how do benzodiazepines work?

[Misfit Toy]

The only benzo's I'm on consistently is Klonopin 1 mg. Ativan is sporadic. I could go months without taking it.

 

[Dreambirdie]

@alice111I am one of the "horror stories" from short term, low dose benzo use. I won't get into specifics because I will scare people from ever touching a pill again, just know that benzos are in a class of their own in terms of physical addiction potential. By physical I mean your body becoming addicted to it, not you.

Like your I took low dose benzos for increased adrenaline due to adrenal fatigue. I regret now every day that I did this but they were the only thing that helped me sleep even a little. The benefit was not worth the damage it caused.

The deregulation in our brains is an influx of glutamate so by the benzo upping the affinity of GABA receptors to GABA it doesn't do anything toward solving the problem, but rather "evens the playing field" temporarily.

I'm not trying to sway you on your decision to take benzos as I know how much it can calm you down, just trying to help awareness of the situation. If I can prevent even 1 person from living the unspeakable hell that ativan put me in it will be worth it.

So sorry that you went through benzo hell. I can relate to much of what you said. I documented my own benzo nightmare here: http://forums.phoenixrising.me/inde...and-sanity-for-4-1-2-weeks.31972/#post-492336

I still struggle so much with the brain toxicity, which I think is an extension of liver toxicity and methylation blocks. The disruption to my sleep is an ongoing frustration. I am wondering if you have found things that have been helpful for that?

 

[Aerose91]

So sorry that you went through benzo hell. I can relate to much of what you said. I documented my own benzo nightmare here: http://forums.phoenixrising.me/inde...and-sanity-for-4-1-2-weeks.31972/#post-492336

I still struggle so much with the brain toxicity, which I think is an extension of liver toxicity and methylation blocks. The disruption to my sleep is an ongoing frustration. I am wondering if you have found things that have been helpful for that?

I'm sorry to hear you've been through the same thing, it's unspeakable.

Its hard for me to say if I've helped anything because this whole disease (ME) is in my brain due to getting it from encephalitis (due to benzo w/d) I'm on a high dose Phosphatidylcholine therapy right now in preparation for methylation and detoxing. I hope to God I see some results

 

[alice111]

@heapsreal thanks for the recommendations!

@Aerose91 do you mind elaborating on what the physical withdrawl was? What were your symptoms?

As for the adrenals, I am actually in the process of weaning off cortef. At first the cortef wa helpful. But I think my adrenals repaired so I did not need it anymore, I started getting some really bad symptoms.

 

[heapsreal]

it seems that the benzo's people have the most issues with are xanax, klonopin, loraz. Im not sure why, maybe bind tighter to receptor sights?? I know my doctor isnt interested in prescribing those benzos. valium, temazepam and mogadon seem to have less issues. The z drugs i think in general seem to be better tolerated as far withdrawal and addiction. Alot of people we read about online, not here, but seem to have a history of abusing benzos recreationally.

Theres always people who are going to react badly to any med, but i think keeping a cap on benzo doses, alternating them with non benzos eg antihistamines etc. I also think if one has sleep quality issues but is getting enough sleep hours than benzos probably arent going to be of help. But if someone has insomnia and lack of sleep ie cant fall asleep for long periods and can only sleep for short periods 4hrs or less, so really sleep quantity is the issue.

its always worth trying natural things first or combination of natural substances.

 

[minkeygirl]

@alice111 in I think it was 2007, using the titration method I took 4 months to get off 1 mg klonopin. I had been taking that dose for years.

The first 2 months were ok. Then it hit me. I didn't sleep more than 2 hours a night for the next 2 months and a year after I was off.

I swore I'd never take another benzo. Then trazodone and suntheanine stopped working for sleep

Now I alternate a differnt short acting benzo or Z drug along with OTC antihistimes for sleep.

Per @heapsreal recommendation I take DM For tolerance and this weekend I'm going to try to use a muscle relaxant to sleep to give my gaba receptors a break.

For me. OTC stuff alone doesn't even come close to helping me sleep.

 

[alice111]

@minkeygirl what is DM?

 

[minkeygirl]

I can't pronounce it. It's the stuff in Tussin DM. @heapsreal has talked about it on a few threads that it helps with tolerance. I take it for a week then take a break. Dextromethorphan?

 

[Aerose91]

@heapsreal thanks for the recommendations!

@Aerose91 do you mind elaborating on what the physical withdrawl was? What were your symptoms?

As for the adrenals, I am actually in the process of weaning off cortef. At first the cortef wa helpful. But I think my adrenals repaired so I did not need it anymore, I started getting some really bad symptoms.

I had over 70 symptoms, most of them psychological. I won't get into depth because I don't want to frighten you but some were 20 hour long panic attacks for 4 months straight, complete psychosis, only seeing black and white alternating with only seeing yellow. I also had a constant, overwhelming feeling of organic terror for 3-4 months straight, far beyond any anxiety or panic. There's much more but I'll leave it at that.

I'm approaching 3 years off now and though I am better, I am far from healed. @heapsreal suggestion is good, try to space out doses of benzos as far from each other as you can and try antihistamines, herbals and even an occasional z drug if you can (though z drugs also bind to GABA receptors) Though obviously, getting to the root of your issue is the most important.

 

[Dreambirdie]

I had over 70 symptoms, most of them psychological. I won't get into depth because I don't want to frighten you but some were 20 hour long panic attacks for 4 months straight, complete psychosis, only seeing black and white alternating with only seeing yellow. I also had a constant, overwhelming feeling of organic terror for 3-4 months straight, far beyond any anxiety or panic. There's much more but I'll leave it at that.

I'm approaching 3 years off now and though I am better, I am far from healed. @heapsreal suggestion is good, try to space out doses of benzos as far from each other as you can and try antihistamines, herbals and even an occasional z drug if you can (though z drugs also bind to GABA receptors) Though obviously, getting to the root of your issue is the most important.

OMG! I thought my 6 weeks worth of 6-8 hour long panic attacks, pressure in the chest, shortness of breath, burning down the arms, and heart palpitations in the middle of the night were bad. Your symptoms were absolutely horrid! SO GLAD you have moved beyond the worst of it. I wish you more relief and recovery to come.

Taking benzos is like playing with a wagonload of explosives. There are literally thousands of people who have had horrible withdrawal symptoms from these drugs. In many cases they have ruined peoples lives.

Here are a bunch of petitions I have signed.
New Rule: Docs Who Prescribe Benzos Long-Term Must Help w/Long-term Withdrawal
http://www.thepetitionsite.com/649/...os-long-term-must-help-wlong-term-withdrawal/

Petition to BAN LONG TERM BENZO PRESCRIPTIONS
https://www.change.org/p/fda-stop-p...an-long-term-prescriptions-of-benzodiazepines

THE PETITION TO THE FDA to put a BLACK BOX WARNING on Benzo Prescriptions
http://www.benzosupport.org/fda_pe.htm

 

[Aerose91]

OMG! I thought my 6 weeks worth of 6-8 hour long panic attacks, pressure in the chest, shortness of breath, burning down the arms, and heart palpitations in the middle of the night were bad. Your symptoms were absolutely horrid! SO GLAD you have moved beyond the worst of it. I wish you more relief and recovery to come.

Taking benzos is like playing with a wagonload of explosives. There are literally thousands of people who have had horrible withdrawal symptoms from these drugs. In many cases they have ruined peoples lives.

Here are a bunch of petitions I have signed.
New Rule: Docs Who Prescribe Benzos Long-Term Must Help w/Long-term Withdrawal
http://www.thepetitionsite.com/649/...os-long-term-must-help-wlong-term-withdrawal/

Petition to BAN LONG TERM BENZO PRESCRIPTIONS
https://www.change.org/p/fda-stop-p...an-long-term-prescriptions-of-benzodiazepines

THE PETITION TO THE FDA to put a BLACK BOX WARNING on Benzo Prescriptions
http://www.benzosupport.org/fda_pe.htm

Yes unfortunately I have met many of them on various boards and such. I didn't even list my worst symptoms there because it was so, so much worse. But thank you for your well wishes and I hope that you soon feel full resolution of your issues. These damn pills ruin lives (not all though)

 

[heapsreal]

I dont want benzos band, that probably would put me on disability as i wouldnt be able to sleep and function long term.
I understand that some people have had a bad experience but what about all those that dont????

I think doctors need to inform the patients better about benzo use and then the patient makes the decision. Banning benzos would probably harm more people than it hurts. Until they get a cure for insomnia, banning benzos would harm me.

 

[minkeygirl]

I swore I would never take another benzo. Partly because I liked them so much. I fought it for months but like heapsreal I cannot sleep without them.

I do think after being on benzo boards for a long time that a big problem is doctor's not understanding how to get people off them.

Many people were in protracted withdrawal because a doctor said to just cut it in half for a week then another week and be done

You can't go to rehab and be done in a month. The longer you take to get off them, and I mean Xanax, Ativan, klonopin the easier time you will have but even then it's hard.

I think dr heather Ashton and the titration method should be taught to doctors.

 

[Aerose91]

I dont want benzos band, that probably would put me on disability as i wouldnt be able to sleep and function long term.
I understand that some people have had a bad experience but what about all those that dont????

I think doctors need to inform the patients better about benzo use and then the patient makes the decision. Banning benzos would probably harm more people than it hurts. Until they get a cure for insomnia, banning benzos would harm me.

I slept 5 hours a week for almost 6 months, then 3-4 hours a day for the next year or so after coming off ativan. I still don't sleep well but it's slowly returning. Mind you, I took 2 mg/night for 2 weeks. Thats it.

As someone who went to the 7th circle of hell from benzos and has had many friends I met along the way die or commit suicide from them, I still don't think they should be banned. They have their purposes but people, doctors included, need to be more informed of their dangers and understand they are for intermittent use only. People run scared of street drugs and not saying they are ok, but most aren't nearly as potent or dangerous as prescriptions. However, I've had a friend who abused the hell out of ativan and quit with no problems at all. Me though, I would do a mountain of cocaine before ever touching a GABA-genic pill again.

 

[Aerose91]

I swore I would never take another benzo. Partly because I liked them so much. I fought it for months but like heapsreal I cannot sleep without them.

I do think after being on benzo boards for a long time that a big problem is doctor's not understanding how to get people off them.

Many people were in protracted withdrawal because a doctor said to just cut it in half for a week then another week and be done

You can't go to rehab and be done in a month. The longer you take to get off them, and I mean Xanax, Ativan, klonopin the easier time you will have but even then it's hard.

I think dr heather Ashton and the titration method should be taught to doctors.

I fully agree with you, minkeygirl

 

[Little Bluestem]

However, I've had a friend who abused the hell out of ativan and quit with no problems at all.

I think people who abuse drugs recreationally have an easier time quitting. They only have to deal with the physical dependance, not the return of whatever symptoms a person taking them medicinally has to deal with.

 

[Aerose91]

I think people who abuse drugs recreationally have an easier time quitting. They only have to deal with the physical dependance, not the return of whatever symptoms a person taking them medicinally has to deal with.

Not 1 of the over 70 symptoms I had when withdrawing from ativan I had before taking it and I'm still dealing with many of them 3 years later. I was only given them for 2 weeks because of adrenal fatigue, anyway. She had zero withdrawal symptoms and I had major symptoms- just a difference in our physical makeup

 

[physicsstudent13]

@alice111
I am one of the "horror stories" from short term, low dose benzo use. I won't get into specifics because I will scare people from ever touching a pill again, just know that benzos are in a class of their own in terms of physical addiction potential. By physical I mean your body becoming addicted to it, not you.
Like your I took low dose benzos for increased adrenaline due to adrenal fatigue. I regret now every day that I did this but they were the only thing that helped me sleep even a little. The benefit was not worth the damage it caused.
My strong recommendation is that if you found a potential cause of your adrenaline surges to TAPER off the benzo. They should really only be used for short term isolated use yet few doctors understand this.
Not trying to freak you out, I'm just trying to look out for you as I'm a living example of the horrors they can cause. I would only take benzos if it was the absolute last resort and the anxiety is intolerable- and even then- intermittently.
@Misfit Toy

It is understood now that adrenal fatigue is a brain toxicity disease, not something that directly effects the adrenals. Taking benzos and other sleep/anxiety aids, though calming in the short term, only add to the toxin load. I say this because I had extremely severe AF which is what lead me to Ativan and ativan withdrawal led me to ME.

The deregulation in our brains is an influx of glutamate so by the benzo upping the affinity of GABA receptors to GABA it doesn't do anything toward solving the problem, but rather "evens the playing field" temporarily.

I'm not trying to sway you on your decision to take benzos as I know how much it can calm you down, just trying to help awareness of the situation. If I can prevent even 1 person from living the unspeakable hell that ativan put me in it will be worth it.

I was prescribed clonazepam/klonopin long term. How does it cause cognitive damage? I think I had better cognition on it from treating my sleep disorder but maybe I was damaged. If the problem is glutamate excitotoxicity from high levels of glutamate then is there another way to treat that?

 

[Aerose91]

I was prescribed clonazepam/klonopin long term. How does it cause cognitive damage? I am one of the people who never had problems with it, no withdrawal symptoms other than terrible sleep and becoming cognitively disabled from hypoxia. if the problem is glutamate excitotoxicity from high levels of glutamate then is there another way to treat that?

Benzos so many other things than just affect GABA and glutamate but those are the principal factors. I don't know of anyway to speed up the recovery of your GABA receptors. Its best to do any normal healing procedures- good diet, rest, stress reduction etc. Some things that have taken the edge off for me were l-Theanine an sometimes valerian root but overall I don't think there's anything that speeds up the process

 

[zzz]

I heard this humming noise once in my head 2 years after being assaulted and blacking out and having Bell's Palsy. is that a sign of excitotoxicity or too high glutamate or glutamine levels from over stimulation of neurons in some area of the brain? and then when I took the klonopin+gabapentin it instantly went away for some reason??

It's hard to say based solely on the information you provided exactly what caused the humming noise. However, as for its disappearance, Dr. Jay Goldstein saw instantaneous changes like this all the time. He attributed them to the reconfiguring of neural networks caused by the drugs. Based on your positive reactions to these drugs, the problem may well have been due to excitotoxicity, which in turn could very well have been caused by excessive glutamate levels. Glutamine itself is not a neurotransmitter, though it's a precursor to GABA, which means it has effects on the brain that are generally opposite to those of glutamate.

I'm taking klonopin+gabapentin it is really a good combination, the best I've found in 8 years of suffering. It does seem to increase my slow wave stage 3 sleep more than trazodone. my neurologist is an Phd/Md from MIT. I'm curious though if this heals the brain lesions from repeated hypoxic events

If the hypoxic events caused death of brain tissue, then once it's dead, it's dead. However, depending on what type of brain tissue is involved, the brain's neural plasticity may allow it to grow new connections and shift the processing functions of the dead tissue to other parts of the brain.

In both this case and the case where hypoxia caused only temporary injury, increasing slow wave sleep can indeed speed the healing process.

I was prescribed clonazepam/klonopin long term. How does it cause cognitive damage?

Klonopin should not cause permanent cognitive damage. If it is abused, or if too much is taken for a particular person, temporary damage may result in the form of the brain's reducing the number of GABA receptors, and in the withdrawal symptoms that follow. But the GABA receptors should always regrow, although in the worst case that can take several years to complete, assuming that there is no abuse of the drug in the mean time. Generally, these problems can be avoided. Dr. Paul Cheney described Klonopin as being neuroprotective. Many people on PR have been taking Klonopin for decades without problems.

Although Klonopin and other benzodiazepines can cause addiction and withdrawal problems in some people, these problems can be minimized. Here's what I have found makes a difference:

• Genetics. People who have addictive-type personalities are going to have a lot more trouble with these drugs, and should be much more careful about even going on them in the first place.
• Final dose. The higher the final dose is, the more likely problems will arise in tapering down. If the final dose is too high, some people may develop problems just at a maintenance level. This is difficult to treat. Dr. Cheney has found that doses above 2 mg/day were the ones that most frequently caused problems with Klonopin.
  
• Taper speed. Slower is better. By tapering off slowly enough from a dose that's not causing problems, it should be possible to get off the drug without withdrawal issues.
• Size of dose reduction. Many people make the mistake of cutting their dose in half on the way down. (Doctors may tell them to do this; doctors are often horribly misinformed about how to taper off drugs.) I have found that by reducing the dose by no more than 5% to 10% of the dose at the taper start, many problems are avoided. Near the taper end, this amount may be reduced further.
• Knowing when to back off. If a dosage reduction causes problems, reverse it immediately, and wait a while before trying again.
• Knowing when to start. Don't titrate up a drug that you may have to quit quickly (e.g. for tests, etc.)

Different people have found other strategies that work best for them, and a Web search will turn up many of these.

if the problem is glutamate excitotoxicity from high levels of glutamate then is there another way to treat that?

Dr. Goldstein's treatment protocol involved many different methods for either reducing glutamate production or receptor sensitivity to glutamate. Please see Betrayal by the Brain and Tuning the Brain for details. This thread has a lot more information on Dr. Goldstein's treatments.

Benzos so many other things than just affect GABA and glutamate but those are the principal factors. I don't know of anyway to speed up the recovery of your GABA receptors. Its best to do any normal healing procedures- good diet, rest, stress reduction etc. Some things that have taken the edge off for me were l-Theanine an sometimes valerian root but overall I don't think there's anything that speeds up the process

There are several treatments that can directly affect the recovery from benzodiazepine withdrawal. Starting with the most effective:

• Flumazenil. Flumazenil is actually another benzodiazepine. However, whereas all other benzodiazepines are positive allosteric modulators of the GABA receptor, meaning that they amplify the effect of GABA agonists (such as GABA itself), flumazenil is a neutral allosteric modulator of the GABA receptor. This means that it just takes the place of other benzodiazepines in the alpha subunit of the GABA receptor, but unlike other benzodiazepines, it has no effect whatsoever. It does, however, allow the main receptor to regrow. There is at least one clinic that treats benzodiazepine withdrawal with an intensive seven-day course of flumazenil; the benzodiazepines are stopped at the beginning of treatment and the flumazenil is started. Seven days later, the flumazenil can be stopped, and there are reportedly no benzodiazepine withdrawal side effects. This treatment is quite expensive, though, partially because the flumazenil has to be administered via IV on a very strict schedule.
  
  Dr. Goldstein appears to have pioneered the use of flumazenil as a nasal spray in order to reverse negative reactions to benzodiazepines and several other drugs in his patients. He did not use it for benzodiazepine withdrawal, since he did not do such treatments, but the nasal spray certainly could be used that way. The olfactory nerves have a very direct route to the brain, but it's not clear how this treatment would compare to the IV route in terms of effectiveness. Based on Dr. Goldstein's experience, it would probably be very close, but trials would have to be run to determine this for sure.
• Gabapentin. Gabapentin (Neurontin), like the benzodiazepines, also binds to the alpha subunit of the GABA receptor. For this reason, gabapentin can be extremely useful in tapering off benzodiazepines. However, gabapentin itself is addictive, and has its own withdrawal issues. Nevertheless, these tend to be less severe than that of benzodiazepines. Someone who uses this approach is essentially trading a benzodiazepine addiction for a gabapentin addiction. However, people generally tend to find this to be a very useful approach.
• Magnesium. At one point, in order to prepare for an Ampligen trial, Dr. Cheney took more than 30 of his patients who were on a 1 to 2 mg dose of Klonopin per day (many of them for years) and got all but two of them off Klonopin completely with no side effects in 30 days. He did so by replacing the Klonopin with daily IM injections of 250 mg of magnesium. As magnesium is helpful for sleep and anxiety, which were the problems for which his patients were taking Klonopin, the patients were able to switch to the magnesium without problems. Magnesium is not at all addicting.
  
• Selank. Selank is a neuropeptide designed by the Institute of Molecular Genetics of the Russian Academy of Sciences. Selank has been shown to provide a sustained nootropic and anxiolytic effect, which is useful for the treatment of generalized anxiety disorder. It is also reported to be useful in repairing damage done by other drugs such as benzodiazepines, and can be useful during a benzodiazepine taper. Selank has no sedating or cognitive side effects and no associated addiction or withdrawal syndrome. Doses up to 500 times the effective dose have proved harmless. Selank has completed stage III clinical trials in Russia. It is easily available in the U.S., but only for research purposes. A lot of researchers apparently follow the nootropic Web sites, as Selank and its usage is heavily discussed there.

Of these treatments, only flumazenil is known definitely to speed up the regrowth of the GABA receptors, although Selank is reputed to do so as well. However, whether the other treatments do or not, they have the same effect, which is why I list them here.