Barbiturates vs Benzodiazepines: What’s The Difference?

Last Updated on June 3, 2024 by Dr. Alberto Solà

Barbiturates and benzodiazepines are two drugs that have been prescribed heavily in the United States and around the world. They are similar, yet different. Do you know the differences and similarities between them? Read on to learn more about these two categories of common prescription drugs.

What are Barbiturates?

Barbiturates are a group of drugs that are prescribed to help reduce anxiety, aid in sleep, and prevent muscle spasms and seizures. Drugs in this category are derived from barbituric acid, first synthesized by German chemist Adolf von Baeyer in 1864. Decades later, in 1903, scientists discovered medical applications for barbituric acid when they learned that it was useful in putting animals to sleep. Soon, barbituric acid was approved for use in the sedation of humans under the brand names Veronal and Luminal (also known as phenobarbital). 

In the 1950s, scientists learned that barbiturates could also be useful in treating behavioral disturbances such as anxiety and insomnia as well, and it began to be prescribed for this use at that time. Concurrently, it soon became clear that there was great potential for physical dependency on these drugs, but they continued to be described as the benefits seemed to outweigh the risks. 

Unfortunately, in the period following the 1950s up to the present day, many people struggled with addiction to barbiturates. Some people who became addicted to these drugs were legally prescribed them initially; others developed dependencies due to recreational use. As a result, barbiturates are rarely prescribed today. For the most part, doctors have instead turned to benzodiazepines to treat conditions for which barbiturates were commonly prescribed because benzodiazepines have less potential for overdose. 

Barbiturates are still in use in some situations, though. Doctors use barbiturates for general anesthesia purposes as well as for epilepsy, acute migraines, and acute tension headaches. Pentobarbital is used for euthanasia, capital punishment, and assisted suicide as well.

What are Benzodiazepines?

In the present day, benzodiazepines are much more commonly prescribed than barbiturates for the reasons explained above. Brand names that fall under the benzodiazepine umbrella include drugs such as Valium, Xanax, Ativan, and Klonopin to name a few. This group of drugs was developed in the late 1950s after being discovered accidentally by Polish-American chemist Leo Sternbach in 1955. The first benzodiazepines were on the market for doctors to prescribe to patients by 1960 and by 1955 they were the most prescribed drug around the world. 

The applications of benzodiazepines are generally the same as the applications of barbiturates. Most frequently benzodiazepines are prescribed for sedative purposes, to relieve anxiety, and to reduce seizures and muscle spasms. 

Today, benzodiazepines are not prescribed as much as they once were due to the introduction of SSRIs for depression and anxiety disorders. However, they are still frequently prescribed, used, and abused around the world.

Barbiturates vs Benzodiazepines: Chemical and Mechanistic Differences

There are many similarities between barbiturates and benzodiazepines. Benzodiazepines and barbiturates are both types of depressants so it’s no surprise that both of these drugs slow down the central nervous system to achieve their effects. As a result, people who have ingested or who have been treated with barbiturates or benzodiazepines will experience feelings of euphoria and relief of anxiety. They also may demonstrate a lack of self-restraint when under the influence of these drugs. Coordination, memory, and coordination may suffer during both short and long-term use, and irritability, paranoia, and suicidal ideation may occur with continued use.

However, these two drugs are different, as well. The main difference between barbiturates and benzodiazepines is the way that they work on the body. Barbiturates act directly on GABA receptors. They work to keep these receptors open for longer than normal, leading to a reduced response from nerve cells. On the other hand, benzodiazepines make GABA receptors more effective but don’t have the same effect on nerve cells. When an individual takes benzodiazepines, brain cells become less sensitive to nerve impulses.

Both of these actions and mechanisms have similar effects on the individual who has consumed the drug, but their functions are different. Due to the way that benzodiazepines work in comparison to the way that barbiturates work, they are less dangerous and less addictive. Barbiturates depress the central nervous system immensely – and in that way, they force the individual to relax. Benzodiazepines do not depress the central nervous system to the same extent, yet have the same relaxing effects. 

Therapeutic Uses

Both of these drugs are used therapeutically to relax individuals both physically and mentally. Both of these drugs cause users to feel relaxed and less anxious and both of them have calming effects overall. They can both be used to help people fall asleep or feel drowsy before receiving anesthesia for surgery, and both can be used to stop seizures and muscle spasms. However, they should never be combined.

Barbiturates and Benzodiazepines: Side Effects and Risks

When it comes to comparing benzodiazepines vs barbiturates and their risks, the risks of benzodiazepines are fewer, but they still offer risks, and they still come with a high chance of dependence if used for a long period. Since both benzodiazepines and barbiturates are types of hypnotic and sedative drugs, people who use them can quickly become enamored with their effects and can soon find themselves physically addicted to them.

The side effects and risks of barbiturates and benzodiazepines are similar. They both cause drowsiness and sleepiness so people using these drugs, even under a doctor’s supervision, should not drive and should not operate heavy machinery. The central nervous depression inspired by barbiturates can result in decreased respiration, decreased blood pressure, lower body temperature, and, in extreme cases, coma, and even possible death. There are currently no antidotes for overdose of barbiturates. 

Benzodiazepines have similar side effects and risks. Overdose of benzodiazepines will result in drowsiness, confusion, respiratory depression, and decreased coordination and reflexes. An overdose of this type of drug can also lead to coma and possible death in extreme cases.

But, are benzodiazapines safer than barbiturates? The answer from most medical professionals is yes. However, people who are prescribed benzodiazepines still need to be cautious about using these drugs on a regular or long-term basis because even though they are not as dangerous and addictive as barbiturates, they are also addictive drugs. 

In the case of a benzodiazepine overdose, there is an antidote available. A drug called Flumazenil works against the effects of benzodiazepines and can help people recover from overdose. In simple terms – the answer to “Why did benzodiazepines replace barbiturates?” is in part because an antidote to overdose is available, and is also due to the fact that the mechanism of action of this drug is less dangerous overall than the ways that barbiturates work. Benzodiazepines are safer than barbiturates, but only to a small degree.

Dependence and Withdrawal

As mentioned numerous times above, both barbiturates and benzodiazepines are highly addictive drugs. Barbiturates are slightly more addictive, but it’s rather easy to become dependent on benzodiazepines as well, especially with ongoing and regular use. 

As a result, individuals who have developed a dependency on either of these drugs will struggle with withdrawal from them when stopping use. Withdrawal from both of these drugs will come with insomnia, irritability, sweating, concentration difficulties, nausea, heart palpitations, headaches, anxiety, panic attacks, tremors, seizures, and even psychosis. 

Withdrawal symptoms from stopping the use of either of these drugs will be intense and will arise quickly after cessation. In the cases of both of these types of drugs, it’s wise to taper off them under medical supervision. It will be dangerous to try to quit using them independently. Almost all individuals addicted to benzodiazepines or barbiturates will need professional help to safely break free from their addictions.

Combining Barbiturates and Benzodiazepines

Using barbiturates and benzodiazepines together is extremely dangerous and is almost setting oneself up for a death sentence. Because barbiturates are central nervous system depressants, combining them with other drugs that have similar effects can result in extreme lethargy, coma, or death. Barbiturates should not be mixed with alcohol, opioids, antidepressants, or many over-the-counter drugs, and they absolutely should not be combined with benzodiazepines. Many people have died when mixing barbiturates with the substances listed above. Don’t become a statistic. 

Conclusion

Benzodiazepines and barbiturates are best described as helpful drugs that are also somewhat dangerous. Both of these drugs have been helping people for many decades in medical settings. They can help people to relax and overcome anxiety and they can treat issues like seizures and muscle spasms. They both can also help people who have difficulty sleeping and can aid in preparing people for surgery. However, both of these drugs also are highly addictive and have intense side effects. They both come with immense risks and should only be consumed under a doctor’s guidance. 

If you are someone who has developed a dependency or addiction to benzodiazepines or barbiturates, help is available. You can break free from your dependency to these drugs, but you will likely need professional support to do so. We at Clear Sky Recovery are here to help you. We are dedicated to helping people break free from any type of addiction. Our innovative ibogaine therapy treatment helps our clients take the first steps toward a clean and sober and healthy lifestyle moving forward. Ibogaine gives people the opportunity to go deep within themselves to discover the root cause of their addiction and can help them avoid painful withdrawals while doing so. When clients visit our facility in Cancun, Mexico, they will work with our experienced staff to move forward in their lives in a positive way that is free from barbiturates, benzodiazepines, and other drugs. Give us a call today. We can’t wait to hear from you!