How come GABA does not return to homeostasis even with slow taper?

Anyone know scientifically why you can get slammed with a debilitating withdrawal even after a slow taper of a benzo?

 

Is it genetic? 

 

It seems like for some people if reduce the dose by say .25mg every 4 months, maybe it takes 8 months for you to readjust to the dose?  You might still be stable but at the end of the taper you could end up ~6-18 months behind with no benzo in your system. 

 

I think nobody really knows the answer to your question. Some people can stop cold turkey and have no problems, while others can taper over 2 years and have prolonged withdrawal symptoms. Actually, most people can stop benzos quickly with little or no symptoms. We're in a "special" group here on BB. I think the explanation most likely genetic due to the high degree of unpredictability in a given individual. I've seen 2 surveys and anecdotal evidence on this site and others that suggest long slow tapers cause fewer problems for most people than cold turkey and rapid tapers. The exception is for people who have allergic, paradoxical or toxic side effects from their benzos. They have to get off quickly. It is a mistake to push your individual experience on others as "the best way to it". It comes down to trial and error and when in doubt, I think, slow down. There will be bumps in the road and other health problems can come and go during withdrawal. I think most of us have a tendency to "push" the taper in order to get off asap. I've done this and it led to problems requiring updosing and a long hold probably prolonging my overall taper time.

 

I think nobody really knows the answer to your question. Some people can stop cold turkey and have no problems, while others can taper over 2 years and have prolonged withdrawal symptoms.

 

Actually, most people can stop benzos quickly with little or no symptoms. We're in a "special" group here on BB. I think the explanation most likely genetic due to the high degree of unpredictability in a given individual.

 

I've seen 2 surveys and anecdotal evidence on this site and others that suggest long slow tapers cause fewer problems for most people than cold turkey and rapid tapers. The exception is for people who have allergic, paradoxical or toxic side effects from their benzos. They have to get off quickly. It is a mistake to push your individual experience on others as "the best way to it".

 

It comes down to trial and error and when in doubt, I think, slow down. There will be bumps in the road and other health problems can come and go during withdrawal. I think most of us have a tendency to "push" the taper in order to get off asap. I've done this and it led to problems requiring updosing and a long hold probably prolonging my overall taper time.

 

Hi Bart.  I've been wondering about how exactly healing from benzos occurs. Ashton uses the term "gene expression" in her 2011 supplement although not in her main manual. http://www.benzo.org.uk/ashsupp11.htm.  Despite Googling I can't find out what it actually is but I think it is the regrowth of our GABA receptor as coded in our genes.

 

However other people have posted and suggested that changes in the number of chloride ions passing into the receptor channel are responsible for healing. I'm not so sure about how that is supposed to work.

 

Have you got any thoughts about which are the biological mechanisms of recovery from benzos?

 

-Zoner

Zoner-

I've been looking for answers to this question for a long time now and it appears  nobody knows for sure. With benzo use when they say gaba receptor function is downregulated what happens is many individual gaba receptors are lost as they are no longer needed. In recovery, gene expression has to increase, mRNA  probably goes up and more gaba receptors are then manufactured. There is no known way to speed this process up with the possible exception of exercise.http://www.ncbi.nlm.nih.gov/pubmed/18801833 . Exercise also increases BDNF (brain derived neurotropic factor) which increases neurogenesis (growing new nerves in the brain). Not everyone can exercise because it also stimulates norepinephrine, cortisol and other adrenocorticotropic hormones which revs up symptoms. If you are able to exercise, by all means do it. Lucky for you. You may heal faster as long as you do not overdo it. Listen to your body.

 

Movement of chloride ions through their channel in the gaba receptor is the mechanism by which the  neuron is hyperpolarized making it less likely to fire in response to stimulatory impulses. That's the reason for the inhibitory effect. This movement of chloride ions has nothing to do with the healing process. I think that by far the most important factor in healing is time and lots of it. Healing does occur throughout the taper as healing means growing more gaba receptors. There is no real difference between "true" healing and healing; just semantics used by some. All this other stuff we do are secondary players (exercise, nutrition, supplements, rest, yoga etc.) that probably helps some and ameliorates symptoms while mother nature works her magic and grows more gaba receptors.

Bart - Great info man thanks!=

 

I'm trying to get an appointment with a neurologist and I'm going to ask him all of our questions.  As you stated, there are so many different scenarios where people may hit tolerance withdrawal during their taper or they can have a smooth taper then get slammed a few weeks after the last dose,etc...

Wow... Ashton's analysis on the functional or structural brain damage did not sound convincing or reassuring from zoners link and I also noticed she said true healing doesn't happen until you are off the drug? I thought the purpose of a taper was to heal as you slowly go down? For whatever reason her supplement was a very depressing read. One thing positive was she said potatoes, rice, wheat and poppy had natural benzos.... Guess I'll be eating more of those. I've been looking up alot of info on repair of GABA receptors and if I come across something worthwhile I'll pass it along!

I think Ashton was a tremendous pioneer; the first credible person to advocate for a slow taper based on clinical evidence. I also think her schedules of dropping down 1mg of diazepam every one or two weeks are way too aggressive for many people below the  5 mg. level. I heard there was a suicide in her original group. I don't know the details, nor am I certain this is true. To her credit she includes a super slow taper schedule as an alternate for the lower levels and also stated this was only a guide and the patient should control the taper rate. I think also she pushed the idea of the long half life of valium (up to 8.3 days) as being of much import rather than the much shorter duration of action or effect concept that is more relevant clinically (6-12 hours). This is why a lot of people need to dose Valium 2-4 times a day. Also, the elimination half life of Valium is biphasic (faster at first, then slower)  "True" healing seems to be her opinion rather than evidence based. Maybe it has something to do with the psychology of being without drugs rather than the physiology.

 

Zoner-

I've been looking for answers to this question for a long time now and it appears  nobody knows for sure. With benzo use when they say gaba receptor function is downregulated what happens is many individual gaba receptors are lost as they are no longer needed. In recovery, gene expression has to increase, mRNA  probably goes up and more gaba receptors are then manufactured. There is no known way to speed this process up with the possible exception of exercise.http://www.ncbi.nlm.nih.gov/pubmed/18801833 . Exercise also increases BDNF (brain derived neurotropic factor) which increases neurogenesis (growing new nerves in the brain). Not everyone can exercise because it also stimulates norepinephrine, cortisol and other adrenocorticotropic hormones which revs up symptoms. If you are able to exercise, by all means do it. Lucky for you. You may heal faster as long as you do not overdo it. Listen to your body.

 

Movement of chloride ions through their channel in the gaba receptor is the mechanism by which the  neuron is hyperpolarized making it less likely to fire in response to stimulatory impulses. That's the reason for the inhibitory effect. This movement of chloride ions has nothing to do with the healing process. I think that by far the most important factor in healing is time and lots of it. Healing does occur throughout the taper as healing means growing more gaba receptors. There is no real difference between "true" healing and healing; just semantics used by some. All this other stuff we do are secondary players (exercise, nutrition, supplements, rest, yoga etc.) that probably helps some and ameliorates symptoms while mother nature works her magic and grows more gaba receptors.

 

Great summary Bart. While the polarisation of chloride ions is a mechanism, there are also genetic variations that effect the rate of hyperpolarisation & other munitiae of the process. Some peeps are probably genetically short changed in the GABA receptor department from the get go so even with a slow taper, their CNS will react adversely to the absence of the artificial binding factor.

 

Ironically, people who are genetically prone to anxiety are probably the very people who should not go near benzos.

Bart, I absolutely agree with her methods. I only wish I could've done it. I am one of those with the horrid paradoxical reactions so in the abrupt manner I had to stop, I'm always looking for that scientific evidence that my brain will heal. Everyone here is reassuring and the success stories are great but I guess in w/d I have that little what if my brain doesn't heal. On a lighter note, I think I'm making tons of progress in less than two months but still looking for that proof... Lol. Thanks

I've been on and off benzos, mostly Librium, much of my life, and never had any symptoms more than 2 weeks after finishing a taper.  In 1994, I did a slow taper off of Librium and not knowing any better, jumped at 5Mg's.  I felt a little roughness for 2 weeks but was fine after that.  In fact, I went on to stay benzo free for 10 years.

 

The main reason I've been on and off benzos is alcohol.  Librium helped with the hangovers.  I've always felt fully recovered in weeks, not months, after tapering.  I can't count the times, I'd be on Librium for a couple months and quit after a rapid taper with no ill effect.  My 5 day hangovers were the reason I would crawl back to benzos.

 

In 2005 I resumed Librium, worked my way up to a high dose, and started tapering in 2011 when my doctor left town and the next one wouldn't prescribe (I had to find an expensive psych doc who would Rx it).  I did a very slow Ashton - I cut and hold, but about twice as slow as her schedule.  When I reached zero, I felt a little wired for a week is all.

 

Circumstances, not some sxs wave, got the better of me and I reinstated a small dose 3 months later.  Then another 3 months after that, when I had more sobriety and stabler circumstances, I started tapering again.  It's been very smooth, especially the last few mgs.  I'm nearing the end of my taper and will reach zero next week.

 

I'm now over 10 months sober and hopeful.

Hj-

If you're improving you have a demonstrated ability to grow new GABA receptors and you will heal. Nobody can tell you how long it will take and why you will have ups and downs along the way. Just be patient (easier said than done). I keep getting in trouble pushing the taper, working too much, not getting enough rest, etc. Eventually all this baloney will end and everything will be all ducky.

It completely baffles me how low doses can still bring on symptoms, i feel really so much better at these lower mgs but the sxs are never far away... that is the one thing that seriously bugs me about this drug, months ago i had no idea the last mgs were potentially so problematic, for me it is the usual case of getting ahead of myself in my taper which is a complete joke when i am taking so long to get off these last mgs and i will be honest here, almost everyone else that is going slow seems to be having problems right now, i will not list names but i can think of half a dozen of people i blog with on here that are struggling in one way or another.

 

Oscar

Oscar-

September has been my worst month yet. Maybe there is something in the water. I had a particularly busy week at work and then came down with the flu. Had my worst wave yet and it came at just under .8mg Valium/day. I ended up doing a lot of updosing and then just held. My tendency has been to be busy at work and play, lots of exercise, not enough rest, sweet tooth, etc. This month has been a wake up call. Am starting to feel a little better but will hold for several more days just to be sure. Also, I'm going to reduce my cut rate to .005mg/day. It seems ridiculous, having to reduce to such a low cut rate; maybe I can pick it up down the road. It is what it is and will end when it wants to not when I want it to. (That will be easier said than done).

Zoner-

I've been looking for answers to this question for a long time now and it appears  nobody knows for sure. With benzo use when they say gaba receptor function is downregulated what happens is many individual gaba receptors are lost as they are no longer needed. In recovery, gene expression has to increase, mRNA  probably goes up and more gaba receptors are then manufactured. There is no known way to speed this process up with the possible exception of exercise.http://www.ncbi.nlm.nih.gov/pubmed/18801833 . Exercise also increases BDNF (brain derived neurotropic factor) which increases neurogenesis (growing new nerves in the brain). Not everyone can exercise because it also stimulates norepinephrine, cortisol and other adrenocorticotropic hormones which revs up symptoms. If you are able to exercise, by all means do it. Lucky for you. You may heal faster as long as you do not overdo it. Listen to your body.

 

Movement of chloride ions through their channel in the gaba receptor is the mechanism by which the  neuron is hyperpolarized making it less likely to fire in response to stimulatory impulses. That's the reason for the inhibitory effect. This movement of chloride ions has nothing to do with the healing process. I think that by far the most important factor in healing is time and lots of it. Healing does occur throughout the taper as healing means growing more gaba receptors. There is no real difference between "true" healing and healing; just semantics used by some. All this other stuff we do are secondary players (exercise, nutrition, supplements, rest, yoga etc.) that probably helps some and ameliorates symptoms while mother nature works her magic and grows more gaba receptors.

Hi Bart

 

I know from reading John Ratley's "Spark" (which you've mentioned a few times) exercise helps secrete various neurochemicals which are extremely valuable in cognitive improvement and regeneration.  Speaking personally I find low to moderate exercise has an immediate beneficial effect especially if I am in one of my frequent downwaves which inevitably includes me being in a state of significant confusion. (Anyone watching me would think I am experiencing something a minor stroke, partial seizure or psychotic episode).

 

There is little doubt exercise helps to (1) reduce benzo withdrawal symptoms and (2) assist with cognitive improvement. However exercise isn't the main factor behind what is making us heal.

 

Our healing process occurs when we remove benzos from our bodies so that they no longer down-regulate the benzo site on the GABA receptor. Maybe that's all there is to it. 

 

I can't get access to Podhorna's article on this page ("The Experimental Pharmacotherapy of Benzodiazepine Withdrawal ") but I wondered if it had some new angles on compounds to help us heal.  Yes, I know this is a near-mythical Holy Grail for us benzo recoverers but I can't stop trying to find it! http://www.benthamscience.com/contents.php?JCode=CPD&Vol=00000008&Iss=00000001

 

By the way, I dug out a few other Medline references related to this to this topic of healing but the abstracts are too brief to really explain things and, again, I can't access the full articles. I wonder if you may have read them in your researches?

 

(1)  "Increase in expression of the GABA(A) receptor alpha(4) subunit gene induced by withdrawal of, but not by long-term treatment with, benzodiazepine full or partial agonists." http://www.ncbi.nlm.nih.gov/pubmed/11483250

 

(2)  "Molecular mechanisms of tolerance to and withdrawal of GABA(A) receptor modulators."  http://www.ncbi.nlm.nih.gov/pubmed/14636957

 

-Zoner

I was pretty stable until ONE MONTH after .25mg of xanax.  It was strange because I felt better a few weeks after the cut to .25mg but a month later I got hit with anxiety, stomach bloating, no appetite, extreme fatigue,etc... 

 

I continued very slowly and tapered off, I THOUGHT that because of my 2 year SLOW taper I would be nearly healed by the time I was off but it GOT WORSE after I was off and I saw a few windows in the ~5 months being off.

 

This is why I bring up the question because no dr. can tell us why it takes so long to return to 100%, we only go by anectdotal success stories with an average time of 6-18 months off benzos.  With no other variables such as other drugs or alcohol use, it looks like the majority of people become exponentially more functional in the 7-12 month range.

 

Ironically, people who are genetically prone to anxiety are probably the very people who should not go near benzos.

 

Very, very true. There has to be a genetic component to this. Nothing else makes sense.

I've read plenty of success stories that people do better during the taper and return to full function in 1-2 months after the taper.  It never took me longer than 2 weeks after a slow taper.

 

We have to remember none of us were 100% before and can't expect pure bliss at the end of the rainbow afterwards.  We still have the baggage we arrived with. 

 

This is my second major taper and, now as before, I'm nearly back to normal during the final 2 months - or in my case, the last 5mgs of Librium.  Once I got below 3mgs I've only felt wired with the resulting insomnia.  The only reason I'm still tapering at 0.5mgs is I have too much going on in my life to deal with possible insomnia when I quit completely.  I'm going to step off next month when I know I can afford to get by on less sleep for a few days.

 

I'm fortunate I've been able to taper with the long-acting Librium and ever mindful and thankful for this.  I just wanted to say that not all of us have waves of symptoms months later.  I went through this in 93-94 and nearly done now - and both times I've only had a little insomnia during the final stage of the taper and afterwards for a couple weeks.  (if that)

 

So I guess I'm disagreeing with the premise that GABA does not return to homeostasis or that healing doesn't occur during the taper itself.

 

 

I've read plenty of success stories that people do better during the taper and return to full function in 1-2 months after the taper.  It never took me longer than 2 weeks after a slow taper.

 

We have to remember none of us were 100% before and can't expect pure bliss at the end of the rainbow afterwards.  We still have the baggage we arrived with. 

 

This is my second major taper and, now as before, I'm nearly back to normal during the final 2 months - or in my case, the last 5mgs of Librium.  Once I got below 3mgs I've only felt wired with the resulting insomnia.  The only reason I'm still tapering at 0.5mgs is I have too much going on in my life to deal with possible insomnia when I quit completely.  I'm going to step off next month when I know I can afford to get by on less sleep for a few days.

 

I'm fortunate I've been able to taper with the long-acting Librium and ever mindful and thankful for this.  I just wanted to say that not all of us have waves of symptoms months later.  I went through this in 93-94 and nearly done now - and both times I've only had a little insomnia during the final stage of the taper and afterwards for a couple weeks.  (if that)

 

So I guess I'm disagreeing with the premise that GABA does not return to homeostasis or that healing doesn't occur during the taper itself.

 

Vribble - Your case as well as probably the "majority" kind of show that the prolonged withdrawal is most likely a genetic predisposition.  For the select few people here who have the long withdrawals, it must be taking us a lot longer for the brain to come back than others.

 

I know many of us have a laundry list of symptoms we didn't have before starting benzos, those are the symptoms we are trying to rid of and from the success stories and night/day differences I see, they too will pass.

Zoner-

Thanks for the info. That articles by Podnorna sure looks interesting. Unfortunately, I think any drug that helps benzo withdrawal symptoms may slow recovery time. In the end, this is mostly a disease cured by tincture of time and lots of it.

My university doesn't have access to the journal the Podnorma article is in. If i thought it covered more than experimental chemicals which are not generally accesible anyway, I would be more inclined to spring for the outrageous $63 they are charging for pay per view, & it's already 12 years old. Will see if I can access via another uni.

My university doesn't have access to the journal the Podnorma article is in. If i thought it covered more than experimental chemicals which are not generally accesible anyway, I would be more inclined to spring for the outrageous $63 they are charging for pay per view, & it's already 12 years old. Will see if I can access via another uni.

 

Hello iHope.

 

If you do manage to get hold of this article then I would be very interested to see what it says.

 

PS: Well done to you for recently jumping from 0.5mgs!

 

-Zoner

I don't think it's as simple as GABA. I think the brain is very complex and I feel like the GABA, serotonin explanations for things are far too simplistic.

 

I'm sure it's more complicated then GABA.

Im with you on that goto.  Seratonin, dopamine all those chemicals play a role in feeling so bad and they just take time to heal

I think it is more than GABA too.

 

Have noted that Bateson, (in the same journal), found that benzos do not appear to produce tolerance and dependence by simple downregulation of receptor number.

 

This challenges the ethos of receptor upregulation. Can't tell you more until& if I can find a way to access the full article.

 

GABAA receptors are hetero-oligomers comprised of multiple subunits encoded by a multigene family, so there are many genes involved which explains the broad range of genetic responses to bzs & wdwl. For every subunit, there is a unique biochemical pathway so we have a highly complex receptor system within a highly complex brain, no wonder we are fumbling around in the dark.

 

It kind of makes the fact that we all recover even more miraculous.