Subjective effects and vigilance after diazepam and oxazepam in normal subjects

Clonidine and diazepam have differential effects on tests of attention and learning

The noradrenergic system has repeatedly been implicated in the mediation of attentional processes. Using a double-blind, placebo-controlled design, the present investigation examines the effects of two doses (1.5 micrograms/kg and 2.5 micrograms/kg) of the alpha 2 adrenoceptor agonist clonidine (CLO) on performance of various computerised tests of attention and learning in healthy, young volunteers. These are compared to the effects produced by two doses (5 mg and 10 mg) of diazepam (DZP) on largely the same set of neuropsychological tests in a comparable set of subjects. Both doses of CLO were found to impair performance of the RVIP test of sustained attention, while the higher dose alone improved visuo-spatial learning. Conversely, the higher dose of DZP produced profound deficits on visuo-spatial learning, and impaired attentional set-shifting. This study suggests a role for the alpha 2 adrenoceptor in selective attention, and for the benzodiazepine receptor in specific cognitive processes mediated by discrete cortical regions.

Benzodiazepines and vigilance performance: a review

The literature on the effects of anxiolytic and hypnotic drugs on performance in tasks requiring sustained attention is confusing. This review is an attempt to evaluate the usefulness of vigilance tasks in the assessment of adverse effects of benzodiazepines. The long, monotonous, character of these tasks may be more relevant to many tasks performed in everyday life than the short, and often stimulating, tasks commonly employed in test batteries. From 37 available studies, 26 were examined in detail. In young, normal volunteers, vigilance tasks were found to be sensitive, often dose dependently, to the impairing effects of drugs, even in low doses (2.5 mg diazepam). With these subjects the tasks may be successfully used to compare different benzodiazepines with respect to residual activity. Both accuracy and speed of performance appear to be affected. However, in people actually using the drugs ("patients"), adverse effects on performance are usually not found. There is no evidence that benzodiazepines aggravate the vigilance decrement occurring under normal conditions. They do affect overall level of perceptual sensitivity, but show less effects on response criterion. The drugs do not seem to interact with anxiety or sleep quality in their effect on performance, but there are few studies with patients, and the assessment of anxiety is not without problems. It is unlikely that impairments in vigilance are simply a byproduct of global, sedative effects, but there is uncertainty regarding measures of general sedation. Developing tolerance with repeated doses has been noted only occasionally, but the opposite of tolerance, aggravated impairment, has also been reported.

The behavioral actions of diazepam and oxazepam are similar

In a double-blind and randomized study, we assessed the comparative pharmacodynamic profiles and behavioral effects of diazepam and oxazepam administered to young healthy volunteers. Diazepam 0.3 mg/kg or oxazepam 1.2 mg/kg or placebo were each administered orally to 13 subjects who were tested with tasks which measured learning and memory, cognition, psychomotor performance and mood before and for 9 h after treatment. The two drugs had similar actions, although subjective effects were milder after oxazepam, which also had a slower onset of action. There was no evidence of rebound behavioral impairment.

Oxazepam in the treatment of anxiety associated with depression: results of treatment in 1600 cases (Studies in depression, VI)

A total of 1600 patients suffering from depression and anxiety was treated in one consultant practice over an 8-year period. In most cases, the depressive component was treated by monoamine oxidase inhibitors, but oxazepam was used as the anxiolytic in all cases in the series. Patients were encouraged to regulate their own dosage of oxazepam, and no difficulties occurred with this technique. The results showed the overall effectiveness of oxazepam as an anxiolytic to be better than 87% in those cases where depression co-existed.