Addiction with benzodiazepines is an extremely dangerous one. Benzos are one of the only type of substances that can threaten death during withdrawals. So, with that in mind, what is a benzo? Is it different from a barbiturate? And how do I stop using them? This article will focus on everything related to benzos and barbiturates.
What Are Benzos And Barbiturates?
Benzodiazepines, a class of psychoactive drugs are the most widely used drugs used to treat anxiety. They are safer and more effective than barbiturates and therefore have largely replaced them in the recent times. Barbiturates are drugs that act as central nervous system depressants and were a cornerstone to sedate patients or induce sleep in the past. Barbiturates are associated with rapid tolerance, dependence, and severe withdrawal symptoms if the drug is abruptly stopped. Barbiturates can also cause coma in very high doses. Due to this, barbiturates are not as widely used as they were once back in the days. Barbiturates are all chemical derivatives of barbituric acid, while benzodiazepine’s chemical structure involves a benzene ring and a diazepine ring.
The first benzodiazepine, chlordiazepoxide, was produced in 1955 by Leo Sternbach while working on tranquilizers. He was initially disappointed with his synthesis and he went on to abandon the project. Later on, in the year 1957, its beneficial properties as an anticonvulsant, anxiolytic, muscle relaxant were discovered. These led to the introduction of chlordiazepoxide to the world as the name Librium. In the coming years, benzodiazepines were commonly used drugs owing to their amazing properties and very few side effects until the discovery of their dependence in the 1980s. Since then, debates are going on regarding their therapeutic uses as well as problems with addiction. Despite all of this, this class of drugs remains highly popular.
Barbiturates on the other hand, were first synthesized in 1864 by a German chemist Adolf van Baeyer. However, it was not until 1903, that the sedative actions of barbital were discovered by the two German scientists, Emil Fischer and Joseph von Mering. It was only in the 1950s that the behavioral effects and physical dependence of barbiturates were recognized.
Types Of Benzos
Types Of Barbiturates
How Do They Work?
Benzos target the GABA (gamma amino butyric acid; an inhibitory neurotransmitter) receptor producing different effects depending on the type of receptor and the area of brain concerned with a specific function.
These drugs also bind to GABA receptors at sites other than benzos. In addition to this, barbiturates can block the glutamate (excitatory neurotransmitter) receptors.
The Purpose Of Benzos
Actions Of Benzos
- Anxiolytic effects: at low doses, benzos are used to treat anxiety by inhibiting certain neuronal pathways in the brain.
- Sedative and hypnotic actions: these drugs produce sedation and hypnosis (artificially induced sleep) at higher doses.
- Anticonvulsant properties: most of the drugs in this class are used to treat epilepsy and other seizure disorders.
- Anterograde amnesia: these drugs can induce anterograde amnesia. This type of amnesia means that the person is unable to form or retain any new memories.
- Muscle relaxant: when given at high doses, benzos reduce the spasticity of the skeletal muscles.
- Anxiety disorders: benzodiazepines are the most widely used drugs for anxiety disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, Obsessive compulsive disorder, and phobic disorder). These drugs are also used to treat anxiety as part of other disorders like depression and schizophrenia. Continuous benzos use is only recommended for severe anxiety. On the other hand, for other milder forms they should only be used for shorter durations keeping in mind their high addictive potential.
- Muscular disorders: diazepam, one of the benzodiazepines is used to treat muscle spasms associated with like multiple sclerosis and cerebral palsy.
- Amnesia: shorter acting agents in this class are given before uncomfortable procedures like bronchoscopy, endoscopy and certain dental procedures.
- Seizures: clonazepam is used to treat certain epileptic disorders while diazepam and lorazepam are used to treat grand mal seizures and status epilepticus.
- Sleep disorders: Benzos approved for this use include triazolam, flurazepam, and temazepam.
Dependence & Other Adverse Effects
Physical and psychological dependence can develop if the person consumes high doses of the drug for long periods of time. Sudden stopping of the drug can produce severe withdrawal symptoms like confusion, anxiety, sedation, agitation, restlessness, insomnia, depression and seizures.
Other adverse effects:
- Drowsiness and confusion: these two are the most common side effects of benzos. Poor coordination develops at high doses and the person may be unable to perform tasks requiring fine motor skills.
- Cognitive impairment has also been noted with the use of benzodiazepines.
- Decreased libido and erectile dysfunction is also a common adverse effect.
- Depression and disinhibition
The Purpose Of Barbiturates
Actions Of Barbiturates
- CNS depression: any degree of CNS depression is possible with the use of barbiturates depending on the dose. At low doses, barbiturates decrease the excitement and produce a sense of calm in the person. At dangerous doses, the drug can cause hypnosis. Further increases in dose can cause anesthesia, coma and eventually death. Persistent use of barbiturates leads to the development of tolerance (that is, when the person requires increasing doses in order to produce the same desired effects).
- Respiratory depression
- Enzyme induction: barbiturates induce the enzyme system cytochrome P450 in the liver. This decreases the concentration of other drugs in the body that use this enzyme system for their metabolism.
- Anesthetic action: ultra-short acting barbiturates are used to induce anesthesia.
- Anticonvulsant: phenobarbital, a known barbiturate is used to treat tonic-clonic seizures, status epilepticus and eclampsia.
- Anxiolytic: barbiturates are used as mild sedatives to relieve anxiety, depression and insomnia.
Dependence To Barbiturates & Other Effects
- Impaired concentration
- Slow mental functions
- Drug hangover: that is the patient feels extremely tired after arousal such that is unable to perform normal daily activities.
- Barbiturate poisoning: this has been a leading cause of death due to overdose of these drugs. This condition is characterized by severe respiratory depression coupled with cardiovascular depression.
- Physical dependence: abrupt stoppage of the drug will produce withdrawal symptoms like tremors, restlessness, nausea, headache, vomiting, seizures, delirium, cardiac arrest. These symptoms are more dreadful than associated with opiates and may even result in death.
These Drugs And Addiction
Both benzos and barbiturates are drugs with addictive properties. Some people are more susceptible to developing addiction with these drugs than others. Chronic use of these drugs can make a person tolerant to it. This can be problematic for the patient in the long run. A person addicted to these drugs will show signs and symptoms of addiction such as problems sleeping, uncontrollable body movements, can’t stop thinking about the drug, restlessness when they haven’t taken the drug, etc.
Even though benzodiazepines and barbiturates have remarkable uses to treat troublesome conditions like anxiety and insomnia, they can frequently be abused. To avoid this, health care professionals are required to cautiously prescribe these drugs to troubled patients.
Lippincott’s Williams and Wilkins pharmacology 5th edition