Benzos Kindling in benzo withdrawal and the science behind it

[Cyanoide]

I have a habit of not being able to make short posts, but I feel it's important that I tell about my past so you can better understand my situation right now.

Unfortunately, I've had a relapse with benzos 5-6 times in the last few weeks before even recovering from my last benzo detox (which ended in mid-May). I've WD'd from benzos 3 times in my life. All have been after using them for long periods (many years) of time in high doses. For the last 16 years, only a year and a half has been completely without benzos. The first withdrawal was from using them for 8 years (oxazepam, temazepam, alprazolan, clonazepam and diazepam, in that particular order). The taper started as an outpatient but from 22.5 mg diazepam to zero was done in rehab. The second time was done as an outpatient with the supervision of a very good psychiatric. That time I had used RC benzos (mainly diclazepam but also flubromazepam, flubromazolam, clonazolan, pyrazolam, etizolam and some diazepam) for about 2 years. The taper was done with oxazepam. The 3rd WD was done this year in a rehab and was very extreme. In most part because of my extreme dose of 10-12 mg clonazepam a day that had gone on for a year. I was switched to diazepam and was tapered from 60 mg slowly to zero. Initially I was put on 30 mg diazepam, had a seizure and went into a catatonic psychosis for which I was given more diazepam, valproate and olanzapine. The detox from 60 mg diazepam was worse than words can describe and I had every damn symptom you can ever get. The only good thing was that I was in a good care place (the first weeks in a psychiatric hospital under constant surveillance because of the severity of my symptoms.) After finally being free from benzos in Mid-May, I still suffered from heavy WD symptoms for a long time and then PAWS started. Probably due to the far too rapid detox from clonazepam to diazepam and from that to nothing.

One would have thought I had learned my lesson, as I still suffer from heavy PAWS. But I unfortunately drank a lot of alcohol for a couple of days a few weeks ago, which triggered extremely intense WD due to me also having alcohol problems and actually being in a combined alcohol/benzo detox the first time I WD'd from benzos. Because of the severity of my symptoms, I had no choice but to take 40 mg diazepam which barely kept me somewhat OK. A few days after this, all hell started to break loose. I think it was 3-4 days after taking the diazepam because it has such a long half life and several metabolites. And so here it began again. I took 15 mg to keep the WD at bay. Then again 3 days and it began again, another 10 mg. And so forth. Basically I'm hooked on benzos again.

So I decided that I have to do a taper again. Now the 4th time in my life. I have enough diazepam to do that. Fortunately I can manage with a somewhat small dose, 10-15 mg (at least for me that's a small dose compared to 12 mg clonazepam). I could have made this thread a lot shorter by just asking if you think kindling will make the WD much worse this time? I need honest answers, which I may not like. And what I also would like to know is if the taper should be done even more slowly than usual, am I at a much higher risk of getting much worse symptoms now because of my past? Is kindling something that affects everyone, so it universally can be said that every WD will gradually become worse?

I can't really say much about kindling in my 3rd first WD's, because the doses and the specific benzodiazepines used were so different. It's very hard to compare WD'ing for that reason. Of course, there is a point where you're at the same dose in every WD, at least equivalently, but the initial benzodiazepine used and the benzodiazepine used in the taper would still differ. All benzo WD is not the same. I found it harder to WD from oxazepam than from diazepam, although oxazepam is a weaker benzo than diazepam. Then again I had severe difficulties switching from clonazepam to diazepam. But not the reverse. These are factors that make it hard to compare a WD to another. I guess what I'm interested in, is if there is something that still generally can be said about kindling.

And what is the science behing kindling? What do we know about it?

 

[PurpleDANK]

What i know from kindling is that multi withdrawals from benzos/alcohol will get worse than the previous withdrawal.
That is the short story about what is kindling.

But lets wait for someone with more experiente about this subject.
I hope you will be fine...

 

[Jekyl Anhydride]

I admit that I don't think I can give a comprehensive reply, but what I will say is that different benzos hit different GABA-A subunits harder than others which might explain the difference in WD syndromes, like the Nitro benzos such as Clonazepam. Kindling originally comes from repeated seizures brought about purposefully with animals in labs through electroshock or drugs like Pentylenetetrazol (which is a GABA antagonist btw), but it's application to humans is still suspect. It's a sick and cruel practice if you read further into it. With each successive seizure the animals behavior becomes worse and seizures start with less triggering.

Secondly the Kindling model was seen in heavy binge drinkers that had large spikes in Glutamate during EtOH cessation that caused awful WD syndromes like DT's, delusions and convulsions. Seeing as Benzos tip the balance beam of the GABA/ Glutamate system
after long term and/or heavy benzo use a spike in Glutamate is inevitable. The sensitization of the excitory role of Glutamate and the downregulation/ uncoupling of the GABAa receptors all contribute to the kindling model and syndrome. Each consecutive time the GABA system is agonized with a benzo or EtOH the "rebound" of Glutamate/ AMPA and other downstream systems is amplified. The damage can really begin when the WD's are bad enough to cause excitotoxicity due to a Glutaminergic storm.

I know my explanation was shite but this might explain it better:

Neuroadaptive processes in GABAergic and glutamatergic systems in benzodiazepine dependence.

 

[thisismylife]

This whole topic of kindling (as I shared in another thread) is brand new to me. There seems to be lots of similar experiences, but I feel like I'm an anomaly. The first time I was on Xanax long-term (less than a year, but many months), I had not one problem when my anxiety went away and I didn't feel like taking it anymore. It took about four weeks to slowly get to a point where I wasn't taking it.

The second time it was forced on me by being in an inpatient rehab for anxiety, and I had about one really bad week; but they tapered me from XR Xanax to regular Xanax, then tapered that (didn't switch me to another long-acting benzo). It was pretty miserable, but somehow I knew I'd survive, and I did.

The third time was after a four-week stay on the psych floor of a hospital, mostly due to treatment-resistant depression and suicidal ideation. I'd been through MANY antidepressants and had no luck with any of them helping with the anxiety. My depression always comes after the unrelenting anxiety that causes my life to stop in the middle of its tracks. But they talked me into ECT and I relented. They made no attempt to take me off of the Xanax, which in hindsight, was really different than everything I'd experienced or heard from others. After my 12 ECT sessions, my depression have lifted and I began to re-engage with life in a way I hadn't in two years. Within 2-3 weeks of finishing ECT, all of a sudden my anxiety started to lessen, and like the first time, I just began to cut back on the Xanax because I wasn't feeling so anxious. It probably took me almost four weeks to get off of it, and I had no withdrawal symptoms. I know ECT is not used for anxiety, but when I had it done for my depression, it made my anxiety go away. I can't explain it. That third time I'd been on 1.5mg. of ER daily for several months.

This current time, I was forced to do it a very inhumane way and I felt worse than when I had sepsis four years ago. In my head, I know if I can't taper off it in a more humane way this time around, and begin to feel hopeless, it will eventually turn to depression and I'd seriously consider ECT again. I know this sounds drastic to a lot of people, but the more physicians I tell that I've had ECT (all the specialists I see...endocrinologist, GYN, dermatologist, ENT, etc.), the more I hear it's one of the most under-utilized treatments in the arsenal of treating mental health. My psychiatrist tried to plant the seed in my head probably six months before I was hospitalized; once I was in the hospital, I saw one of her colleagues because she didn't have admitting privileges there, and I'm so glad he talked me into it. It was done at a major teaching hospital. Where I was at in rehab this past month, although considered a hospital, it was NOT prepared to handle what I experienced physically, not only the GI symptoms, but the disassociation, hopelessness, suicidal ideation, cognitive impairment and physical exhaustion.

Like I said, I'm probably an anomaly, but I wouldn't rule it out in the future. I certainly wouldn't due ECT if I just had anxiety and couldn't get off a benzo, but for me, that has once led me to a very serious depression that was fixed with ECT. The ability to taper off the Xanax rather quickly was a nice side effect.

 

[Barry big tits]

This is clearly a very complex situation that you are in. And one that will not be resolved quickly or easily as you well know. As a former chronic binge drinker. From the age of 14 to 28 im sure i have done some damage to my brain and caused a chemical imbalance in my brain.

Apparently chronic binge drinking causes more damage to ones brain than every day drinker alcoholics. because of the repeat exposure to the effects of kindling. Im not sure what your initial pattern of drinking and benzo use was like. But i think you need to cut the alcohol out of your life first. And very slowly. like as slow as physicly possible. if you can do that then your halving the effects on the gaba receptors in your brain and reducing the potentiation of benzo's from the alcohol.

Then you start on the benzo taper. It will probably take years to taper to a very low dosage of diazepam. You might never be able to come off it completly. But thats ok.

Alcohol and all benzo's share the same cross tolerance. So by reducing one you are bringing down your overall tolerance and dependence.

The fact that you'v been on such a high dosage of CNS depressants for a very long time means it will be extremely difficult to completely come off the benzo's. But the drink needs to go. Otherwise your liver will die before you even get a chance to recover.

The repeat effects of kindling will make it harder to come of the alcohol and benzo's. Each previous attempt to detox and then relapse will increase the intensity of PAWS and WD symptoms.

You sound like you'v been to hell and back and i really feel for you. But the road to recovery will be a very slow and careful one.

I have heard that the drug Acamprosate and gabanoids are very effective in reducing WD effects.

This website gives a fantastic detailed explanation of the science behind kindling and repeat WD's. I read it myself in order to try and provide you some information. https://www.benzo.org.uk/pws04.htm

You are going to need a lot of psychological assistance throughout your detox. Talking therapies will hopefully be of some use to you during your difficult detox.

I wish you all the best and my heart goes out to you sir. I am also on benzo's and my psychiatrist thinks instead of tapering i should stay on my current dose and possibly increase it when i become more tolerant. It looks like i might be headed down the same road as you one day. I only hope that i will eventually have the courage to try and come off it like you have.

Be as determined as you can and take all the help you can get.

Good luck mate.

 

[adder]

The key in my opinion is a very slow steady taper, ideally with a long-lasting weak benzodiazepine introduced at the proper time. I definitely wouldn't switch from a high dose of clonazepam or alprazolam to a diazepam equivalent dose, but first taper as low as possible and then do a switch. Also, when you switch, it should be as smooth as possible, so it's best to first partially substitute the stronger benzodiazepine with diazepam and then after some time substitute the remaining dose. I personally find clorazepate best for this purpose as its active metabolite nordazepam lasts very long and is only a partial agonist, if nordazepam was available, I'd choose it instead. Diazepam gets metabolized into nordazepam as well but is also active on its own. What also helps a great deal in my experience is understanding the reasons for anxiety, so the right form of therapy could complement your taper.

I'm currently switching from ~0.1667 mg of alprazolam twice a day to 5 mg of clorazepate after 9 months on alprazolam with the highest dose at 1.5-2mg a day taken for ~2 months, I tapered to my current dose in 4 months. It's my second time quitting, 5 years ago I quit clonazepam after taking 6 mg a day for 5 years and earlier 7.5-10mg of lorazepam for 3 years, my psychiatrist starting my taper reduced 6mg to 4mg right away, then further reduced it to 2mg in a manner of several weeks, in 10-11 months I got down to 0.5 mg a day and then he stopped prescribing it. I struggled for a few weeks more taking 10 mg of clorazepate a day but eventually stopped and withdrawal was very painful, more painful than it could have been if he switched me and brought the dose down slowly. Unfortunately, I'm weaning myself off completely on my own as I don't know a psychiatrist who would do a slow taper.

 

[Barbalos]

I was until very recently a frequent yet periodic binge drinker, who had gone through alcohol withdrawals many times, and I finally succumbed to the effects of kindling. My withdrawals from a relatively short binge drinking period left me with with the beginning of DTs, before I had to call 911 and they gave me a small supply of diazepam to get through the alcohol withdrawals. I had tried to quit cold turkey after that binge, and that was the wrong idea. I was at the point where I could feel a type of 'aura', like epileptics will have before a seizure, feeling extreme pressure and tingling in my extremities, hypertension to the point where my vision was extremely blurred and heart was pounding, and horrendous anxiety. I won't be drinking anymore, and it's a pretty easy decision for me to make, as that was one of the most terrifying experiences of my life. The wiki has some good information on kindling:

Kindling due to substance withdrawal refers to the neurological condition which results from repeated withdrawal episodes from sedative–hypnotic drugs such as alcohol and benzodiazepines.
Each withdrawal leads to more severe withdrawal symptoms than in previous episodes. Individuals who have had more withdrawal episodes are at an increased risk of very severe withdrawal symptoms, up to and including seizures and death. Long-term use of GABAergic-acting sedative–hypnotic drugs causes chronic GABA receptor downregulation as well as glutamate overactivity, which can lead to drug and neurotransmitter sensitization, central nervous systemhyperexcitability, and excitotoxicity.

https://en.wikipedia.org/wiki/Kindling_(sedative–hypnotic_withdrawal)