The present study addresses the possible role of endorphins in mediating the anxiolytic properties of diazepam (DZM) in man. The ability of a low dose (0.4 mg. i.v.) of the specific opiate antagonist, Naloxone (NLX) to modify the anxiolytic action of DZM (0.07 mg/kg i.v.) in 22 patients anticipating minor orthopaedic surgery was evaluated. The study was performed in a double-blind placebo (saline)-controlled, randomized design. DZM administered 3 houts pre operation, reduced the anxiety experienced by subjects as estimated on a formal rating scale completed by the patients. NLX, as compared to saline, given 30 min post DZM significantly and strongly attenuated, but did not abolish this effect of DZM. These findings parallel observations in rats of the ability of NLX to block the action of DZM in the conflict test and suggest that the anxiolytic action of DZM in man may be partially mediated by endorphins. A diversity of studies have suggested the benzodiazepines (BZPs) produce their characteristic effects via an enhancement of GABA ergic transmission. Although this apparently represents their primary mechanism of action, other neurotransmitter networks are, evidently, involved in the expression of their effects. Of especial interest in this respect are the endorphins. It was, thus, found that the acute administration of BZPs leads to rapid alterations in the levels of certain endorphins in discrete brain structures (1, 2). Further, although certain actions of BZPs, for example, their discriminative stimulus properties and sedative effects appear to be effected indepentently of endorphins (1, 3, 4), many of the actions of BZPs are moderated by the opiate antagonist, NLX. These include their hypoventilatory, hyperphagic and antinociceptive properties and their ability to facilitate intracranial self-stimulation (1, 5, 6). Of particular interest is the finding, by a number of independent laboratories, that NLX attenuates the anxiolytic activity of BZPs in the conflict test, a method designed for the detection of anxiolytic agents, in animals (1, 5, 6). We have therefore examined the possible role of endorphins as mediators of the anxiolytic actions of BZPs in man.
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