Stimulation of GABA-A (Diazepam) and GABA-B (Baclofen) receptor by a benzodiazepine depended patient: intoxication, clinic, treatment – a case report

Introduction: We describe the case of a 28-year-old patient (m) with preexisting dependence on Diazepam, also to alcohol on the ground of a heavy depressive-anxious disorder which was taken up now to the treatment by Baclofen (1 g/day) and Diazepam (60 mg/day). Method: Clinical course documentation, use of validated questionnaires, measurement of the drug levels, picture-giving procedures (MRT, SPECT), EEG. Results: Our patient took for over 2 years regularly Benzodiazepine (Diazepam) and for approx. 2 years regularly Baclofen and fulfilled the criteria also of a Baclofendependence (to ICD 10th): Baclofenlevel with 2370 ng/ml (anti-spastic therapeutic area 100–600 ng/ml; toxic: > 1000 ng/ml, deadly area from LD50=78mg/kg (rat). Summary and discussion: A distinctive parkinsonoid pointed above all in the intoxication to patient without rigor, completely distinctive craving with regard to the GABA-substances Baclofen and Diazepam as well as prolonged anxious symptoms, lack of drive and depressive mood, without pathologica in MRT, SPECT and EEG. The drug levels degraded in spite of therapeutically high dosis to a CYP unspecific increased hepatic metabolizm by Benzodiazepine. The role of the GABA B and GABA A receptor for the dependance, the psychopathology as well as the therapy is discussed.