Negative Effects of Hypnotics (By John Richmond)
This recent piece of research highlights the negative effects of hypnotics on our society. I had a conversation yesterday with a patient recently when I was asked to prescribe a sleeper as they were really struggling to sleep and the other anti-depressant medication they were on was ineffective.
It is difficult in this situation as our natural tendency as doctors is to wish to reduce suffering i.e. to be beneficent. There is also a part where it is just easier to prescribe than not, as in the words of The Human League 'when the best of men take bribes, isn't it the fool who doesn't?'. It does certainly make us feel fools to be faced with patients saying that other (and implied better and more caring doctors) would prescribe to hem and the evidence is out there that a lot of doctors do.
However, I see a lot of patients with significant hypnotic dependencies that are extremely anxious, unable to move on in their lives, committing crime when under the effects of benzodiazepines and generally under the impression that their hypnotics are the answer to rather than the cause of many of their problems.
So, I said to my patient that I do not prescribe hypnotics in these circumstances because of a wish to first do not harm i.e. non-maleficence. I could see it on his face - 'what a plonker'. Ah well....I'll keep on being a fool for now.