Posted by med_empowered on July 16, 2005, at 15:51:26
from what I understand, barbiturates are still used--albeit very, VERY rarely--for anxiety, and, more commonly, night-time sedation and control of convulsions. At the height of the barbs popularity, there were dozens of different chemicals--each slightly different from the others--flooding the marketplace. Then there the combos--barbs with uppers (Dexamyl, Eskatrol, etc.) for depression/weight loss, barbs with other barbs (Tuinal) for enhanced sedation and presumably better side-effect profile and improved toxicity, barbs with pain killers (fioricet/fiorinal, still around today)...even, apparently, barbs with antipsychotics (I cant find the name of this particular preparation, but I've seen it referenced in a few places...I want to say it was a barbiturate+perphenazine combo. can you imagine?) Some sources even mention complicated mixtures of barbs--for sleep--with stimulants designed to be released after 6-8 hours, to prevent the infamous sleeping pill hangover and get the patient up and at 'em. Despite the development of alternatives (placidyl, doriden, quaaludes, etc.) in the 1950s-1960s, the RX'ing of barbs actually peaked in the late 1950s and 1960s, and there wasnt a major move away from them until well into the 1970s. I have a 1974 edition of some health guide for women. As you might imagine, there's ALOT of information about psychotropics--for depression, anxiety, fatigue, psychosis, whatever. Anyway, the section on anti-anxiety drugs treats the benzos as new drugs that may be no better than old stand bys...and then goes on to recommend Seconal to thrifty housewives. Anyway, Tuinal, Seconal, Nembutal, and Alurate are still around, although some of them are only in generic form now. Now and then, someone will receive barbs for anxiety or insomnia, although docs seem to prefer Phenobarbital. Alurate is rarely used, but it is safer than seconal/nembutal, which are schedule II drugs; Alurate is a schedule III...basically, it CAN be addicting and it CAN kill you, but the odds are much better than with the short/ultra-short acting barbs. Psychiatry has a history of demonizing old treatments once something that looks better, more effective, more tolerable and more expensive hits the scene; look at what happened to tricyclics when prozac popped on the scene, and the sudden change of heart shrinks have had about Haldol and other old-school neuroleptics now that the atypicals are available. Yes, a lot of times the new drugs are somewhat better, but a lot of times once the smoke clears the difference appears to be one of degree rather than representative of some sort of revolution or miracle in the field of psychiatry. Although barbs have a terrible rep, and they were simply terrible if someone DID end up abusing them hardcore, I have plenty of older relatives (mostly women) who took barbs in various forms way back when and lived to tell the tale. The difference seems to be that their doctors didn't buy the "modern, proven, safe as breathing air" hype and exercised some restraint in how they RX'd the stuff. As a result, the women in my family who took the barbs are just as healthy as anyone else their age, and none of them ended up on the streets, in the hospital, or in rehab. Anyway, theoretically, panic that doesn't respond to benzos could respond to barbiturates. But, usually, if panic doesn't "respond" to benzos, there's a problem on the doc's end; either other meds/lifestyle things are interfering with the benzos OR (far more commonly) the benzos aren't being supplied in sufficient quantity to stop the anxiety and allow the patient to function normally. It seems that, usually, when benzos alone aren't enough, stuff is added; buspar, anti-depressants, Neurontin, Gabitril, or, frighteningly commonly, an atypical neuroleptic (ANYONE who has experienced akathisia will be both amused and horrified at the idea that these drugs can somehow make anxiety BETTER and render the patient MORE functional.) When docs do use barbs, it seems like they dose them kind of like other controversial meds, like Desoxyn; they simply don't use enough of it, and they don't use it for long enough. Anyway, barbs are still kicking, and I imagine they'll be used now and then until something really effective comes along, or until shrinks stop being so damn miserly with the benzos; I read somewhere that barbiturates constitute about 10% of all sedative-hypnotic prescriptions (the data apparently was collected in such a way as to exclude barbs prescribed for epilepsy..usually long-term phenobarbital, although nembutal can also be used).
poster:med_empowered
thread:528639
URL: http://www.dr-bob.org/babble/20050713/msgs/528639.html