Benzodiazepine drugs such as clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax) and diazepam (Valium), are prescribed for anxiety, insomnia, panic attacks, and to control alcohol withdrawal symptoms. They have a very high addiction potential. Even among the most experienced Alliance treatment providers, the withdrawal from benzodiazepines is considered to be tougher than that of any other drug withdrawal. Not only is there a real danger of seizure, but prolonged misery from insomnia, anxiety, and many other symptoms, even long after complete withdrawal, can end in permanent disability and even suicide.
A 6 to 12 months-long taper may be required, which means that it cannot be accomplished successfully in most residential treatment programs, though some programs may promise that it can be.
GABA is our naturally tranquilizing (or inhibitory) neurotransmitter. Since benzos target GABA receptors, nutrition-based therapy starts with oral supplements of GABA and/or theanine and taurine, as all three amino acids promote improved GABA function in the brain.
GABA, theanine, or taurine should be taken several hours before or after taking a benzodiazepine. Ask your prescriber for specific recommendations.
The calming amino Tryptophan that may be indicated by neurotransmitter assessment and other calming nutrients (like inositol or magnesium) can be helpful, along with vitamin C for withdrawal support.
Nutrition-wise practitioners will also often test day-long cortisol levels (collecting five salivary samples) before starting to taper benzodiazepine doses. Cortisol is our primary adrenal stress response hormone. Chronically elevated cortisol levels can be triggered by a period of unrelentingly high stress that lasts more than three weeks. This can cause permanent agitation and/or insomnia that only benzos can relieve short term. However, benzos can jack cortisol levels up even higher after the initial calming effect wears off. Levels can rise higher still during the stress of detox. High cortisol is part of all drug withdrawal agitation, but it can be particularly severe and long-term in benzo withdrawal.
Lowering cortisol levels with nutrients can be very effective. Phospho-serine (brand name Seriphos), at bedtime, as needed, is the most universally effective nutrient for this purpose.
If step-down discomfort is experienced at any point in the taper, many have found it helpful to switch to an equivalent dose of Valium as per the Ashton Manual. (Heather Ashton was a British M.D. specializing in Benzo withdrawal. Her Manual is available on the Internet.) Valium has a much longer half-life than benzos like Xanax and Ativan do, so it can be tapered more easily. Even so, many cannot tolerate the final complete withdrawal from Valium without more assistance.
These supplements can allow for a comfortable, gradual benzodiazepine withdrawal for some people, as the woman described in the following case:
DM is a 57 years old office manager, obese from the age of 3. She has a binge eating disorder; very low energy and motivation in spite of being on Wellbutrin for 20+ years; chronic insomnia, due to obsessive worry; and chronic anxiety and panic. She transferred from Citalopram to Buspar in December because it wasn't working. She abruptly stopped the 2 mg of Ativan that she had been on for 4 years. Within 3 weeks, her insomnia and anxiety were far worse, she was too nauseated to eat, had skin crawling sensations and severe dizziness. Within a week of being on 200 mg L-theanine and 1000 mg L-glutamine 4 times a day, plus 1000 mg L-Tryptophan at bedtime, and starting the Pro-Recovery diet, adding significant amounts of protein every four hours, all of her symptoms were significantly better, except for the fatigue, worry, and self-consciousness. So, we added 1000 mg L-Tyrosine at breakfast and lunch, 100 mg 5HTP upon arising and mid-afternoon with the Theanine, and 400 mg Magnesium Glycinate at bedtime. Her symptom scores all improved dramatically in a week. She reported significantly more energy and enthusiasm, significantly less worry and self-consciousness, and was asleep within 20 minutes each night. She never needed to go back on Ativan. Her sugar cravings were gone. She had cut her Buspar in half in three weeks and was about to begin a Wellbutrin taper which is typically very smooth on the above supplements.
(This case description was contributed by Christina Veselak, LMFT, CN, Alliance Past President
IV Amino Support During Benzo Tapers
On each taper-down day, once it gets tough, one to three hour IVs can be helpful. Contents: a mix of nutrients always including vitamin C and magnesium with the amino acids taurine and/or GABA.
It is possible for benzo-withdrawers to get these withdrawal support IVs done near home as well as during treatment in some nutritional recovery-oriented programs.
IV GABA Warning: IV GABA regularly causes a brief (a few seconds) shortness of breath. Because we’ve also seen this happen with 500 mg or higher oral GABA dosing, we’ve learned to start GABA dosing at 125-250mg and only go up as needed. Taurine does not do this, but, alone, is not as effective. (GABA and theanine are more effective orally.) Because of the upset that the breathing problems can cause, providers and patients need to be made aware of it in advance. We know of no actual harm resulting from this common reaction to IV GABA or to oral doses of 500mg or more.
Benzo IV tapers, because it may be needed long-term, has not been carried out in well-supervised settings, as other IV amino detox protocols (e.g. for opiates) have been. It was done successfully by Dr. William Hitt in Mexico, but exactly what he used is unclear. His protocol involved an all-day, cold-turkey IV provided daily for one to two weeks or more. There is evidence that he added the amino acid NAC (N-acetyl cysteine) to his IVs but he is now deceased and the actual formula he used may never be known. He often spoke about the danger of seizure with his abrupt benzo detox procedure but said his patients had seldom had to use the anti-seizure medication, Dilantin, that he sent them home with at night from his clinic.
The optimal Benzo step-down process for severe addiction is, unfortunately, not yet fully established or available, as of 2017. We welcome the experience of others to add to our efforts so far to help this large and tragic group of addicts, many addicted by their own doctors with no prior warning given regarding the well-known risks for addiction.
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