Paradoxical reaction

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In medicine, a paradoxical reaction is the reaction of the body to an active substance that causes the opposite of the intended effect. Examples include insomnia after taking a sleeping pill or increased anxiety after taking an anti- anxiety drug .

Paradoxical reactions can often be observed in people affected by ADD / ADHD . A paradoxical reaction is also described in 1.2% of children who received the active ingredient phenobarbital before diagnostic procedures . Such reactions can also be observed with benzodiazepines . The opposite effect, namely that a stimulating substance can also have a dampening effect, has been described for caffeine .

The paradoxical reaction must be distinguished from immunological drug reactions and effects that arise after tolerance development (see withdrawal syndrome ) on certain substances. The increase in the risk of suicide in the initial phase of administration of certain antidepressants is also not a paradoxical reaction in the strict sense.

causes

GABA A receptor with binding sites for various substances.

The mechanism of a paradoxical reaction in humans has not yet been fully clarified in a single case (as of 2019). This is due to the fact that the signal traffic of individual nerve cells in the relevant subcortical area is generally not accessible in humans.

However, there are numerous indications that the paradoxical reactions to - among other things - benzodiazepines, barbiturates , inhalation anesthetics , propofol , neurosteroids and alcohol ( ethanol ), there are certain structural deviations in GABA A receptors . The composition of the five subunits of the receptor (see figure) can be changed in such a way that, for example, the reaction of the receptor to GABA remains unchanged, but the reaction to one of the other substances mentioned is drastically changed.

It is estimated that around 2–3% of the population can suffer from such changes, for example, severe emotional disturbances and up to 20% moderate disturbances of this kind. It is assumed that genetic and also epigenetic deviations underlie the changes in GABA A receptors lie. There are indications that the latter can be triggered, among other things, by social stress or burnout .

Web links

Individual evidence

  1. ^ B. Langguth, R. Bär, N. Wodarz, M. Wittmann, R. Laufkötter: Paradoxical reaction in ADHD. In: Deutsches Arzteblatt international. Volume 108, Numbers 31-32, August 2011, p. 541; author reply 541-541; author reply 542, doi : 10.3238 / arztebl.2011.0541a , PMID 21886668 , PMC 3163785 (free full text), version in German .
  2. ^ VE Karian, PE Burrows, D. Zurakowski, L. Connor, KP Mason: Sedation for pediatric radiological procedures: Analysis of potential causes of sedation failure and paradoxical reactions. In: Pediatr Radiol. 29, 1999, pp. 869-873.
  3. ↑ C. Robin, N. Trieger: Paradoxical reactions to benzodiazepines in intravenous sedation: a report of 2 cases and review of the literature. In: Anaesth Prog. 49, 2002, pp. 128-132.
  4. ^ JT Rubin, RB Towbin, M. Bartko, KM Baskin, AM Cahill, RD Kaye: Oral and intravenous caffeine for treatment of children with post-sedation paradoxical hyperactivity. In: Pediatric radiology. Volume 34, Number 12, December 2004, pp. 980-984, doi : 10.1007 / s00247-004-1303-8 , PMID 15365651 .
  5. ↑ Red List 2011. Frankfurt, 2011.
  6. ↑ C. Robin, N. Trieger: Paradoxical reactions to benzodiazepines in intravenous sedation: a report of 2 cases and review of the literature. In: Anesthesia progress. Volume 49, Number 4, 2002, pp. 128-132, PMID 12779114 , PMC 2007411 (free full text) (review).
  7. ↑ Carol Paton: Benzodiazepines and disinhibition: a review. In: Psychiatric Bulletin. 26, 2002, p. 460, doi : 10.1192 / pb.26.12.460 , PDF .
  8. ↑ T. Bäckström, M. Bixo, M. Johansson, S. Nyberg, L. Ossewaarde, G. Ragagnin, I. Savic, J. Strömberg, E. Timby, F. van Broekhoven, G. van Wingen: Allopregnanolone and mood disorders. In: Progress in neurobiology. Volume 113, February 2014, pp. 88-94, doi : 10.1016 / j.pneurobio.2013.07.005 , PMID 23978486 (review), PDF .
  9. ^ EN Brown, R. Lydic, ND Schiff: General anesthesia, sleep, and coma. In: The New England Journal of Medicine . Volume 363, number 27, December 2010, pp. 2638-2650, doi : 10.1056 / NEJMra0808281 , PMID 21190458 , PMC 3162622 (free full text) (review).