Can barbiturates be used where benzodiazepines are contraindicated?

[doug2113]

Hello, I'm Doug. I'm 20 years old and have recently been diagnosed with panic disorder. I'm also a chronic pain sufferer of degenerative disk disease, hyperkyphosis, lumbar stenosis, sciatica, bulging disks at L3-L4 and L5-S1, herniated disk at L4-L5, and radiating nerve pain down my legs, and am required to walk with a cane. I'm pretty sure the panic disorder stemmed from the chronic pain as I never really had issues with anxiety before it. Following a suicide attempt that involved a multiple drug overdose including my clonazepam, my doctor has stated that benzodiazepines are contraindicated with me as a result.

My question is, are barbiturates such as phenobarbital a possible route for me? I've tried many different types of depression medications for anxiety/depression, but these don't even take care of the depression, let alone the anxiety. If anyone could respond with constructive advice it would be greatly appreciated.

Thanks

[Siegfried]

Hello Doug! I'm very sorry for your back problems.

Have you been to a psychiatrist? You say you have tried many different meds for depression. Could you tell us which?

Why did your doc say that benzos are contraindicated in your case? My guess is that since you misused them once, he/she fears that it may happen again. But guess what: an average failed suicide attempt with benzos is a sure overkill with barbiturates. That's why they are seldom used anymore: much greater toxicity for similar therapeutic effects.

Pending your answers to those questions above, all I can say is that maybe you should consider getting a second opinion, and working with a doctor that will help you find the right meds for you, especially since you're probably taking other stuff for your back. Easier said than done... Do not lose hope, though! Keep us posted so that we can help you as best we can!

[alankay]

I agree with Siegfied, I'd consider another opinion or doc as I don't believe, in your case, a benzo is absolutely contraindicated(although I admit we've never met). It might be rx'ed with extreme caution though considering your suffering and state if mind now. Yes a sincere attempt would sure complicate it all though. Benzos are infinitely(well...much, much less) lethal than barbs. So you could find a doc who will rx a small amount of a benzo and require frequent visits with no refills on any prescription so he could follow you very closely. You could also ask about lyrica or maybe atarax for anxiety. You should be on and ssri/snri or TCA. Really allot also has to do with where you were back during the attempt and where you are now. Were there any reason(s) that complicated your mental state at the time? Was this a long time ago?
Bottom line, you might be able to get a doc to listen to all your history and rx you a small amount of a benzo and require very frequent visits or try other meds for anxiety. I will be difficult but not impossible IMHO. PM me any time. Alankay

[doug2113]

Thanks for the responses. I'm currently studying medicinal chemistry (well, on medical leave at the moment), so I know the risks of barbiturates, but just tired of having to deal with these panic attacks by either doing nothing about it or running to the ER when it gets bad enough (though I only do this when there are other medical problems causing the panic state (i.e. acute abdominal pain, back pain hitting an 8, etc.). The whole reason I tried to commit suicide was the amount of pain I'm already in, and I only used benzodiazepines/opioids as a means of self-euthanasia, if you will. I just assumed the benzodiazepines would black me out, while the combination with opioids would cause respiratory arrest. I went into the institution where they were treating me with 40mg OxyContin, 40mg Norco, 300mg Lyrica, 150mg Tramadol, 150mg Effexor and 4mg Xanax per day. When I went to leave, they assumed my doctor would resume treatment, so they didn't write me any prescriptions when I left. I had about 30mg of clonazepam when I was released, which just barely got me to my follow up appointment with my doctor and she stopped prescribing everything, stating that she would no longer prescribe anxiolytics or pain medications.

I'm awaiting a call from a psychiatrists office 60 miles away at the moment as all the ones nearby are booked, and I have a pain management appointment on the 16, so hopefully I'll get some relief then as most of my anxiety stems from pain. As far as things I've been treated with, there's Wellbutrin, Seroquel, Cymbalta, Buspar, Abilify, and now Effexor. I just hate taking these serotonin reuptake inhibitors as when I was on the maximum dose of tramadol (which has mild serotonergic activity and is a moderate NRI), they tried me on cymbalta and buspar simultaneously, which had me going into urgent care with serotonin syndrome within about 2 weeks. Was not a pleasant experience.

Once again, thanks for the replies.