Dose tolerance to lorazepam develop with once weekly dosing?

Mnestic disorders in long-term high-dose diazepam abuse: a pilot study

Cognitive impairment in long-term high-dose diazepam abusers (dose > 30 mg diazepam/day; duration of abuse > 12 months) was examined by administering four memory-related tests and comparing the outcomes with those of matched controls. Deficits were found in spatial and visual learning, spatial and visual short-term memory (STM) as well as for spatial and visual long-term memory (LTM). As for verbal aspects of memory, solely the acquisition of novel verbal material (verbal learning) was impaired, Furthermore, deficits in a concentration task were observed. In chronic abuse the established memory deficits are similar to cognitive impairment after single doses. Relaxing or anxiety-reducing effects of diazepam were no longer present. The results of this experimental study demonstrate the risks of diazepam use beyond therapeutic range.

Alprazolam 0.125 mg twice a day improves aspects of psychometric performance in healthy volunteers

The effects of alprazolam (0.125 mg) taken twice a day on several cognitive and performance tasks (Pictures test, Digit-Symbol Substitution Test, Choice Reaction Time [CRT], Critical Flicker Fusion [CFF]) were investigated in healthy students. A double-blind, independent group design was used to compare placebo with alprazolam (32 volunteers in each group). After random assignment, all subjects received placebo for 3 days (D) followed by 14 days of treatment with either alprazolam or placebo. Subjects completed a battery of tests at D0, D3, D7, D10, and D14. D3 performance was poorer in the alprazolam group except for CFF values (ascending values and total values), and the only significant improvement was in total reaction time on the CRT test. However, a significant improvement in performance (except in recognition reaction time) was shown at D7, D10, and D14 in the alprazolam group compared with the control group results. This study shows that repeated low doses of alprazolam produce small improvements in some aspects of psychomotor and cognitive functions. Training effect, tolerance effect, anxiolytic effect, and changes in receptor function and/or number are discussed to explain the performance improvement.

The laboratory assessment of daytime sleepiness in childhood

Excessive daytime sleepiness is a disabling symptom of diverse etiologies. This article reviews the various, currently available diagnostic techniques that can be applied in the evaluation of childhood hypersomnolence, along with their merits and limitations. Normal polysomnographic data of children differ from those of adults. Serial studies may be required in evolving childhood narcolepsy for establishing a definitive diagnosis.

The behavioural and neuronal effects of the chronic administration of benzodiazepine anxiolytic and hypnotic drugs

Benzodiazepine anxiolytic and hypnotic drugs are some of the most widely prescribed drugs in the Western world. Despite this fact, the mechanisms that underlie the development of tolerance to, and dependence upon, benzodiazepines are poorly understood. The aim of this review is to summarize and critically evaluate the experimental evidence relating to the chronic behavioural and neuronal effects of benzodiazepines. Behavioural studies in animals generally indicate that tolerance gradually develops to the muscle relaxant, ataxic, locomotor and anticonvulsant effects of benzodiazepines. The evidence relating to the development of tolerance to the anxiolytic effects of benzodiazepines is less clear. The literature on the possible mechanisms of benzodiazepine tolerance and dependence is large, highly complex and difficult to interpret. The effect of chronic benzodiazepine treatment varies enormously as a function of the benzodiazepine used and the treatment schedule employed. Many studies have demonstrated a down-regulation of benzodiazepine binding sites, although affinity is usually unchanged. The evidence relating to the number and affinity of GABAA binding sites is unclear. Some studies suggest that chronic benzodiazepine administration results in a reduction in the number of Cl- channels associated with the GABAA receptor complex, although it is not clear that the efficacy of the GABA binding site in operating the Cl- channel necessarily changes. There is, however, substantial evidence to support the hypothesis that chronic benzodiazepine treatment results in a reduction in the coupling between the GABAA and benzodiazepine binding sites (the "functional uncoupling hypothesis"). Although some electrophysiological studies suggest that chronic benzodiazepine treatment results in a subsensitivity to GABA, this effect seems to be highly area-specific.

Time-dependent sensitization to triazolam? An observation in three studies

Evidence of time-dependent sensitization (TDS) to triazolam was observed in three separate clinical studies. Study 1 was conducted in 12 normal-weight and 12 obese men; an intravenous bolus dose of triazolam, 0.5 mg, was administered on two occasions. Study 2 was a balanced crossover of three 0.25-mg oral doses and one 0.20-mg oral dose of triazolam in 11 men. Study 3 was a balanced crossover of one placebo, one 0.5-mg, and two 0.4-mg oral doses of triazolam. In all three studies, treatments were separated by 6 days and included serial blood sampling for characterization of pharmacokinetics. Psychomotor response was assessed with the Digit Symbol Substitution Test and the Continuous Performance Test (CPT). Sedation was rated by an observer. For each measure, an effect ratio was calculated as the area under the effect curve divided by the area under the triazolam concentration curve; this parameter relates the extent of response relative to drug concentration in plasma. Effect ratios increased progressively by week for CPT; the percentage increase ranged from 31.9% in the study 1 normal subjects (week 1 to week 2; p = 0.08) to 631% in study 2 (week 1 to week 4; p = 0.0013). Similar increases were observed for other responses. Overall, the effect ratio data demonstrate increasing responsiveness per unit of triazolam concentration when triazolam was administered as a single dose at 1-week intervals. This observation was incidental to the original objectives of the studies. However, the data suggest that definitive studies to verify the occurrence of this phenomenon need to be conducted.(ABSTRACT TRUNCATED AT 250 WORDS)

Lorazepam 0.25 mg twice a day improves aspects of psychometric performance in healthy volunteers

The effects of lorazepam (0.25 mg) twice a day on several cognitive and performance tasks, pictures test, digit-symbol substitution test (DSST), choice reaction time (CRT) and critical flicker fusion (CFF), were investigated in healthy students. A double-blind independent group design was used to compare placebo and lorazepam (30 volunteers in each group). After randomisation, all subjects received placebo for 3 days (D), followed by 14 days of treatment, with either lorazepam or placebo. Subjects completed a battery of tests at Do, then D(3), D(7) , D(10) and D(14). D(3) performance was poorer in the lorazepam group except for CFF (ascending values and total values), yet the only significant improvement was in total reaction time on the CRT test. However, a significant improvement of performance was shown at D(7), D(10) and D(14) in the lorazepam group compared with the control group (except in recognition reaction time). The current study shows that low repeated doses of lorazepam are able to produce small improvements in some aspects of psychomotor and cognitive functions in healthy volunteers. Different points are discussed to explain the performance improvement: training effect, tolerance effect, partial inverse agonist effect and the possible release of cholecystokinin.

Memory functions, alprazolam and exposure therapy: a controlled longitudinal study of agoraphobia with panic disorder

Benzodiazepines (BZs) produce transient anterograde amnesia when given to normal subjects. The present longitudinal study assessed whether BZs impair memory functions in a clinically anxious group. Eighty-two agoraphobics with panic disorder were randomly allocated to one of four treatment groups resulting from a combination of two drug treatments (alprazolam or placebo) and two psychological treatments (exposure or relaxation). Of these, 38 subjects were assessed on a range of objective and subjective indices of memory and mood at three time points: before treatment, after 8 weeks of treatment and again at 24 weeks when patients had been free of medication from 5-8 weeks. Alprazolam produced pronounced impairments on a word recall task. At the 24-week medication-free follow-up, alprazolam patients were still impaired on the task compared with placebo patients. Alprazolam did not impair performance on an implicit memory task and did not affect digit span. Differences between psychological treatments emerged mainly in subjective memory effects. Findings are discussed in terms of the specificity of BZ-induced amnesia and differential tolerance to the varying effects of BZs. Implications are drawn out for the patient's ability to function optimally in daily life while taking alprazolam.

Behavioral analysis of diazepam-induced memory deficits: evidence for sedation-like effects

Rats were trained on a nonmatching-to-sample task with delays of 2, 5, and 10 min. Subsequently, performance was assessed in three groups of rats following treatment with saline or diazepam (2.0 mg/kg) administered acutely or tested chronically in six administrations. Relative to treatment with saline, diazepam produced a deficit in discrimination performance, which was greater in the acutely treated rats than in those treated chronically. The deficit was not dependent on the length of the delays. Diazepam-treated animals differed from controls in erring on trials in which they failed to investigate both test objects, failed to investigate the test object for a long enough period of time, and displaced the test object on the preferred side of the apparatus. The hypothesis that these effects represented a sedation-like reduction in behavioral variability was also supported by evidence of a diazepam-induced decrease in gross bodily activity, increase in inactivity, and increase in latencies to respond to objects. No support was found for the involvement of diazepam-induced changes in habituation, extinction, or reward effects.

Pharmacologic aspects of benzodiazepine tolerance and dependence

Benzodiazepines, which are among the safest and most effective drugs, possess all the characteristic of abuseable compounds. Although there appear to be differences in potency among compounds and variations in sensitivity among individuals, benzodiazepines have clear reinforcing properties. Tolerance to the depressant effects of benzodiazepines is rapid, but tolerance to the anxiolytic effects develops slowly and to a limited extent. Although abusers use very high doses, most long-term users persist at daily doses in the low therapeutic range (10-20 mg of diazepam or its equivalent) without dose escalation. Physical dependence is a risk associated with long-term use, even at therapeutic doses. The withdrawal syndrome is mild at low doses. Continued self-administration of low therapeutic doses is maintained to alleviate withdrawal symptoms. The advances in the recent understanding of the molecular biology of the benzodiazepine receptor gives hope to the development of new anxiolytic compounds with less dependence liability than the present ones.

Models of memory dysfunction? A comparison of the effects of scopolamine and lorazepam on memory, psychomotor performance and mood

The effects on memory, psychomotor functions and mood of intramuscular scopolamine (0.3 mg, 0.6 mg) were compared with those of oral lorazepam (2 mg) and placebo. Thirty-six volunteers took part in a double-blind, independent groups design. Subjects completed a battery of tests 1 and 3 h after drug administration. Both doses of scopolamine produced levels of sedation comparable to that produced by lorazepam. The time course of effects of scopolamine and lorazepam differed but the pattern of psychomotor impairments and amnestic effects produced was very similar. In terms of mood, lorazepam had an anxiolytic effect whereas scopolamine increased ratings of anxiety. Levels of sedation, indexed by either subjective ratings or motor retardation (tapping speed), were related more to psychomotor performance than to performance on memory tasks. The results suggest that benzodiazepines and scopolamine have similar amnestic and sedative effects and as such may not offer distinct models of memory dysfunction.

Benzodiazepine receptors modulating serotonergic neurotransmission in rat hippocampus do not desensitize after long-term diazepam treatment

Previous studies have shown in the rat that long-term diazepam treatment induces a desensitization of gamma-aminobutyric acid (GABA) benzodiazepine receptors which modulate serotonergic (5-HT) neuron firing activity in the dorsal raphe. We have examined the effect of a 21-day treatment with diazepam (5 mg/kg/day, i.p.) on the benzodiazepine receptors (BZR) which modulate the efficacy of the electrical stimulation of the ascending 5-HT pathway in suppressing the firing activity of rat dorsal hippocampus pyramidal neurons. The efficacy of the stimulation was not modified 24 h after the last dose of diazepam. Moreover, the potentiating effect of acute diazepam (1 mg/kg, i.v.) on the efficacy of the stimulation was similar in diazepam- and vehicle-treated rats. These results indicate that GABA-benzodiazepine receptors that modulate the release of 5-HT in the rat dorsal hippocampus are not desensitized by long-term diazepam treatment.

Simultaneous modeling of the pharmacokinetic and pharmacodynamic properties of benzodiazepines. I: Lorazepam

This investigation compares the time course changes in the central nervous system (CNS) impairment effects on psychomotor and cognitive skills and relates these changes to the plasma lorazepam concentrations in a pharmacokinetic-pharmacodynamic (PK-PD) model. Six male subjects received a single oral dose of lorazepam or placebo. The CNS effects were measured by using computerized continuous tracking (TRKN), body sway with eyes open (SWAY OPEN), and digit symbol substitution (DSS) tests. Plasma lorazepam concentrations were best characterized by a two-compartment model with first-order absorption. Plotting the plasma lorazepam concentration and measured effect across time revealed a counterclockwise hysteresis loop. Fitting the time course of the effects in an integrated PK-PD model required an effect compartment with the equilibrium rate constant between it and the plasma compartment. The magnitude of the temporal lag was quantified by the half-time of equilibration between concentration in the hypothetical effect compartment and the plasma lorazepam level (t1/2keo). The CNS effect measured by TRKN was characterized by a mean estimate of maximum predicted effect (Emax) of 418 with a t1/2keo of 0.43 hr, an estimate of effect site drug level to produce 50% of Emax (EC50) of 35.8 ng/ml and a power parameter (gamma) of 6.29. Corresponding parameter mean estimates for SWAY OPEN and DSS as measures of drug CNS effect were quite similar.

The scopolamine model of dementia: chronic transdermal administration

The transient impairments of memory produced by the muscarinic antagonist scopolamine have been adopted as a pharmacological model of Alzheimer-type dementia in normal volunteers. In this study we examined the effects of chronic (72 h) transdermal administration of scopolamine on memory, attention, sedation and visual function. The transdermal patches provided constant plasma levels of scopolamine for the duration of the study. Indices of the peripheral effects of scopolamine (visual near-point and pupil size) showed impairments that were sustained for 3 days. However, measures of sedation and memory revealed impairments that were maximal the day after patch application and which were no longer present 3 days after application. This pattern of results is discussed in relation to pharmacological modelling of Alzheimer's disease.

Withdrawal, tolerance and sensitization after a single dose of lorazepam

Forty-eight hours after a single dose of lorazepam (0.25 mg/kg), there was tolerance to the lorazepam-induced reduction of locomotor activity in the holeboard; but no tolerance to the reductions in exploratory head-dipping or rearing. Mice tested undrugged at this time showed significant hyperactivity and increased rearing, indicating withdrawal responses, but no change in head-dipping. In the elevated plus-maze, no tolerance could be detected to the effects of lorazepam (0.25 mg/kg) when the mice were tested 48 hr after an initial dose; in fact, there was a trend towards enhanced effects in this group. When mice were tested undrugged 24, 48 or 72 hr after a single dose of lorazepam there was an increase in the % time spent on the open arms, compared with controls, that reached significance for the 24 hr group. This indicates a sensitization to the anxiolytic effects of lorazepam, as assessed in the plus-maze. These results demonstrate long-lasting effects of even a single dose of lorazepam.

Behavioral measurement of benzodiazepine tolerance and GABAergic subsensitivity in the substantia nigra pars reticulata

Rotational behavior was elicited by unilateral microinjection of the benzodiazepine flurazepam, and the gamma-aminobutyric acid (GABA) agonist, muscimol, into the substantia nigra pars reticulata (SNpr). This response was used to quantitate benzodiazepine tolerance and GABAergic subsensitivity after chronic benzodiazepine treatment. Studies in naive rats established the dose requirements for inducing contralateral circling and demonstrated the reproducibility of the behavioral response as a measure of SNpr function. There was a large difference in potency between the two drugs for causing dose-related rotation. The response to microinjected flurazepam could be blocked by 16 mg/kg of the benzodiazepine antagonist, Ro15-1788. Tolerance to intranigral flurazepam (50 micrograms) was measured by a reduction in the turning response after a 1- or 4-week chronic flurazepam treatment. The time course for the reversal of tolerance after a 4-week benzodiazepine treatment correlates with the time course of the reversal of benzodiazepine receptor down-regulation in the SNpr. Subsensitivity of the GABAergic system was demonstrated by the decreased rotational response to muscimol (10 ng), confirming the idea that the GABAergic system is also functionally altered by chronic benzodiazepine treatment. The time course of the decreased sensitivity to muscimol does not coincide with the development and reversal of tolerance to the turning produced by flurazepam or with benzodiazepine receptor down-regulation. These data suggest differential regulation of SNpr sensitivity to benzodiazepine and GABA agonists following chronic benzodiazepine treatment and may provide a basis for differential tolerance; the development of tolerance to some but not other benzodiazepine actions.

Drugs and information processing in skilled performance

A concise review is presented of recent research on task aspects with respect to determining the effects of drugs on human information processing. It is concluded that progress in this area is hampered by lack of a theoretical basis to most behavioral tasks, preventing firm conclusions about the effects of drugs on either well-defined mental functions or on real-life performances. It is argued that the effects of drugs should only be tested in behaviorally well-researched tasks. Some proposals are discussed with an emphasis on perceptual-motor skills.

Assessment of the effects of drugs on memory

This survey is based on 70 controlled investigations of the effects of drugs on memory in healthy volunteers. Although detracting effects were predominant, enhancements were reported as well. The effects of 29 well-known drugs on 15 familiar tests are summarized in a way that permits comparisons of the effects of different drugs and of test sensitivities. There is a discussion of factors that could bias or obscure investigations of the effects of drugs on learning and remembering.

Long-term treatment of anxiety: benefits and drawbacks

Anxiety disorders are common conditions, often chronic, occurring in the general population with a prevalence of about 3%. Long-term use of tranquilizers varies from 0.5% of the total adult population in Sweden and 1.3% in Denmark to 3.1% in Great Britain and 5% in France. This use is tending to become more and more long-term. Long-term efficacy of benzodiazepine medication has not been established. Adverse effects include psychomotor and cognitive impairment, especially in the elderly; some, but not all, effects show tolerance. Some impairment can be demonstrated even after years of use. Rebound and withdrawal reactions after long-term use are common. Practical guidelines to minimize long-term use are suggested.

Acute and subchronic effects of Org 2305 and diazepam on psychomotor performance in man

Three doses (15, 30 and 60 mg) of Org 2305 (O 15, O 30 and O 60 respectively), a novel anxiolytic drug chemically related to mianserin, were compared with placebo and 15 mg diazepam (DZ) on human psychomotor performance in a double-blind, cross-over study with 15 healthy volunteers. Objective measurements (choice reaction, tracking, flicker fusion, Maddox wing, digit symbol substitution, memory recall) and subjective assessments (visual analogue scales) were done at baseline and 2 and 13 h after the first dose. This testing procedure was repeated on day 7 when administering the seventh consecutive daily night-time dose. After the first dose O 15 did not differ from placebo and O 30 rarely differed from placebo. O 60 impaired various objective functions similarly to, or less than DZ. Subjectively, DZ and O 60 were felt as sedative. During subchronic treatment, DZ caused some impairment of baseline due to accumulation of bioassayable benzodiazepines, but significant responses to the last DZ dose were less than those to the first dose. DZ but not O 60 was reported to have caused lethargy and clumsiness during subchronic treatment. In the doses used Org 2305 impaired psychomotor performance less than diazepam did. A dose of 60 mg Org 2305 may offer some advantage over 15 mg diazepam, provided that their anxiolytic effects are about similar.

Influence of dosing regimen on alprazolam and metabolite serum concentrations and tolerance to sedative and psychomotor effects

The relationships between alprazolam and metabolite concentrations and CNS effects were determined in a double-blind placebo controlled four-way crossover trial in 16 normal male volunteers. Active drug treatments consisted of 4-day regimens of 4 mg alprazolam PO daily as 2 mg bid., 1 mg qid, and 0.25 mg each hour. On days 1 and 4, the kinetics, sedative and psychomotor effects were evaluated. Plasma concentrations of the 4- and alpha-hydroxy metabolites of alprazolam were less than 10% of unchanged alprazolam levels on both days. Accumulation of these metabolites and alprazolam was dependent on alprazolam half-life (11.6 h). Acute and chronic tolerance to the sedative and psychomotor effects was observed with all active drug treatments. All alprazolam treatments resulted in significantly greater sedation than placebo on days 1 and 4. However, on day 4, sedation was 16-36% less than observed on day 1, despite plasma concentrations 1.4-2.76 times the day 1 concentrations. Sedation from alprazolam was reduced in each successive study phase, suggesting a tolerance which was sustained during the 10-day washout between phases. By day 4, psychomotor performance was not different from placebo, indicating more complete development of tolerance than occurred for the sedative effect. Sedation and psychomotor impairment on day 1 were greatest with 2 mg alprazolam bid. During the initiation of therapy, the patient will likely experience less sedation and psychomotor impairment with smaller, more frequent doses. Since tolerance develops to these effects, the advantage of more frequent dosing regimen dissipates by the 4th day.

Differential amnesic properties of benzodiazepines: a dose-response comparison of two drugs with similar elimination half-lives

The effects on memory and psychomotor functions of oxazepam (15, 30 mg) were compared with those of its chlorinated derivative lorazepam (1, 2 mg) and placebo. Forty five volunteers took part in a double-blind, independent groups design. Subjects completed a battery of tests before and 1.5 and 3 h after drug administration. Lorazepam and oxazepam had similar dose-related effects on tests of attention, manual motor speed and recoding skills and all active treatments produced similar levels of subjective sedation. Both drugs caused anterograde impairments of long-term verbal memory and had no effects on short-term verbal span or recency. Neither drug produced retrograde amnesia for material learned before drug administration nor affected retrieval from semantic memory. The high (2 mg) dose of lorazepam positively facilitated recall of pre-drug information. The magnitude of anterograde amnesia produced by the two benzodiazepines was not linearly dose-related in that the two low doses had similar effects whereas the high dose of lorazepam produced impairments many times greater than oxazepam 30 mg. We conclude that drugs with similar half-lives may have similar effects on some cognitive and mood factors but be completely different in terms of amnesic effects. Differing potencies of the two drugs may be a more important factor determining amnesic side-effects.

Tranquillising memories: a review of the effects of benzodiazepines on human memory

Studies from 1973 to 1985 of the effects of benzodiazepines on memory are summarised and reviewed. Anterograde amnesia appears a common effect of all benzodiazepines although its onset and duration vary with the particular benzodiazepine, its dose and route of administration. Memory impairments increase with task difficulty. There is some evidence that partial tolerance to amnesic effects develops with repeated doses of diazepam, but research with other benzodiazepines is inconclusive. Amnesia is in part a by-product of the sedative action of benzodiazepines, although these drugs may also have a specific effect of disrupting the consolidation of information in long-term memory. State-dependent effects are partial and relatively small. Methodological problems are discussed and attention is drawn to the lack of repeated dose studies, of studies with patient populations and with anxious volunteers.

Repeated administration of diazepam and triazolam to subjects with histories of drug abuse

The present study examined the effects of repeated administration of diazepam (DZ) and triazolam (TZ) on psychomotor performance and subject-rated drug liking. Subjects were 11 males (30-41 years) who had documented histories of drug abuse and who resided on a behavioral pharmacology research ward. Six subjects received 80 mg DZ every third day (3 subjects) or every sixth day (3 subjects) for a total of 3-6 dosing occasions and six subjects received TZ (2.0 or 3.0 mg) every second day (4 subjects) or every third day (2 subjects) for a total of 3-5 dosing occasions. The results showed that on the first dose occasion, the two drugs produced generally similar degrees of psychomotor impairment and subject-rated drug liking. Following the first DZ dose, subsequent doses produced less of an effect (i.e. single-dose tolerance). Across at least the first three dose occasions, progressive tolerance development was observed with DZ but no tolerance was observed with TZ. It is hypothesized that pharmacokinetic differences between DZ and TZ may account for the difference in the development of tolerance.

Acute tolerance to diazepam induced by benzodiazepines

It was observed that the effectiveness of diazepam in causing sleep, as defined by the loss of righting reflex, was significantly decreased after a single exposure to either diazepam or lorazepam. RO 15-1788, a benzodiazepine antagonist, in contrast did not induce tolerance to diazepam. The mechanism for this acute tolerance is unclear. The rapidity in its development may exclude metabolic tolerance while alterations in brain sensitivity to diazepam remain a possibility.

Effects of repeated doses of fluvoxamine, mianserin and placebo on memory and measures of sedation

The effects on memory and learning of fluvoxamine 50 mg twice a day were compared with those of mianserin 20 mg twice a day and placebo, each given for 8 days in a double-blind cross-over design to nine healthy human volunteers. At least 1 week was left between the 8-day courses of drugs. Subjects were given a learning task (three trial recall of categorisable word lists) before and 3.5 h after a morning dose on day 1 and before their morning dose on day 8. Delayed recall was assessed on days 1, 4 and 8. Fluvoxamine had no effect on memory performance. Mianserin reduced learning and recall after a single dose but had no effect on day 8 of treatment. The single dose of mianserin had no retrograde effect on memory, affected primacy and middle position items but not recency in the serial position curve, and was seen in reduced inter-trial subjective organisation of recall. Subjects' performance on the first trial of the memory task correlated significantly with their performance on a simple reaction time task, with finger tapping speeds and with their subjective ratings of alertness. It was concluded that the impairments of memory produced by one dose of mianserin are partially by-products of the sedative effects of the drug. Tolerance to both memory impairments and sedative effects built up over the 8-day treatment of mianserin.

A comparison of the effects of lorazepam with those of propranolol on experimentally-induced anxiety and performance

In a double-blind cross-over study the effects of propranolol (80 mg) and of lorazepam (1 or 2.5 mg) were assessed in normal student volunteers using a number of performance tests and mood-rating and bodily symptom questionnaires. Drug effects on experimentally-induced anxiety were also studied. The high dose of lorazepam impaired performance in digit-symbol substitution, symbol copying and verbal learning tests, and increased subjects' ratings of dizziness. Both lorazepam and propranolol increased simple reaction time. Lorazepam but not propranolol increased ratings of sedation. Although the stressor increased subjects' ratings of anxiety, neither drug altered anxiety ratings. Propranolol decreased and lorazepam increased subjects' pulse. These changes were not reflected in subjects' self-ratings - lorazepam caused a reduction in ratings of palpitations. The results suggest that if administered acutely, neither drug is beneficial in the treatment of short-term anxiety associated with intellectual stress.

The amnesic action of benzodiazepines in man

A qualitative description of the amnesia produced by the benzodiazepines in man is presented. The benzodiazepines exert their greatest effects in tests of long-term episodic memory in which they cause a dose-related impairment in the acquisition of new information, do not appear to affect retention and may facilitate retrieval. Benzodiazepines do not appear to impair semantic memory or the acquisition of skills. Although state-dependent learning may be observed with benzodiazepine treatment it is a small effect and cannot account for most of the observed impairments. The amnesia appears to be characteristic of all benzodiazepines and may be related to the sedative action of these compounds but evidence on the latter point is inconclusive. The importance of the amnesic action in a population of clinically anxious outpatients taking benzodiazepines over an extended period remains to be investigated. The benzodiazepines may provide the cognitive psychologist with a useful tool to investigate the mechanisms of normal memory.

The nature of lorazepam-induced amnesia

The effect of lorazepam (2.5 mg) was assessed in two tests of short-term retention (digit-span and Benton Visual Retention), and in verbal learning and picture recognition tests. Lorazepam was without effect in a test of digit-span, but it impaired performance in the Benton Visual Retention and picture recognition tests. In the verbal learning test lorazepam caused a severe anterograde amnesia. Increasing arousal during the presentation of material partially overcame this effect, but also improved the performance of controls. Lorazepam-treated subjects were able to learn a backwards-reading task at a rate no different from controls. The deficits caused by lorazepam are similar to those that have been observed in patients with the amnesic syndrome.