Posted by mattdds on November 26, 2002, at 14:39:24
In reply to Re: What to take for ADD that won't worsen Donne, posted by utopizen on November 26, 2002, at 8:36:06
<<Phenobarbital came out in 1912.... that's quite a longer, more extended record. I'm still not convinced benzos are better for anxiety, given the data that compares the two.
What on earth are you talking about? There are a number of extremely good reasons that benzos are far superior to the barbiturates. Reasons for which the barbs have been almost entirely supplanted by benzodiazepines. The only indication I know of for barbs for which it is still useful (besides reducing meth or crack jitters) is treatment-resistant epilepsy!
First, the therapeutic index of diazepam (or other benzos) is several times that of phenobarbital. I believe the LD-50 of diazepam is something like 620 mg/kg, while phenobarbital is like 240 mg/kg. Do you know how much diazepam this would be? You would be drowning in a sea of little blue pills! On the other hand, phenobarb will depress your respiration after extremely small overdoses: the therapeutic index is a mere 2!! T.I. of diazepam is 20.7!
Second, benzodiazepines are WAY more *selective* anxiolytics, i.e. anxiolysis comes way before sedation on the anxiolysis-sedation spectrum in diazepam. With phenobarb, you cannot get anxiolysis without sedation. They come together in a neat little brain-fogging package. For example, one study involved some macaque monkeys with injuries to the septal area of the brain, making them permanently irritable. Benzos selectively calmed and tamed these monkeys, with no sedation. Barbiturates calmed them too, but only after a great deal of sedation. Other studies of people with these same brain injuries have shown the same results. Barbs also suppress neural activity in ALL areas of the CNS, including the cortex, slowing thinking. Benzos tend to be more selective for the hippocampus and the amygdala (the "fear" nucleus), areas involved in anxiety.
Last, barbs are extremely lipophilic, getting stuck in the lipid bilayer for long periods of time. This is the physiological basis of the notorious "barbiturate hangover". Anyone taking benzos knows that this does not occur.
So be careful in telling people that barbiturates have a better track record for anxiety. These are dirty, and somewhat dangerous drugs, especially if in the wrong hands. For the vast majority of cases, benzodiazepines are far more safe and effective. Could you kindly point out some of the "data" that you mentioned that indicates barbs are superior for anxiety?
Best,
Matt
poster:mattdds
thread:129188
URL: http://www.dr-bob.org/babble/20021122/msgs/129432.html