop driving if possible. But with society's contradictions, it's not easy to draw the line. This is something that, to be honest, troubles me as a psychiatrist. Next, I'd like to talk about another important point. "Putting your brain to sleep" with medication is not the same as natural sleep. We've learned a lot about sleep recently. In the past, people often thought that the brain shut down and didn't do anything during sleep, and that dreams were meaningless. But now, the prevailing view is that during sleep, the brain organizes and updates information, consolidating fragments of memory. I of...