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Methods of last-result to treat harsh benzodiazepine withdrawal

Apostacious

Apostacious

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A revealing one
I know that benzodiazepine withdrawal is a tired old subject. I hope that there might be some that have gone through a couple treatments and to see what the long-term effects as well as short-term effects that two treatments for intense benzodiazepine withdrawal are.

The only true drug that can help alleviate benzodiazepine withdrawal in patients has been flumazenil. As some may know this is a benzodiazepine antagonist and has the ability to reset the whole spectrum of gaba receptors within the brain. My main concern with this is the alarming lack of research and use of this method on patients. I've never come across a negative result from flumazenil, but there are no long-term checkups with patients to see if withdrawal symptoms dissipated entirely. Perhaps this can mean a good thing since patients do have the means to spread anything negative of the flumazenil treatment through various venues.

Since the medical community worldwide is in the dark ages when it comes to gaba-ergic drug withdrawal (well, for the most part benzodiazepine withdrawal, since benzodiazepines are used to treat alcohol, ghb, gbl, barbiturate, etc withdrawal therefore patients are stuck with another gaba-ergic addiction that isn't lethal when continuously prescribed) then flumazenil treatments are much more rare and the studies are as well.

Another temporary treatment that is rarely used, but is successful at least in detaching the person from benzodiazepine withdrawal without administration of a substance that causes dependence is through the use of nmda antagonists. I assume the issuing of ketamine to a patient (instead of another gaba-ergic drug to induce anaesthesia which can create a kindling effect on withdrawals) is to temporarily constrict the release of glutamate levels in the brain through nmda receptors. Glutamate is the primary reason patients go into seizures during gaba-ergic withdrawals since sensitivities of glutamte are drastically increased during an abrupt cessation of a benzodiazepine. I've yet to see a study where an nmda antagonist is administrated more than once. I assume this is to avoid delirium to an extent. But more information would be nice since I can't find anything of note.
 
Apostacious said:
Since the medical community worldwide is in the dark ages when it comes to gaba-ergic drug withdrawal (well, for the most part benzodiazepine withdrawal, since benzodiazepines are used to treat alcohol, ghb, gbl, barbiturate, etc withdrawal therefore patients are stuck with another gaba-ergic addiction that isn't lethal when continuously prescribed) then flumazenil treatments are much more rare and the studies are as well.
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There is no real magic bullet treatment for benzodiazepine withdrawal. The consensus in the medical community (supported by evidence/clinical studies) is that the most successful treatment is (1) switch the patient to a benzo with a long half life, and then (2) gradually taper down doses over a period of roughly 10 weeks to allow for a slow but continuous decline in tissue/plasma concentrations, while (3) providing psychological counseling to deal with the non-physical aspect of the addiction. This method is tried, tested, and true.

Anecdote: My partner (severely GHB-addicted) was admitted to a hospital ER with acute and potentially lethal symptoms arising from sudden discontinuation of the GHB supply. Treatment involved rapid induction of a coma state using IV lorazepam, followed by diazepam substituion over the next 24-hours. The diazepam plasma concentration was maintained for 24-hrs and then gradually reduced over the next 8 days. She woke up from the coma 48hrs after the diazepam reduction began, and experienced no further withdrawal symptoms as the diazepam was tapered off over the remaining days. Not an exact comparison, but you should be able to see similarities.

If you refuse to believe the medical community that gradual reduction is the best approach to benzo withdrawal management, I'll toss this your way too:

Some recent evidence in the literature suggests that the anti-convulsants Carbamazepine and its derivative oxcarbazepine show some potential in reducing benzo withdrawal severity. I'll refer you to the following studies:

Study
Study
Study
 
I have personally used Ketamine to aid in Benzo withdrawals before. It works well, but only if you have the capacity to be completely dysfunctional for a week (or however long your withdrawals last). That is because you will need to be in what I call "2nd plateu" doses of K - where you are feeling full anaesthesia and loss of coordination but not much in terms of psychedelic-like effects yet.

Also large doses of gabapentin can be helpful, but they do not do much for anxiety. Gabapentin also remains a very expensive drug.

I have also used low-dose Ethanol binges in benzo withdrawal. I know it is not exactly a safe thing to do, but sometimes it is the only thing you have access to that works. Of course, it is a given that basically become a temporary alcoholic, but unless you have an addictive tendency towards alcohol, you should be able to stop before developing any dependence to ethanol.

Flumazenil treatment scares me... I would imagine that giving flumazenil to someone withdrawing from benzos is pretty much a guaranteed seizure?
 
raybeez-

I understand fully that a slow, gradual reduction in blood plasma levels of a benzodiazepine is absolutely needed (that's what I'm doing to take care of a 5-year addiction to clonazepam by using a 1-year gradual reduction). I was just reading into what the medical community does with people that have to abruptly discontinue (either due to benzodiazepine toxicity or if their doctors are sadistic assholes and truly hate them).

jamshyd-

Interesting that you used ketamine in moderately low doses. Did it temporarily relieve muscle spasms/jerks? I assume that low doses of ethanol would alleviate most of the symptoms while its active although since ethanol has an extremely short half-life in comparison to most benzos I wonder if it worsens symptoms right afterwards depending on how hard gaba receptors were hit from the withdrawal.

Thanks.
 
In all honesty, I do not remember... mostly because I was too fucked up at the time to remember ;). I would wager that it does not, though, since Ketamine doesn't seem to have much of a muscle relaxant property.

On the other hand, Gabapentin seems to stop those. I have used Ketamine and Gabapentin together before for benzo withdrawal and I found I needed lower doses of Ketamine to cope. In fact, I was rather funtional for the most part.

As for the ethanol - you are right. But as I said, it would have to be sustained administration... what I did was mix a large bottle of gin cocktail, and drank increments at fixed times. To "taper" from that, ice was added so that the drink was more and more diluted as time went by.
 
I'd use Gabapentin.

Captodiamine is a possibility too!

i think it's captodiamine anyway, i might have that a bit off
 
If Phenibut and alcohol (not combined!) might help, what about something like GBL or GHB? If you were dosing yourself to stay effected for 24 hours a day for a few days you probably wouldn't get addicted - you wouldn't want to have to withdraw from either of these afterwards. I beleive you can use benzos and similar to help with GBL withdrawl, but then you'd be a bit like the old woman who swallowed the fly.
 
Using GHB for benzo withdrawal makes as much sense as using fentanyl for Heroin withdrawal. The GHB withdrawals (and dependance happens QUICK) make benzo withdrawals feel good.

Splat: These all sound like good suggestions, although as I mentioned elsewhere, I have my doubts about phenibut. Between phenibut and gabapentin, I would definitely pick the latter.

Captodiame - thats a new one for me, although wikipedia says that it is anxiolytic and used successfully for benzo w/d. How interesting!
 
It's got a great name, too. A nice ring to it (captodiamine- a little super hero-y).

Wikipedia's got it named as "captodiame" but mostly it's written as captodiamine. I dunno why. I prefer the latter.

Anything that's going to get you high in the process should be considered a no-no if you're looking for real abstinence, anyway. If you just wanna fool yourself, sure- go ahead and use GHB to substitute. Don't say we didn't warn ya though.
 
I have found phenibut extremely useful for GBL withdrawal, it didn't cover all symptoms but did make the experience bearable and I was able to sleep normally. It made what would have been 3 sleepless days of torment nothing more then slight anxiety and boredom. Its also fairly cheap, 15 USD worth which is the smallest amount sold is about four times what is needed.

Completely subjective experience but don't write phenibut off so soon.
 
Flumazenil treatment scares me... I would imagine that giving flumazenil to someone withdrawing from benzos is pretty much a guaranteed seizure?
Click to expand...

Besides which, if you want an expensive drug, this is hideously expensive (although that's not a concern if you live in somewhere like the UK with an NHS setup)
 
Wow, I had no idea Flumazenil even existed until now. What a dangourus drug to administer, jesus christ! You have someone come in on a benzo overdose and you just gotta assume they are addicted. Then what are you gonna do when they seize?

Are benzo receptors different than the gaba receptors barbs and ethanol act on?
 
^benzos act on the same GABA receptors (GABA-A right?), as well as 'benzodiazepine' receptors additionally
 
Kava works well, though only pure root, whole or powdered. Dosage is typically 2-10 grams, so those capsules they sell at helth food stores a definite waste. GABA supplements and valerian root can help as well, though not as well. GABA does not cross the blood brain barrier well, although a very small portion does, still from personal experience, I can tell you that it does help. Phenibut is likely also quite helpful, though it works on GABA-b receptors.
 
Niacin with GABA is meant to increase permeability.

I noticed that Captodiamine is a derivative of dipenhydramine- I may try the old dramamamine to see if it can at least get rid of this restless leg problem.

Correct me if I;m wrong, but during benzo withdrawl isn't simply increasing GABA pointless, due to downregualtion of receptors?

This is a topic I am very interested, through force- I'm in the midst of withdrawal, via a atapering schedule and with a drug worker. So please guys, any other hints could be good. I am very unsure of the availability of phenibut in Australia, I'll have to look into that.
 
I wouldn't count on dramamine to help you with RLS. It only makes it worse for me.

As does alcohol and seroquel, ime.
 
^Yeah, I don't get along favourbaly with dramamine anyway, I seem to be very sensitive to the ghost people syndrome. What medications are there for RLS- even herbs or vitamins would do...?
 
Ham-milton said:
I wouldn't count on dramamine to help you with RLS. It only makes it worse for me.

As does alcohol and seroquel, ime.
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I agree with dramamine and seroquel making RLS worse, as well as benadryl. Not sure about alcohol though, but I'd imagine the same. My two cents.
 
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