Paradoxical reaction
[citation needed] In a minority of cases, antidepressants can lead to violent thoughts of suicide or self-harm, as observed in some patients during and after treatment, which is in marked contrast to their intended effect.
[citation needed] Chlorpromazine, an antipsychotic and antiemetic drug which is classed as a "major" tranquilizer, may cause paradoxical effects such as agitation, hallucinations, excitement, insomnia, bizarre dreams, aggravation of psychotic symptoms and toxic confusional states.
[11] Some case reports postulate a high rate (10-20%) of paradoxical response to anesthesia in ADHD patients, though this has not been objectively corroborated in controlled studies.
[12] Benzodiazepines, a class of psychoactive drugs called the "minor" tranquilizers, have varying hypnotic, sedative, anxiolytic, anticonvulsant, and muscle relaxing properties, but they may create the exact opposite effects.
Susceptible individuals may respond to benzodiazepine treatment with an increase in anxiety, aggressiveness, agitation, confusion, disinhibition, loss of impulse control, talkativeness, violent behavior, and even convulsions.
[14] Paradoxical rage reactions due to benzodiazepines occur as a result of an altered level of consciousness, which generates automatic behaviors, anterograde amnesia and uninhibited aggression.
The author warned that environmental or social stresses such as difficulty coping with a crying baby combined with the effects of tranquilizers may precipitate a child abuse event.
The prevalence of this paradoxical reaction is unknown, but research into the phenomenon suggests that it may be as a result of the medicine's interactions with the CYP2D6 enzyme, and that a metabolite of diphenhydramine may be to blame.
[27] The mechanism of a paradoxical reaction has as yet (2019) not been fully clarified, in no small part due to the fact that signal transfer of single neurons in subcortical areas of the human brain is usually not accessible.
[citation needed] There are, however, multiple indications that paradoxical reactions upon – for example – benzodiazepines, barbiturates, inhalational anesthetics, propofol, neurosteroids, and alcohol are associated with structural deviations of GABAA receptors.
