Author Topic: The Case for Exercise in Benzodiazepine Withdrawal  (Read 5178 times)


The Case for Exercise in Benzodiazepine Withdrawal
« on: November 01, 2019, 08:47:10 pm »
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I have long thought that the benefits of exercise are under-appreciated in benzodiazepine withdrawal. Everybody knows that exercise is "good for you" and most people will say that exercise causes the release of endorphins which makes you feel better. But exercise does far more and effects the production and release of a number of molecules which are highly beneficial in the benzodiazepine damage healing process and in the amelioration of the symptoms we experience while withdrawing. I was motivated to look into exercise and benzodiazepine withdrawal further after reading the book SPARK by John Ratey, MD and Eric Hagerman. Ratey is the well known Harvard psychiatrist who popularized the diagnoses of ADD and ADHD before he began studying exercise and brain function. Except for cortisol and catecholamine release, blocking agents, the specifics of exercise in benzo withdrawal and my personal experience and observations, most everything I will discuss can be found somewhere in this book. I'm not going to site references as when I studied the subject it was for myself only and not for publication. Besides this book all the non-personal material was found on PubMed and with simple "Googling". 

First the bad news:

Not everyone in benzodiazepine withdrawal is able to exercise. Many are just too symptomatic and have all they can do to just maintain a minimal level of self-care. I was in my 5th month of tapering before I was able to exercise and my first "workout" consisted only of walking on my treadmill for 2 minutes at a speed of 1mph. I very, very slowly increased from there. Exercise releases chiefly cortisol which is primarily responsible for our symptom increases. ACTH, epinephrine, norepinephrine and unfortunately glutamate levels go up albeit to a lesser significance than cortisol. There may some other "bad" stimulative molecules released but cortisol is by far and away the main bad boy as far as our symptoms go. There are a number of things that can be done to ameliorate this problem. Most importantly, cortisol release goes down with habituation. This means that after starting an exercise program, in time  you will release less cortisol and experience fewer symptom flare ups while working out. Intensity and length of time for each exercise session correlate directly with induced serum cortisol levels so keep it short and very easy at first. A number of supplements have been shown to directly reduce cortisol levels both chronic and exercise induced. They are: Vitamin C (3 grams in one study prior to running had a big effect), ashwagandha, L-theanine, magnolia bark extract (honokiol, magnolol), epimedium, and phosphatidylserine. I take a "cocktail" of these as well as some other things before working out.

Now the good news:

The following substances are all elevated and positively modulated with exercise:

BDNF (brain derived neurotrophic factor) caused a tsunami of laboratory research when it was discovered that it acted as sort of Miracle-Gro for brain cells. When sprinkled on nerve cells in a petri dish BDNF causes them to sprout new connections. It and other factors activate genes that call for the production of more BDNF, serotonin and other chemicals that build up synapses, encourage neuronal growth and protect against neuronal cell death. It is a key player in neurogenesis and in what we call neuroplasticity as well as a critical biological link between thought, emotions and movement. LTP (long-term potentiation) is a dynamic process involved in learning and memory particularly in the hippocampus and is enhanced by BDNF. The levels of BDNF go up with exercise and scientists put lab rodents on running wheels to raise this substance when they are studying its effects. While there is no direct evidence as of this time, my suspicions are that BNDF may play a significant role in benzo damage healing particularly in the hippocampus due to the myriad of favorable effects on neuron growth, repair, protection and indeed neurogenesis it has been found to have. BNDF is of particular interest to researchers as it seems to lower the brain damaging effects of stress due to its role in brain energy metabolism which I won't get into as well as neuroplasticity. It looks like a blast on Miracle-Gro in your brain seems to guard against the damaging effects of stress induced cortisol. If I were in the neurosciences department I would think of this as a  productive research area.

Exercise optimizes energy utilization by increasing the production of more insulin receptors. This will keep your blood glucose levels more stable and limit cell damage as well as mood fluctuations due to changing  levels.

IGF-1 (insulin-like growth factor).
Exercise raises the level of this factor which also helps regulate glucose getting into cells. In the hippocampus IGF-1 increases LTP, neuroplasticity and neurogenesis.

VEGF (vascular endothelial growth factor) and FGF-2 (fibroblast growth factor).
These factors also go up with exercise. Their role in the brain is to build new capillaries and expand the vascular system.

ANP (atrial natriuretic peptide).
This recently discovered hormone is produced by cardiac muscle tissue and  tempers the body's stress response.
ANP levels go up with exercise and correspond directly to the degree of exertion. ANP works by putting the brakes on the HPA axis. This is a specific biochemical mechanism whereby both the feeling of stress and the body's response to it is reduced with exercise.

Serotonin and Dopamine.
Naturally, up with exercise. I'm getting tired of typing this. An important thing to know here is that serotonin, dopamine and actually norepinephrine serve more as modulators of neurotransmission rather then just transmitters themselves. Raising or lowering a particular level of a neurotransmitter or modulator does not have a one to one effect; rather it unleashes a cascade of relationships in the CNS resulting in the final effect. For some reason, exercises promotes a balance of all these and probably yet identified factors which produces a favorable clinical effect.

Yes, good old brain GABA levels go up with exercise.

Now for benzo withdrawal symptoms:

Interestingly, cardiologists seem to bigger on the effects of exercise on anxiety then the general medical community including psychiatrists probably due to the correlation of anxiety with heart disease. Exercise has been shown to reduce the symptoms of anxiety by more than 50% according to some cardiologists. Exercise has also been shown to work as well as clomipramine for reducing anxiety in another study.

Outrunning anxiety.
Exercise lowers anxiety levels and reduces panic attacks by the following mechanisms:
1. It provides distraction. Literally, it puts your mind on something else and takes it away from your problems for a time.
2. It reduces muscle tension. Exercise serves as a circuit breaker in the muscle spindles just like beta-blockers. This muscle tension reduction effect serves to reduce anxiety.
3. It builds brain resources. These are the  factors and their relationships mentioned above.
4. It teaches a different outcome. Exercise stimulates the sympathetic nervous system, raising your heart rate, breathing, etc. just like a panic attack does. But this is a good thing because you learn to associate these symptoms with something positive, something you initiated and can control. The self-fulfilling fear of these symptoms will subside over time.
5. It reroutes your circuits. By stimulating the sympathetic nervous system via exercise you send pathways down a different part of your amygdala and diminish the stimulatory pathways responsible for panic attacks augmented with non-exercised induced sympathetic stimulation.
6. It improves resilience. Exercises teaches you that you can control anxiety and prevent it from turning into a panic attack. In making the decision to exercise you realize that you can do something for yourself. A useful tautology.
7. It sets you free. Researchers immobilize rats in order to induce stress. Anxious people are locked down. Some curl up in a fetal position. Agoraphobics may be trapped in their homes. Exercise is the opposite. It is taking action, going out, exploring yourself and your environment. Moving.

Everybody seems to know about how exercise induces endorphins,  natural opioids, which relieve depression so I won't dwell on this. There are forty different types of endorphins in our bodies. And yes, exercise may work better than anti-depressant drugs and without the side effects for many people. Our old friend BDNF was found in one study to be reduced in every one of 30 depressed patients in whom it was measured. Aside from endorphins, exercise elevates all of the neurotransmitters targeted by anti-depressants. Norepinephrine wakes up the brain, gets it going and raises self esteem. Dopamine improves mood and enhances feelings of wellness. Besides raising dopamine levels, exercise triggers the production of enzymes that create dopamine receptors in the reward centers of the brain. Serotonin is important also for mood as well as impulse control and self-esteem. All of these substances are increased and positively modulated by exercise.

The Program.

Much of what I wrote here is the Cliff Notes version of Dr. Ratey's book SPARK, but those of us in benzodiazepine withdrawal have to depart from his prescription a little bit at first. That is to say we need to begin at an extremely low level of intensity and duration due to our exaggerated response to cortisol release in our untrained states. The secret is to start and stay at a level that does not produce a perceived increase in withdrawal symptoms due to cortisol release. Like I said previously, I could do nothing for the first five months of my taper and then started with 2 minutes of walking at 1mph on my treadmill. Maybe this first little "workout" was more psychological than physical. I can't recall. My first weight workouts were with very small dumbbells and a 0 weighted Smith machine. Initially, I limited my reps on weight workouts to about 4 reps before failure to stave of cortisol release as much as possible. 11 months later I'm jogging up to an hour at a time and steadily progressing with the weights stopping 1 or 2 reps before failure on my larger body part exercises and going to failure on the smaller muscle groups. Dr. Ratey, who was around 60 years old at the time of his book was doing 3 or 4 aerobic sessions per week on the stairmaster, treadmill or elliptical trainer 2 of which only go for 20 minutes but included 5 bouts of sprinting for 20-30 seconds each. He did weights, crunches and balance exercises twice a week.

What matters most is that your body perceives some level of exertion and begins to make the above factors in response.
You could even begin your exercise program with just walking around your bedroom a couple of minutes or "laps" back and forth between walls or down a hall. Just slightly increase your walks a very little bit most days of the week and you're on your way. Any little bit will help, both psychologically and physically as well as their increasingly acknowledged interdigitations.

I'll conclude with a quote in Ratey's book for you philosophical types just to show that some of us scientists have actually heard of the field.

"In order for man to succeed in life, God provided him with two means, education and physical activity. Not separately, one for the soul and the other for the body, but for the two together.  With these two means, man can attain perfection."

Or a philosopher closer to my heart:
"Get 'er done"
                        ----Larry the Cable Guy

Palo Alto

Largely plagiarized from:

John Ratey, MD and Eric Hagerman

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