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Forum Name: Neurology Topics

Question: Alternatives to Butalbital for the treatment of GAD


 BinaryMan - Mon Sep 21, 2009 2:26 pm

I have had symtoms of anxiety for most of my adult life, although during college the physical symptoms became worse (persistent muscle tension, migraines, and tension headaches). Although I am considered to be above average intelligence, my cognitive function is also directly impaired by this disorder (difficulty with encoding or recalling memories, occuring at random; very acute attention at the expense of senseing the rest of the environment; confusion with manipulating or identifying everyday things I typically have no problem with). I have always done well at school, but am constantly stressed at any job and sometimes in public (ie, shopping) because sensing and responding to social situations is difficult (circumstancial memory and thoughts are often triggered and it's difficult to focus on a conversation; I am always gravitating towards "somewhere else" mentally). In addition, my "fear response" is always on and hypersensitive to things that I know logically are not a threat (ie, I am sometimes afraid of people attacking me when they are too close or looking at me, and I assume worst case scenarios instead of likely scenarios when the outcome of something in uncertain). This condition appears to be at least somewhat geneticly based by observation of my parents and grandparents.

Butalbital was originally given to me for the constant headaches, but I soon realized that nearly every symptom of the disease was being treated (including improvement with unexpected things like asthma and coordination of smooth movement). Once I realized how much it was affecting my life through the contrast, I started seeing my school psychiatrist in order to find a regular treatment schedule. I was extremely disappointed. After over two years of trial and error, I realized that he was not using any kind of logical process; after some research, I found that every single drug given to me was an antidepressant class drug - and none of them helped (in fact, some made the headaches worse, especially SNRIs). He never tried alternative types of medications.

I researched neurochemistry and found that Butalbital affected the GABA neurotransmitter; more specifically, it appears to affect the thalamus and other sensory processing regions with a mild sedative effect on the rest of the brain. In effect, it was helping to prevent overstimulation and improve coordination among parts of the brain. I have never suffered negative side-effects or addiction from theraputic use of this drug at a constant dosage, and in fact function significantly better in all respects (physically and mentally), but all doctors are concerned about the class of the drug and potential for abuse (to my frustration, I can never get more than 1.5 months supply and have to pay a doctor visit for less than $15 worth of medication rather than recieving a 6-month perpetual prescription; although I understand that this medication does in fact get commonly abused, I hate having to take less than the effective dosage to avoid doctor bills all the time since I have no insurance typically).

I have also tried Alprazolam (Xanax) thinking that its GABA effect would be similar, since most doctors view benzodiazapines as being superior to barbituates. However, it tends to have a very high sedative effect that makes it impractical. Benzodiazapines appear to affect a different receptor site, and I think that targeting certain parts of the brain that are out of balance is critical, but difficult. In fact, I got lucky with discovering Butalbital because it's the only drug that has given me relief from fear and pain, and a clear thinking process.

So after all of that background, the real questions are, is there medications that would achieve a similar effect but that doctors would not be so paranoid about? Would seeing a neurologist be more beneficial since I am trying to narrow down the neurochemical problem with my brain? Do doctors generally use a logical process to find an effective medication or just go down a list like my psychiatrist? After over 100 hours of research coupled with my own self-observations, it's frustrating to be dismissed by doctors who apparently have no more knowledge of what's going on than I do. Who is qualified to figure out what the chemical problem is, at least by intelligent rather than blind trial and error?
 Debra Van Ness RN - Mon Oct 12, 2009 8:47 am

Doctors can really only use their very best educated guesses at medication. Some of the time the med works, sometimes it won't. But I believe most docs are looking at the individual when they are prescribing something.

Butalbital is not normally prescribed for anxiety disorders. But then again, sometimes an off label purpose occurs in some individuals. And please understand that doctors are under scrutiny by the FDA and DEA for prescribing controlled substances. Perhaps the doc just does not want to prescribe the drug for the anxiety disorder because it was not originally intended for such reason. I do understand your frustration though.

Some people can take meds such as Butalbital over extended periods and NEVER become addicts. It depends on the peron. We are all different. Now, you could have DEPENDENCE on the drug. But that is different from addiction.
Perhaps you might look for another doc whom you have a better raport with. Sometimes certain doctors and patients just don't fit and you have to look for another person. (not meaning the patient or the doctor are wrong).
You will likely find though that a perpetual refill prescription is highly unusual for any substance which is in the control class of Butalbital or xanax or anything of that nature because of the control issues and need for continual assessment by the physician based on your needs. Doctors must protect their licenses. And it does not necessarily mean that they don't believe you and don't want to help you. But most will require a monthly visit at least in order to continue a controlled substance.

Best of luck to yoo,
Debra Van Ness RN

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