Marilyn Monroe started her acting career at a young age, but it also ended at a young age. Her rise in the world of the seventh art was hampered by excessive consumption of numerous drugs, which consequently led to her death. Was it possible to prevent her premature departure by properly dosing and prescribing medication and to enable her, and us as viewers, to continue enjoying the stage presence of the famous diva?
What killed Marilyn?
Barbiturates are a group of drugs that act on the central nervous system. Although they are used today as anesthetics and anticonvulsants (substances that prevent seizures), in the past they gained their infamy for their anxiolytic, hypnotic, and sedative effects. One of the victims of the side effects of barbiturates was Marilyn Monroe.
Her doctors prescribed pentobarbital, along with a number of other psychoactive drugs, to calm her down. Namely, short-term consumption of pentobarbital is intended for people who are struggling with insomnia or in the emergency treatment of seizures. Although Marilyn thought that she was keeping her dosage of medication under control and that her health was improving, almost 60 years have passed since an unfortunate sequence of events proved the exact opposite.
Mechanism of action
The target binding site of barbiturates is the GABA-A receptor. GABA (gamma-aminobutyric acid) is the main inhibitory neurotransmitter, i.e. its binding to receptors reduces the excitation of neurons and prevents further transmission of nerve impulses. In addition to its natural substrates, drugs can also bind to this receptor.
Barbiturates act as positive allosteric modulators and agonists of GABA-A receptors. By binding, they prolong the time during which the ion channel (receptor) is in its open state and increase the sensitivity to the natural ligand – GABA. In addition, they can also open chloride channels directly. When the ion channel is open, chloride ions enter the cell leading to hyperpolarization of the neuron which prevents further signaling in the pathway and reduces neuronal excitability.
Fatal dose
Instead of improving her quality of life by taking medication, Marilyn took her own life by taking very high doses of medication. Blood analysis proved lethal concentrations of pentobarbital and chloral hydrate which act as sedatives and hypnotics. Considering the fact that both drugs act on the central nervous system, the first symptom of an overdose is a depression of that same system. In addition, a failure of the respiratory system, dilation of the pupils, and an increased heart rate also occur.
Between 1957 and 1963, 8469 cases of barbiturate poisoning were recorded. The antidote still does not exist, and the use of activated charcoal (if the drug is administered orally) and urine alkalinization helped in the treatment.
No medicine is harmless, and adherence to the precautions and instructions for use of the medicine is important when using “ordinary antibiotics” or dietary supplements. Marilyn has been the center of attention for years, a source of gossip, but also a prominent face on the covers of magazines. She lived under the watchful eye of the public, which cost her her life. Her quotes are known around the world, and some of them, such as: “If I close my eyes and think of Hollywood, all I see is a varicose vein,” have been given a whole new meaning.
Sources
2.Marilyn Monroe: Inside Her Final Days and Fragile State of Mind, 2019, https://www.biography.com/, accessed 16.3.2021.
3.Skibiski J, Abdijadid S. Barbiturates. Florida, StatPearls Publishing, 2021.