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Benzodiazepines vs. Barbiturates

Benzodiazepines and barbiturates are both prescription drugs that help to calm you down and help you sleep. They’ve both been used to treat insomnia and anxiety in the past, and they both work in the brain in a similar way. However, one of these drugs is still widely used today, while the other has faded into obscurity. Learn more about why one of these drugs continues to be prescribed for anxiety and insomnia, while the other is only a rare anesthetic today. 

What are Barbiturates?

Barbiturates are potent central nervous system depressants that have their origins in the 19th century. They are among the oldest prescription depressants that were widely used in the United States, and they were once one of the most popular medications on the market. Through the 20 century, barbiturates were used to treat everything from anxiety to seizures. They were also widely marketed as sleep-aids until the 1970s. Today, they are less common and typically prescribed as anesthetics. 

Barbiturates work in the brain in a way that’s similar to other depressants. They’re GABAergic, which means they work by interacting with a naturally-occurring chemical in the brain called gamma-aminobutyric acid (GABA). GABA is a chemical messenger in the brain that binds to its receptors and regulates nervous system excitability. People with anxiety disorders and sleep problems may have some psychological or biological issue that makes slowing down excitability in the brain and nervous system more difficult. In some cases, GABAergic drugs like barbiturates can help. 

Barbiturates bind to GABA receptors and increase the chemical’s effectiveness. This can help facilitate, anxiolysis (anti-anxiety) and rest. Barbiturates are potent drugs and can affect the body to an intense degree. Barbiturates can cause hypnosis, drowsiness, a loss of motor skills, and disinhibition. Barbiturates eventually fell out of standard use when it came to common disorders like anxiety and insomnia. With abuse and overuse, barbiturates can cause some serious consequences, including dependence, potentially dangerous withdrawal, and deadly overdose. 

Using the drug for too long can quickly lead to a substance use disorder, even if it’s taken in normal doses. High doses and mixing the drug can lead to fatal symptoms. In fact, there were a number of high profile overdose deaths in the 20th century that involved barbiturates, including Jimmi Hendrix, Judy Garland, and Marilyn Monroe. 

What are Benzodiazepines?

Benzodiazepines, or benzos, are also central nervous system depressants that are prescribed for insomnia and anxiety. Benzos work in a way that is very similar to barbiturates, and they are also GABAergic chemicals that increase the potency of GABA by binding to receptors. However, they achieve their effects through different means. Benzos increase chloride channel frequency opening while barbiturates increase the duration of GABA receptor currents. In other words, they use different chemical actions to achieve the same result, which is to make your GABA more effective. 

In the 1960s and 70s, benzos largely replaced barbiturates as the standard medication for anxiety, insomnia, and other issues causing nervous system overactivity. Benzos were thought to have a safer side effect profile. Though they can cause some of the same adverse effects like tolerance, addiction, withdrawal, and overdose, they aren’t as likely to lead to severe symptoms as barbiturates. 

Benzos are sometimes abused for their intoxicating effects. As a depressant, they can cause intoxication in a way that’s similar to alcohol when abused. They are also sometimes used to enhance the effects of alcohol or other drugs, but this can be even more dangerous. Benzos aren’t likely to lead to a fatal accidental overdose on their own unless a very high dose is taken. However, they can be more deadly when combined with other substances. If benzos are mixed with alcohol, barbiturates, opioids, or other sleeping pills, it can cause something called potentiation. 

Potentiation is when two or more substances combine to cause more intense effects in the body. Because of this, even standard doses of each individual drug can cause an overdose when combined. According to the National Institute on Drug Abuse, more than 30 percent of opioid overdoses also involved benzodiazepines. 

How Do They Compare?

On the surface, benzodiazepines and barbiturates can seem like pretty much the same drug. However, they do have some fairly significant differences. Some that are so crucial, one drug is still used today while the other is fairly obscure. Still, both substances have some clear similarities. They are both depressants that work in the brain in similar ways and are used for similar purposes. Today, barbiturates have largely replaced by benzos as a remedy for anxiety and insomnia because benzos are considered safer. Barbiturates are more likely to lead to addiction and deadly overdoses on their own, while benzos generally require very high doses, or mixing to be fatal. 

Benzos are more likely to cause respiratory depression, a symptom of overdose that can slow or stop your breathing. Most depressants and opioids can cause this side effect when taken in a high enough dose. However, benzos seem to cause it more readily than benzodiazepines. Respiratory depression can cause oxygen deprivation, brain damage, coma, or death. If you or someone you know is using an opioid or a depressant and their breathing slows down, and they lose consciousness, it’s important to seek medical help as soon as possible.

Why Seek Addiction Treatment?

If you or someone you know is struggling with a substance use disorder, there’s help available. Substance use disorders have a tendency to get worse before you realize there’s a problem. If you’ve noticed that you are using more of a drug than usual or if you’ve tried and failed to quit or cut back, you might have a substance use disorder. 

Substance use disorders can get out of control quickly, affecting multiple aspects of your life. If left untreated, addiction can cause health problems, social issues, financial instability, and legal problems. However, addiction is treatable, and addressing it early can help you avoid some of the worst consequences of addiction. However, treatment may help you, no matter where you are in the disease of addiction. To take your first steps toward recovery, learn more about addiction treatment today.

Sources

Higuera, V. (2017, August 2). Respiratory Depression: Symptoms, Causes, and Treatments. Retrieved from https://www.healthline.com/health/respiratory-depression

National Institute on Drug Abuse. (2018, March 15). Benzodiazepines and Opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids

RxList. (2018, September 24). Barbiturates: Side Effects, Dosages, Treatment, Interactions, Warnings. Retrieved from https://www.rxlist.com/consumer_barbiturates/drugs-condition.htm

Twyman, R. E., Rogers, C. J., & Macdonald, R. L. (1989, March). Differential regulation of gamma-aminobutyric acid receptor channels by diazepam and phenobarbital. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2471436

U.S. National Library of Medicine. (2004, September 16). gamma-Aminobutyric acid. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/gamma-Aminobutyric-acid

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