I am headed into my second year of having been "bit" by benzos. While I am not a biochemist, I have certainly had a lot of time on my hands to research and think about what is potentially going on with me/us - especially those of us who experience a great deal of emotional/mental symptoms such as fear, dread, doom, gloom, terror, depression, etc. Please just take from this what makes sense, it's not meant to be scientific --- just my own ponderings and thought I would share!
1) With any psychiatric medication there is a certain level of neuro-adaptation that happens....how the brain and nervous system adapt to what you are putting in it. For each of us, it is slightly different due to genetic and biological differences. That said, let's start by thinking about the neurotransmitters amino acids - GABA and glutamate. As many of us know, GABA are the natural inhibitors in our system (the brakes) and it is the MOST COMMON neurotransmitter in the body. Glutamate is an excitatory neurotransmitter and it serves as (the gas). The goal is for GABA and glutamate (as well as many other things like dopamine, serotonin, norepinephrine, acetocholine, glycine and hormones like progesterone, estrogen, testosterone, oxytocin and our stress hormones like adrenaline and cortisol) to all work to be in balance to create a sense of homeostasis.
So, when we are NOT on a benzo, the natural GABA in our bodies binds to the millions of gaba receptors that exist throughout our bodies - sort of like a lock and a key. the GABA is the key and the GABA receptor is the lock. when we take a BENZO, over time, the benzo now binds to that same receptor and the lock slightly changes shape. As we take the benzo away, it's not that we don't have enough GABA in our bodies, it is that our natural GABA doesn't have the exact same shape that the benzo did --- the key isn't exact -- and so as our natural GABA tries to bind and fit into that lock to create a sense of calm -- it doesn't work. It takes time, and sometimes lots of time, for that lock to re-adapt for our natural GABA to fit neatly back into that lock and create a sense of calm and peace.
So, when people think they need to just flood themselves with GABA supplements, that isn't the issue. We aren't deficient in GABA in withdrawal, it's simply a matter of our natural GABA (the key) no longer fits nicely into the lock (the GABA receptor) thus it cannot do its function of calming us down.
Also, because we have less ability for our brakes to work for a period of time, it also throws our GABA/glutamate balance out of whack. So, we feel like we have TOO MUCH GLUTAMATE -- that's not the case, its that we don't have enough GABA binding to is receptor to produce the brakes to balance out the glutamate in our system.
Think about it like as if you were making a vodka tonic. If you are supposed to use one part vodka, and three parts tonic but you only have enough tonic to add in one part --- you will drink that drink and think "Oh my God, there is too much alcohol in this -- its terrible!" --- there isn't more alcohol in it, there is just not enough of the tonic to dilute it. same thing with our gaba and glutamate.
2) Okay, so there are literally hundreds of millions of GABA receptors all over our body -- and we just figured out that our GABA is not able to properly bind to it for a period of time when we are in withdrawal. There are high numbers of these receptors (the now slightly disfigured locks) all over our gut and limbic system. So, let's start with our limbic system: our limbic system in our brains is our most primitive part. It was the part that hasn't evolved much over time and it was what kept us safe when we had to sleep out in the open and be on the look out for saber tooth tigers.
So, let's look at how it works: your amygdala’s job is to alert you to danger. It takes a perceived threat and sounds a distress signal. Let's call it a fire alarm. It perceives danger ( a fire) and sends off an alarm to the hypothalamus. Now the hypothalamus is basically our command center. It takes this raw data from the amygdala and decides whether it is a false alarm or a real threat. Now if our limbic system ISN’T injured (which ours IS in benzo withdrawal) -- typically the command center says "thanks for the warning but all is well" and our parasympathetic nervous system is alerted that we are fine and we feel calm and often we never even really feel this process...it happens in nanoseconds. (for example: standing on a corner you aren't looking and thinking fully "is that car going the right speed limit, what about that one, what about that one? -- its happening almost automatically).........but the amygdala's job is to keep you safe and so it would rather throw up 100 false alarms and keep you from being eaten by the tiger or hit by the car then to get lazy and you get eaten or hit.
anyway, in our injured limbic system our amygdala is throwing up constant alarms - it is not working properly and it is trying to keep us safe --- but our command center is not working either and so it is AGREEING WITH our amygdala and saying "yep, that could be dangerous" and activates our sympathetic nervous system and alerts the adrenal glands to shoot off adrenaline. Now keep in mind all of this is happening in nano-seconds. So in a non benzo-injured person - they are standing on a curb, they step off, a car comes barreling around the corner at 90 mph, the alarm is sounded, the control center says "danger", adrenaline is released and BOOM before you know it and can even think about it -- you have jumped back on the curb out of harms way. then you feel that rush and it takes a minute or so to calm down.
BUT for us -- we are constantly getting bombarded with floods of adrenaline which creates all sorts of physiological changes (heart rate, breathing, and we certainly are unable to think rational, calm thoughts). teddy bears look like grizzly bears --- our limbic system is highly populated with these GABA receptors that are now temporarily not working and so the entire system keeps us in a dysregulated state and in fight/flight or freeze.
If that wasn't bad enough, the control center that has signaled the adrenals to shoot off adrenaline has now alerted the HPA axis (hypothalamus, pituitary and adrenals) to react and this basically keeps the gas pedal down with each of the three parts shooting off hormones -- including the adrenals shooting off cortisol.
So, our main two stress hormones are adrenaline (epinephrine) and cortisol. One way to think about them is adrenaline is like Xanax (short and potent) - adrenaline is meant to come on fast, do its job and leave. Cortisol is more like valium. It comes on slower and sticks around a while and allows us to remain on high alert for longer periods of time. Because our limbic systems are malfunctioning - we are experiencing more consistent bursts of adrenaline as well as the longer term doses of cortisol due to the chronic stress on our systems. Adrenaline and cortisol affect different organs. Adrenaline tends to affect our muscles and respiratory system while cortisol can affect our digestive, reproductive and immune systems. Together high levels of these stress hormones over extended periods of time lead to an array of symptoms -- both physical and mental. It explains not only why so many of us feel so much fear and terror.
3) The state of our nervous system drives our story. What do I mean by this? Our overly sensitized and taxed nervous system that is now being over run with stress hormones creates a background of fear, terror, unease, dread, and doom. And since we are meaning making machines --- we automatically work to answer the question "why am I feeling so terrified or awful" by creating stories. This is how intrusive thoughts, phobias and other symptoms come to be. We may feel terror and think “I don’t feel safe, why?” and we answer by assigning a fear value to a store, driving, the outside world, being alone, afraid we are going to die, going to have a heart attack, etc. We are constantly scanning to make meaning of our emotions and sensations, our thoughts and our feelings. Also, we tend to see a bad day, week or month as a sign that we are back at ground zero or will never heal. I like the idea of “regression for the sake of progression” – sometimes our symptoms increasing or re-emerging are not a sign we are going backwards, but a sling shot of sorts to move us forward.
Unfortunately, as humans we have a built in negativity bias. This has been an adaptive function in our evolution as it kept us from getting too cumfy and getting eaten by a saber tooth tiger. If our negativity bias was we might not be safe, we were more apt to be on alert to protect our families from bears and tigers. Fortunately most of us don’t have to worry about bears or tigers but our negativity bias continues to be a part of our human psychology. In benzo withdrawal, multiply that x 1000. In fact, I have found that any of my worst traits, existing fears, vulnerabilities, etc are super exaggerated in withdrawal. Why? I think because we are basically a walking raw nerve and everything hits us with more force. It’s kind of like Claire Weekes talks about – we are and have a super sensitized nervous system. So, everything has a propensity to have a greater impact on us.
For example, many women in withdrawal experience heightened symptoms during ovulation or PMS or during menstruation. Is this because suddenly my estrogen is rising and dropping at higher rates – not necessarily. It’s that we are feeling it due to our highly sensitized system. It’s like taking a penny and dropping it into a tin can – it will make a loud noise. Drop that same penny on a soft bed – hardly a sound. Has the penny changed? No. The system it has interfaced with is different. We are like the tin can. Any fluctuation in hormones, any change in our routine, food, vitamins, supplements, exercise, stress, illness—can all hit our highly sensitized system and have a much greater impact than it normally would.
4) I think its important to think of our body’s as a soup. We are made up of all sorts of neurotransmitters, hormones, vitamins, chemicals, bones, blood, tissues, organs, genetic coding. And when we put something in our big pot of soup – LIKE A BENZO – its like adding salt to our soup. Once you add that salt to soup, you can’t reach in and just take it back out. It has now intermingled with the broth, the vegetable, the meat. Just like we would like to believe we can simply take a medication like a benzo and then reach in and take it out – it usually doesn’t work like that. There are consequences as this med (the salt) has now intermingled and affected every other part of our soup.
That said, I do believe we heal. I am banking on it. Our bodies and minds are resilient. However, unfortunately healing doesn’t happen on our time frames. What can we do in the meantime – what do we actually have control over? Well, we don’t have control over our random, automatic thoughts, our feelings, our emotions, our sensations – but we do have control over our attitude towards them. Sometimes just knowing and being able to say “Yep, I’m in withdrawal” rather than “Oh no” or “What if?” is enough to keep us from going down the rabbit hole. We get good at what we practice. Our amygdala doesn’t respond to words – tha ‘s why we are often so not reassurable in this process. We have to SHOW our amygdala the mailbox is not a grizzly bear, the phone or car or store is not a monster. As hard as it is, if I am able, I try each day to just work to not be in complete potato mode where I am trapped in fear. Someone once said to me “[...], step a bit outside of your comfort zone.” I looked at them like they had four heads and said “what comfort zone? I haven’t felt a comfort zone in two years.” But I knew what they were saying – I had to speak the language of my primitive brain and SHOW IT that the world has not become dangerous overnight by taking little steps, not letting myself turn completely inward. Learning a bit about the mechanics of what MIGHT be going on with this has been helpful to me -- doesn't take away the symptoms but makes them a tad less scary.
