withdrawal

Phenibut for anxiety and insomnia: FDA warns 3 companies to cease distribution of their products

April 19, 2019 By Trudy Scott 63 Comments

Earlier this week, on April 16, 2019, the FDA issued warning letters to 3 companies have products that are marketed as dietary supplements with a label saying they contain Phenibut. These companies have been told to stop distribution of the current products and to let the FDA know within 15 days what they plan to do to be compliant with the law.

Quite frankly, I’m surprised it’s taken this long, and I actually agree with the decision. However, there are some major problems that are being overlooked with a decision like this, such as the dire consequences for susceptible individuals currently tapering from Phenibut or needing to do a slow taper once they no longer have access to Phenibut (more on that below).

The good news is that GABA, when used correctly i.e. used sublingually as part of a trial process to find the ideal amount for each person, is as effective and with none of the dependence and withdrawal issues.

Here is the announcement on the FDA site:

Phenibut has been found in products labeled as dietary supplements, sometimes marketed for uses such as a sleep aid. Phenibut does not meet the definition of a dietary ingredient Under the Federal Food, Drug, and Cosmetic Act (FD&C Act). Products labeled as dietary supplements that list phenibut as a dietary ingredient are misbranded.

Phenibut is also known as:

fenibut

phenigam

PhGaba

Phenigamma

Phenygam

4-Amino-3-phenylbutanoic acid

β-(aminomethyl)benzenepropanoic acid

beta-(Aminomethyl)hydrocinnamic acid

β-phenyl-γ-aminobutyric acid

The companies have 15 business days from the date of receipt of the letter to communicate to the agency the specific steps they will take to bring their products into compliance with the law. The warning letters also caution the companies that the FDA may take enforcement action without further notice if they do not immediately cease distribution of the products.

A reaffirmed commitment to traditional advisory and enforcement actions, such as warning letters, in combination with the newly launched rapid-response tool, the Dietary Supplement Ingredient Advisory List, are integral parts of the FDA’s overall effort to strengthen the agency’s regulation and oversight of dietary supplements. We continue to look for ways to modernize our approach to protecting consumers from misbranded, unsafe, or otherwise unlawful dietary supplements.

I have always been very open with my warnings and have never recommended Phenibut because of the dependence issues and the fact that withdrawal can be similar to benzodiazepines. I blogged about my concerns back in 2016: Why I recommend GABA for anxiety instead of Phenibut

Here are a few highlights from this blog:

I have concerns with Phenibut and I don’t feel anyone should be using it
It is widely used in Russia as a prescription medication for anxiety, tension, fear, to improve sleep, pre- or post-operatively, depression, post-traumatic stress, stuttering and vestibular disorders
It’s available over-the-counter and as a supplement in the USA and the UK. It’s no longer available in Australia as a supplement
It’s very effective for anxiety and insomnia and this is why anxious individuals really love it and many practitioners recommend it before they start to see problems
One of the reasons Phenibut seems to work so well is because it is so similar to benzodiazepines.
The adverse effects can be similar to those experienced with benzos. This case study is one of many that report physical dependence can develop, including tolerance and withdrawal

Here are a few more recent case studies, reviews and papers on Phenibut:

Phenibut exposures and clinical effects reported to a regional poison center (the numbers are small: “56 exposure calls over 19 years with 48 (85.7%) calls within the past five years” but we know not everyone feels the need to call poison control)
Phenibut (β-Phenyl-γ-Aminobutyric Acid): an Easily Obtainable “Dietary Supplement” With Propensities for Physical Dependence and Addiction

Over the last several years, multiple case reports have highlighted phenibut’s potential to produce the conditions of physical dependence, withdrawal, and addiction. In cases involving intoxication, patients have presented with a varying degree of mental status changes, from being minimally responsive to manifesting symptoms of an agitated delirium. Phenibut is a potent psychoactive substance with GABA_B agonist properties, which is emerging as a drug of misuse through growing internet sales. Its marketing as a “dietary supplement” is inaccurate and misleading, given its pharmacological profile and ability to induce the physiological changes associated with withdrawal and physical dependence

Acute phenibut withdrawal: A comprehensive literature review and illustrative case report . In many of the published cases “Patients were typically younger and had coexisting substance abuse disorders to other drugs” but based on feedback I’ve had from folks in my community and elsewhere this is certainly not the case across the board. However it may be that prior benzodiazepine or fluoroquinolone use may play a role in individuals being more susceptible to issues.
Phenibut (β-Phenyl-γ-Aminobutyric Acid) Psychosis. This case study was a situation of recreational abuse but even so it shows how severe symptoms can be.

I see no reason to use a product like Phenibut given the potential to cause harm and because GABA (when used correctly i.e. used sublingually as part of a trial process to find the ideal amount for each person) is as effective and with none of the dependence and withdrawal issues.

Phenibut: initially very promising results and then rebound anxiety, panic and insomnia

I’d like to share a story from someone in my community who posted on the 2016 blog above. He shared this about the addictive aspects he observed when he used a Phenibut product called GABA Wave, saying his initial reaction was very positive and quite extreme compared to his previous trials of GABA:

The initial response in the first couple of weeks was great, especially a couple of hours after taking it. The effects were a marked elevation in mood to the point of euphoria, enhanced appreciation for music, improved focus and cognition initially (but that became memory difficulty), marked relief of anxiety, increased motivation, renewed interest in things, being more talkative, a significant calming/relaxation effect, generally a deep and great night’s sleep the night of the morning it is taken.

He then shares how this changed after a few weeks with rebound insomnia, panic and anxiety, and other adverse symptoms:

However, after a few weeks it was the reaction on the following day of taking it that kicked me in the butt, literally. On the following day I began to feel very low, groggy and spaced out, almost like a hangover and then during the following night I began having brutal insomnia – a complete turn-around from the night before. A kind of rebound response. I imagine that’s when the tolerance and addiction begins to develop because one craves the next dose to provide the good night’s sleep after the bad sleep on the second night. Other side effects included mood swings, irritability, rebound anxiety, panic, loss of short-term memory, total and utter loss of any form of libido and constipation!

He shared that his diet and self-care are excellent, but he is dealing with and working past emotional and psychological traumas – and this may make him more susceptible to the adverse effects.

And this is one of the problems with Phenibut – you’ll hear excellent initial reports and for some people this continues. Not everyone is adversely affected but you just don’t know in advance if you will be someone who is adversely affected or just how badly you’ll be affected.

Merry has had very severe ongoing adverse effects from Phenibut.

Merry Citoli shares her warnings about benzodiazepine, lunesta and Phenibut withdrawal

Merry Citoli shares her warnings about benzodiazepine, lunesta and Phenibut withdrawal. Lunesta and then Phenibut were recommended to help her taper from the benzodiazepine she was prescribed for perimenopausal anxiety. At the time of this recording, she had tapered off the benzo and lunesta, but was having great difficulties tapering off Phenibut – almost as bad as her benzo taper.

You can learn more about Merry on Follow Your Bliss. She shares how cathartic it is to share her story and the desire to help stop others going through what she has been through. I’d like to acknowledge Merry for doing this (and all of you for sharing your stories and posting encouraging messages here on the blog for each other).

I’d also like to give a shout out to the Benzodiazepine Information Coalition who is doing amazing advocacy and educational work about these awful medications.

The comments in my 2016 blog: Why I recommend GABA for anxiety instead of Phenibut are worth a read if this affects you. You’ll see there are some very different thoughts on Phenibut safety and folks saying GABA won’t work. This is typical of what you can expect to hear elsewhere online.

I don’t have all the answers

I know many Phenibut users are going to be very concerned about this and we’ll be dealing with many withdrawal issues and folks looking for an alternative. I recognize that this is not going to be easy if there is no Phenibut available for tapering. There are also very serious concerns for those who can’t go cold-turkey off Phenibut and won’t have the time to taper. Abrupt discontinuation of Phenibut may result in withdrawal which can be severe and require hospitalization.

What I don’t know:

if other companies and products will be targeted too?
if Phenibut will be made available as prescription in some form or another?
what resources are in place or going to be put in place for individuals who are in the process for trying to taper from Phenibut right now (or if there is even the awareness that this is an issue and very needed? For people like Merry, cold-turkeying off Phenibut could be life-threatening)
what advocacy groups and benzo support groups know and what advice do they have?
what my colleagues know and are planning to do?
why so many practitioners recommended it and why so many companies made it available as a supplement, given the research/case studies and the issues so many individuals report?
if there will be a place to submit concerns and complaints?

What I do know – GABA and the foundations

Give GABA serious consideration for safe and comfortable tapering (assuming there is enough Phenibut to do slow tapers) and for ongoing support of the low GABA symptoms of physical anxiety and tension.

It’s really best that you work with your practitioner. As with a benzodiazepine, before starting a Phenibut taper, I’ve always found it’s best to get nutritionally stable as possible first and address all root causes of anxiety before starting to taper and then tapering Phenibut very very very slowly. For some folks it’s just very uncomfortable for a few weeks and for others it’s a long-term ordeal.

I use GABA sublingually after an initial trial to find the ideal amount for each person. I have found that for both a benzo and Phenibut taper, very very tiny amounts (like a pinch or dab) will be enough for some folks.

Other nutrients are used based on each person’s need – such as theanine, tryptophan, melatonin, niacinamide, zinc and vitamin B6 and others. Light therapy, exercise, yoga, meditation, getting out in nature and essential oils like lavender, citrus and jasmine are also wonderful to incorporate. Of course, diet, blood sugar control and gut health are the foundation.

These are various GABA products I use. You can find some examples on my supplements blog here:

Source Naturals GABA Calm (with additional information here)
Nutritional Fundamentals for Health GABA-T SAP: gamma-aminobutyric acid (GABA) 300 mg, l-theanine 150 mg. This is pleasant-tasting when opened on to the tongue and works very well when GABA Calm can’t be used. I find best results when it is used opened on to the tongue.
Enzymatic Therapy GABA: gamma-aminobutyric acid (GABA) 250 mg. This is also pleasant-tasting when opened on to the tongue and works very well when GABA Calm can’t be used. As with all GABA products, I find best results when it is used opened on to the tongue.
ProThera 500mg GABA: gamma-aminobutyric acid (GABA) 500 mg. You will likely need to open this up and start with less than a full capsule during the day. A full capsule may be fine at night for some individuals.

They can all be purchased from my online store here.

As you can see, I don’t have all the answers about this FDA announcement, but I wanted to share what I do know so you are aware of what’s going on.

In the next few weeks I’m going to be reaching out to benzodiazepine groups, colleagues, the companies affected and individuals who are in the process for trying to taper from Phenibut. As I learn more, I’ll share what I learn.

In the meantime, please post questions you may have, and I’ll do my best to either answer them now or find answers for you.

And please do share your Phenibut stories (both good and bad), your concerns, and any resources you may have.

And do share if GABA has help you taper from Phenibut.

How do I taper tryptophan without withdrawal symptoms: a tight band around my head, brain zaps and agitated free-floating anxiety?

September 21, 2018 By Trudy Scott 23 Comments

I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. However, I recently had someone ask this question on the blog (and then had someone else ask a similar question) so I’m sharing these questions and my responses in the hope of gleaning some additional information (and educating you if this applies to you). I never say never and am always learning. I’m also very interested to know how common this is and what some of the underlying factors could be.

Here is the question that was asked by Lara (we’ll call her Lara) and slightly paraphrased for clarity:

I’ve been taking 1500 mg of tryptophan for 3 months, and it has helped a lot with sleep and depression. I dropped to 1000 mg about a week ago then 500mg just to see how I’d do without it. I didn’t think it was numbing my feelings, but I am experiencing a return of feeling good.

I’ve been on antidepressants before and I am feeling the same withdrawal effects as when I weaned off meds. This is exactly why I chose to not go back to pharmaceuticals. It was difficult to wean off. How do I taper tryptophan without experiencing withdrawal symptoms? Thank you for your valuable knowledge.

These are the kinds of questions I’d ask a client in this situation:

Was the 1500mg helping and which low serotonin symptoms were eased?
How did this change when you reduced to 1000mg and then reduced to 500mg? i.e. did the low serotonin symptoms come back?
Which antidepressant are you comparing these affects to? And how long ago did you wean off the antidepressant?
Which brand of tryptophan you are using? (I find Lidtke is the best quality)

Keep in mind that we always want to be sure it’s not a one-off situation. In order to be sure someone is observing mild adverse effects from a supplement I’ll often have my client stop it and then add it back to make sure. And sometimes more than once.

In this instance repeating the process may be a good idea i.e. going back to 1000mg and then 1500mg and then reducing again, carefully documenting in a food mood supplement log.

It turns out that Lara was using the Lidtke tryptophan and she was seeing wonderful benefits for her low serotonin symptoms with none of the typical SSRI side-effects:

the 1500mg before bed with a small carb helped me get to sleep and stay asleep. It also helped with anxiety and depression during day. I tend to be a worrier, have social anxiety, and get stuck with negative thoughts about myself and others. And have very little interest in life.

I was on Zoloft from 2005 – 2009. Got off of that and did Lexapro for only 6 months in 2012. The Zoloft was life changing for me but I did not like the side effects and being on an antidepressant for the rest of my life.

The tryptophan is superior to these SSRIs [selective serotonin reuptake inhibitors] – no sexual side effects, no weight gain, or anhedonia [inability to feel pleasure in normally pleasurable activities].

She describes how she reduced the tryptophan and how her withdrawal symptoms were similar to those she experienced when tapering off her SSRIs in the past:

The withdrawal effects were felt when dropping from 1500mg to 1000mg, to 500mg, then zero over 2 days and they lasted about 3 days. By the 4th day I was no longer feeling bad.

The symptoms are hard to explain – it felt like a tight band around my head, also brain zaps (this is a common SSRI withdrawal symptom many describe feeling in their head).

The worst of it was a deep agitated free-floating anxiety like you’re walking along the edge of a cliff and there’s a physical pain in your gut. Fortunately, it was only present from waking up till around 2pm.

These are questions I’d ask or wonder about

As I mentioned in the introduction, I have not had any clients experience the need to taper or slowly wean their tryptophan dose or report tapering side-effects similar to those they experienced when tapering off an antidepressant. But if this is an issue some individuals experience I’d like to know about it

I’d also like to know how long the tapering side-effects of tryptophan last and how severe the symptoms are. In Lara’s case the symptoms were pretty severe but fortunately they only lasted 3 days which is very much shorter than SSRI tapers.

There could be confounding factors and here are additional questions I’d ask or wonder about if a client experienced similar adverse tapering effects. These are questions you could ask yourself if you have experienced this when stopping tryptophan abruptly:

Could the prior use of SSRI prescriptions be a factor? (but I have worked with many clients with prior use of SSRIs and not have tryptophan tapering issues)
What else has changed in terms of stress, diet, hidden gluten exposure, or even the something like a recent introduction of collagen (which may deplete serotonin levels in susceptible folks)?
Are there hormonal changes that could affect serotonin levels – like in a woman with PMS or perimenopausal or menopausal symptoms? (again, I’ve worked with many women of all ages and haven’t observed this to be an issue)
If you are prone to the winter blues and reduced winter serotonin, could stopping the tryptophan in the winter play a role? (I have had clients have SSRI tapering issues in winter because of being prone to the winter blues and choose to work with their doctors on their SSRI taper in the spring and summer for this reason)
Could this also be an issue with summer blues in hot states like Arizona?
Could any of these play a role: a recent medical procedure, a course of antibiotics (especially fluoroquinolones) or antifungals, poor gut health, a new infection, decreased immunity or increased inflammation?
Could low levels of these nutrients play a role: vitamin B6, ferritin, magnesium and zinc?
Would using high doses of vitamin C during the “taper” help reduce some of the symptoms? (this works well as an antidote when you take tryptophan and don’t need it and want to negate some of the negative effects, so may help in this situation)

Stopped tryptophan and felt very angry and down

The other question I had about tryptophan weaning is this one from someone who shared that she had suggested tryptophan for a friend. This friend was

experiencing a lot of ruminating and anxiety. She responded beautifully and felt great. About a year later, she tried to stop taking it, and said she felt very angry and down. Is there a weaning process for the tryptophan?

This could possibly be related to the above and you could pose similar questions but based on on what I see with clients I feel this is more of a matter of stopping the tryptophan too soon while she still had low serotonin – especially if the ruminating and anxiety came back. Feeling angry and down are classic signs of low serotonin.

The questions asked were specifically about tryptophan but they could also possibly apply to some individuals who stop 5-HTP abruptly.

I’d love to hear if you’ve experienced anything like this with either tryptophan or 5-HTP and if yes please share your answers to some of the above questions.

Right now, I’m afraid I don’t have an answer for you on how to taper tryptophan without these withdrawal symptoms: a tight band around the head, brain zaps and agitated free-floating anxiety. Right now, I’m not sure how big an issue this is. If it is common, I’m hoping some of the feedback I receive may provide some answers.

The Autoimmune Fix by Dr. Tom O’Bryan: gluteomorphins, casomorphins and withdrawal

September 23, 2016 By Trudy Scott 4 Comments

Alzheimer’s disease, multiple sclerosis, Type 1 diabetes, Hashimoto’s Thyroiditis, celiac disease, osteoporosis, and lupus are all autoimmune diseases and can be reversed because 70% of them are found in the gut. In Dr. Tom O’Bryan’s new book, The Autoimmune Fix: How to Stop the Hidden Autoimmune Damage That Keeps You Sick, Fat, and Tired Before It Turns Into Disease he provides a practical and much-needed guide to navigating autoimmune diseases to help you feel better and develop a plan that works for you.

A big factor with many autoimmune diseases and conditions is going gluten-free and often going dairy-free too. As Dr. O’ Bryan states:

This does not mean that everyone with a systemic autoimmune disease has a sensitivity to gluten, but it does show the very high correlation.

He also shares that Marios Hadjivassiliou MD believes that

gluten sensitivity is associated with autoimmune disease and that celiac is just one manifestation of it.

Here is a wonderful success story from the book – a gluten-free and dairy-free diet, and the nutrition to heal her intestinal permeability (or leaky gut):

Nancy never left the house without a packet of tissues. She suffered from chronic allergies but could never figure out exactly what she was allergic to. She was also constantly battling her depression, and although she didn’t think of herself as someone who had digestive problems, she always felt bloated. The comforting allure of a box of doughnuts, a pint of ice cream, a bowl of noodles, or, when things were really bad, a roll of raw cookie dough was often too hard to resist and seemed to calm down her anxiety. She dressed to hide her weight gain in public, hoping to pass invisibly through life. She didn’t even consider dating. She had lost interest in men anyway, despite being only 28 years old.

To the average doctor, Nancy was a classic depressed patient who needed a prescription for antidepressants, perhaps some antianxiety medication, and a good weight-loss and exercise program. But here’s what most doctors miss with people like Nancy: Her depression, anxiety, and weight gain were actually the result of immune responses that were causing chronic inflammation. Nancy, like so many women, had a constellation of symptoms that all pointed to one culprit: a systemic inflammatory cascade.

When Nancy came to my office, I ran an antibody test to determine the cause of her problems. I discovered that the culprits for her immune reaction were a sensitivity to gluten and dairy and elevated levels of LPS [lipopolysaccharides] in her blood. These molecules were activating her immune system. But how did these molecules enter her bloodstream? The answer was the third factor: intestinal permeability. With the proper testing and treatment, a gluten- and dairy-free diet, and the nutrition to heal her intestinal permeability, Nancy’s antibody load to LPS reduced within 6 months. She stopped throwing gasoline on the fire (by removing gluten and dairy), and her symptoms began lifting within the first 2 weeks as her inflammation subsided. Within 6 months, she was down two dress sizes and came back to see me, vibrant with life.

It really can be as successful as this and I see these kind of results with so many of my clients who make these few simple changes.

However, for some people, it can be more challenging and you may experience withdrawal symptoms when you give up wheat and dairy, and feel tired, depressed (or anxious) or nauseated:

Some don’t want to exercise, and some have headaches (just like with coffee withdrawal). This is especially true of those who in their blood tests have elevated levels of the peptide in wheat called gluteomorphin or elevated levels of the peptide in dairy called casomorphin.

These poorly digested peptides can stimulate the opiate receptors in the gut and brain. Opiate receptors trigger the production of hormones called endorphins and enkephalins that produce that feel-good response. Remember the last time you laughed out loud in a movie or with your friends? Perhaps you even had belly laughter—when you laugh so hard your belly hurts? Remember how good you felt after that? It’s because your opiate receptors were stimulated and you now have a little more endorphins circulating in your bloodstream. Well, gluten and dairy can mildly stimulate these same receptors. And just as an addict may have withdrawal symptoms when they stop their drug of choice, such may be the case with gluten and dairy withdrawal. My friend William Davis, MD, author of Wheat Belly, even came up with a name for it: wheat withdrawal. The same may be true for removing dairy or sugar.

If this happens to you, don’t be surprised. First of all, this may be the first time you had to give up some of your favorite comfort foods cold turkey. And these favorite foods become comfort foods for a reason: Sugar-laden foods, especially refined carbohydrates, are highly addictive. Your body is actually going through a gliadin-casein-sugar–derived opiate withdrawal.

You may ask how common is it to have these withdrawal symptoms? This can be different for each individual and can differ from one practice to the next:

Dr. Davis [author of Wheat Belly] believes that wheat withdrawal can be quite unpleasant for close to 40 percent of the population. That has not been my clinical experience. Our number has been closer to 10 percent, which is still a substantial number. You may have a friend or family member who has tried to go gluten-free and has told you, “My body must need wheat. It’s been 3 days since I’ve had anything made of wheat, and I feel awful!” This response can be scary. But remember, it’s not that the body needs wheat; it craves it. This is just the body craving a toxic substance that it has gotten accustomed to. Don’t worry: The symptoms will disappear quickly. And best of all, the cravings for sugar and wheat will subside, and then you feel wonderful!

It is interesting to read that Dr. O’Bryan finds that only 10% of his patients have unpleasant withdrawal symptoms. I’d like to add to the discussion and share that with the anxious women that I work with, it’s even higher than the 40% that Dr. Davis reports. It’s in these instances that I find the targeted amino acids so helpful to break the addiction, prevent the need for having to use willpower and provide instant mood and anxiety relief at the same time: tryptophan (if it’s afternoon/evening cravings), GABA (if you stress-eat), DPA (if you comfort-eat) or glutamine (if you crave due to low blood sugar).

Dr. O’Bryan does recommend glutamine for gut healing, together with vitamin D, fish oil, probiotics, zinc carnosine and colostrum. I suspect he doesn’t recommend the amino acids I mentioned above because he doesn’t see as many unpleasant or difficult withdrawal symptoms.

Some of my other favorite sections from this new book include:

his brilliant description of the immune system and how antibodies are created, and how inflammation is the primary tool in our immune system’s arsenal that keeps us healthy
the differences between autoimmune diseases and the many autoimmune conditions (he lists 159 that are on the autoimmune spectrum!)
the differences between celiac disease and gluten sensitivity
the leaky gut and lipopolysaccharides discussion, and the section on the microbiome and dysbiosis (and the big connection to stress)
the connection of a disproportionally large forehead to celiac disease (fascinating!)
testing and measuring autoantibodies (I love that he calls them “messengers from the future”) and the chart that shows the likelihood as to whether you will develop a particular disease
the extensive lists of the hidden sources of gluten in supplements, cosmetics (this is surprisingly long) and even household products
the connection between gum disease, mouth bacteria and leaky gut
his food and nutrient recommendations
the long list of references and study summaries – if you’ve have the wonderful opportunity to have heard Dr. O’Bryan speak live or on summits (he’s a popular speaker on prior Anxiety Summits) you’ll recognize and love this style of his right away

If any of this is new to you and you suspect you may have an autoimmune disease or condition, then this book, The Autoimmune Fix is a must-read. It launched earlier this week and as you would expect from Dr. O’Bryan, it’s brilliant! You can order your copy here on Amazon. This is groundbreaking information we all need to know!

Let us know if you have an autoimmune disease or condition and if going gluten-free and/or dairy-free has helped you? Was it an easy change for you to make or did you experience withdrawal symptoms? Did you power through or did you successfully use amino acids to help? Have you done any of the testing he discusses or addressed dysbiosis? Healed your leaky gut?

If you have already purchased and read the book, please share some of your favorite sections and what has helped you.

Medication tapering and withdrawal: an interview with Dr. Kelly Brogan

April 8, 2016 By Trudy Scott 71 Comments

I recently had the absolute pleasure of interviewing Dr. Kelly Brogan, holistic women’s health psychiatrist and author of the new bestseller, A Mind of Your Own. I’ve had the section on medication tapering and withdrawal effects transcribed because it’s so valuable.

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Kelly: Now much of my practice is devoted to psychiatric medications tapers. Guess what? I didn’t learn that in my training. There wasn’t a single hour of education on this subject. I have learned how to do this from patients, and really from patients globally who are educating each other and frankly educating physicians about how to engage in a safe and responsible psychiatric medication tapers……

…when you try to taper off a medication after long-term exposure, either because you’re no longer deriving that initial benefit from it, or because something has changes about your life circumstance and you want to try a different kind of healthcare maybe, they you might learn that these are some of the most habit forming medications, I would say habit forming substances, on the planet.

I wouldn’t believe this if I haven’t seen it with my very own eyes, but this is what actually compelled me to put down my prescription pad for good. After I read that book, I began to take patients, or at least offer them the opportunity to taper them off of medication. Even when we did it responsibly, I was essentially running an outpatient rehab. I mean from neurologic symptoms to psychiatric symptoms, physical symptoms, autoimmune diseases flaring, patients developing impulsive behavior and even violence. It was beyond description.

Then I began to see that actually a lot of patients around the world are talking about this. They’re talking about withdrawal from anti-depressant specifically, but of course other medications as well. Their doctors are totally ill-equipped to help them because we don’t learn about how to do this in our training. We actually in fact dismiss patients when they talk about these being addictive medications. Of course, now finally Fava is a group of researchers who have finally begun to publish the reality of this withdrawal syndrome, and how disabling it can be.

Since I have 4 grounded lifestyle interventions, and actually begun with nutrition such that I don’t even begin a medication taper until about 2 months into lifestyle change, everything is different now in my practice. I feel that once you can optimize your physiology, you really put yourself in a much, much better position to safely and strategically taper. Wow. Isn’t that something you would want to know before taking your first prescription? I certainly never told any patients that it could be like a horror show and you might never be able come off of a psychiatric medication if you’re taking it for longer than a year or so. I never informed patients of that.

A lot of what I discuss and describe in this book is in service of presenting people with a full picture of what the science has to say before they make a decision. I think we really wish that there was a magic pill. We really wish there was a safe effective quick fix. Unfortunately, what is available is really anything but that.

Trudy: Yeah. We want that quick fix. I’ve got a few follow on questions, because this is a lot of good information here. The fact that you see all these problems when people are coming off the meds, is there a time frame, or is that really dependent on each person?

Kelly: It’s very, very dependent on each person. That ends up being the take home that we are talking about. What I like to call end of one medicine. We’re talking about the fact that our levels of biochemical individuality have ever been more relevant than when we’re exploring how we interact with chemicals in our environment, in our pharmaceuticals. We really need to understand that every single person is an individual.

When I taper patients off of meds, I normally do what’s called a test dose decrease, which often is around 20% to 25% of the dose. We come down by that. Again, this is after we’ve done the initial months at least of fairly strict dietary compliance working with relaxation response, doing 20 minutes or more of movement, working on sleep. All of this has to happen first. Then we begin, and so we start with a test dose. If we see in about 2 to 4 weeks that test dose is completely well-tolerated, meaning you don’t even notice the difference, then we probably can work in bigger increments. That’s actually a godsend. These tapers, when we’re working in 10% and less doses, could take literally years.

You want to begin to learn about what your body is capable of bouncing back from. We begin with 25%. If that’s not a pretty picture, then we’ll just scale it back to about 10% of the initial dose, and work with that 10% increment at about every 2 to 4 weeks, sometimes unfortunately slower. The increment and then the speed are 2 variables that we have to learn for each patient.

I don’t know what I would do without a compounding pharmacy. While many of these medications are available in liquid form, and some of them, like Effexor for example, have beads inside a capsule, to be able to tailor and personalize the dosage to each individual patient is wonderful and that I have that option through compounding pharmacy. I work with one in Massachusetts named Johnson Compounding, and they’ve just been a wonderful support over the years to my patients.

Trudy: Wonderful. Very slow and then obviously very individualized. Now I’m very familiar with the effects of benzodiazepines and the slow taper process that’s needed for someone on the anti-anxiety benzodiazepine medication. Would you say that SSRIs can have comparable effects in some people, or are they not as bad as the benzodiazepines?

Kelly: That’s a great question. What we’ve observed in psychiatry is that there’s really been a transition from using benzodiazepine as sort of like a spot treatment to transitioning into using anti-depressants long-term. When I was in my training, the typical gold standard protocol would be to start somebody on both benzodiazepine and anti-depressant, and then taper them off to benzodiazepine and leave on the anti-depressant with the thinking being that benzodiazepine are acknowledged for their habit forming properties and anti-depressants are totally safe.

What we are learning is in fact, that group that Fava runs, with the papers that they’re putting out, they are essentially equating the anti-depressant withdrawal phenomenon to benzodiazepines. In my clinical experience, I would actually argue that SSRIs are worse with long-term exposure. A lot of people at this point, given that it’s been decades since Prozac, have been on these medications for more than 10 years. We’re really talking about a level of habituation that could be challenging to undo. It’s not that I haven’t. I struggled a lot with Klonopin for example. It’s not that I haven’t encountered challenges with benzodiazepines.

A patient in my practice I’m taking off of Lexapro a thousandth of a milligram a month. I’ve never heard of something like that. Heroin, crack, cocaine, oxycontin: show me something that would ever require that. It’s unbelievable. I think it’s at least comparable I would say, and that’s what the literature is beginning to demonstrate, is that there are actually comparable phenomenon, but we really never ever talked about anti-depressants in this way, so it really is a game changing perspective.

Trudy: The fact that you say people are not told that this could be a possibility, and the fact that you’re talking about this and writing about it I think is so important, because people need to know. They would choose not to do this if they did know. I see there is this MA bill going through [correction: being proposed – you can read more here]. It’s about benzodiazepines and people needing to consent to the fact that it’s going to possibly cause them issues. It sounds like we need to do the same with these anti-depressants.

Kelly: Absolutely, 100%.

Trudy: Now, I’ve heard that certain SSRIs are worse than others. I’ve heard that Paxil can be really bad. Have you seen a difference between different medications?

Kelly: Basically we look at half-life of these medications, and we extrapolate from there. Assuming that Prozac would be the easiest, and there are medications like Paxil and Effexor that are more challenging. In my experience, there are 2 ways of discontinuation – the field likes to call it discontinuations issues. The first is acute. It’s within 72 hours of a dose change where you can get brain zaps and headache, and gastrointestinal distress, you feel agitated. The Paxils of the world are much more likely to cause those more immediate withdrawal symptoms.

What I have found is unfortunately there’s no free lunch. There isn’t a medication that actually is effortless to come off for everyone, so that even when you’re on Prozac, for example, for a long period of time, even though it has this long half-life, it should be easy to come off of, in my experience, it can often be challenging as well. These other medications often manifest as second waves. What I have found is almost uncanny – after about 2 months, it’s almost always 6 to 8 weeks after the final dose or after a major dose change. It’s like the other shoe can drop.

You have those immediate withdrawal symptoms, and then about 2 months later, you can begin to have what has historically been categorized as a relapse. This is when your doctor will tell you, “You see, you should have never even tried to go off your medication. You need it for life. Now you know.” That’s what we’re taught to say. In fact, it’s actually a protracted withdrawal phenomenon. Again, this has now been documented that this can occur for unfortunately, I don’t want to scare anyone, it can occur for months and months and even years after the final dose. That being said, there is a medication that spares you from that arm of this problem.

Even I went for years tapering patients off of Wellbutrin and thinking, “Well, this is the easy one. I can even come down by 50% of the dose, and it’s not a problem.” Right now, I have in my practice, a patient who has been completely destabilized coming down by 25 milligrams of Wellbutrin. Again, it’s a very individualized process, and I don’t think that there are any obvious choices in terms of medications that are easier come off of after long-term exposure.

Trudy: Thank you for sharing that. It’s scary, but the good thing is that there are solutions. People on these medications must do the slow taper and make all the changes that you’ve talked about. I’m glad that you mentioned, “Don’t rush into this, make all the food changes.” We’re going to talk about some of the things that you recommend in a second, but get yourself in a better place to start making these changes. If you’re listening to this and you’re thinking, “Oh my gosh. This is terrible.” Don’t go and rush out and just stop. You simply don’t want to stop cold turkey. You want to be working with someone. Then obviously read the book and get resources so you can be in a good place when you’re starting to make these changes.

Kelly: Absolutely. That’s all incredibly important. Yes. Please don’t ever consider just stopping your medication.

Trudy: Absolutely. I have one final question on the medication aspect. You’ve got a small section in the book where you talk about using amino acids are helping people taper, and as you know, my community is very into using the amino acids. I find them very helpful for helping people with mood and anxiety issues. Can you talk a little bit about how you use the aminos and how beneficial you find them when someone is doing this taper?

Kelly: Yes. Absolutely. I am quite certain that there are many, many, many roads to physiologic and psycho spiritual resiliency. I, in no way, intend to position myself as having the answer by any means. I am very much trying to create a space for all of those who are passionate about natural healing, including yourself and our colleagues, because I think that just about everything in the natural health arena offers you the potential for very high yield, very low-risk healthcare.

I certainly don’t consider myself an expert in amino acids and don’t have a fraction of the knowledge that you have about this arena. That being said, I do use them for tapers specifically. If I use supplements I wait after a month of dietary change before introducing any supplements, mostly because I want to, I don’t know, send patients the message of what a single intervention, in terms of lifestyle, what a dietary intervention can do in terms of moving the needle of their health. I often don’t want to cloud the picture with other interventions like even supplements or even detox.

After that period, if it is necessary, I’ll often lead with some of the supplements that I talk about, whether it’s probiotic or glandulars, I use a lot based on my work with the only mentor I’ve ever had, Dr. Nicholas Gonzales. I learned a lot about using glandulars, using specific minerals, using fatty acids, that sort of thing. Well, we’re working with SSRIs. I tend to use tryptophan more often than 5-HTP. I do use tryptophan even in the 3 to 6 gram range before dinner and before bed. I would say that it’s helpful often, not in every case, with a lot of the insomnia specifically. It’s about the worst thing that can happen in the setting of a taper. It’s the kind of insomnia that’s induced by psychiatric medication taper.

I have several tricks up my sleeve, and that’s certainly one of them. Through my own self-education, and again, you may have a more sophisticated perspective on this that when you use 5-HTP or tryptophan for the longest period of time, meaning over a couple of weeks, so you want to balance it out with tyrosine or DL-phenylalanine. If we are using it for a period of time, I might incorporate that. I have found that when I work with Wellbutrin tapers, it’s extremely helpful. Tyrosine and actually an herb called mucuna support dopamine.

Then all of my patients who are tapering – I have them on a blend of amino acids.

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We cover much more than the medication taper and withdrawal and you can listen to the entire interview here:

A Mind of Your Own: The Truth about Depression and How Women Can Heal Their Bodies to Reclaim Their Lives is superb, brave, bold, science-based (which I love!) and offers holistic solutions for depression (and anxiety). Get the book from Amazon or better yet, get a copy from your local book store (ask them to get it if they don’t carry it)!

It launched March 16th and there is a grass-roots effort to share this book widely because of the mainstream media blackout. Join the grassroots effort and help share this valuable message!

Take a picture with the book and post on social media with #amindofyourown and you can have an impact. You’ll also automatically show up in “hall of fame” on the tagboard.

You can go and get the first chapter of the book if you’re on the fence (get it here: http://kellybroganmd.com/amindofyourown/?ref=35). After reading the first chapter, I know you’ll want to get the book and join the grass roots effort.

If you already have the book lets us know in the comments what you think.

Feel free to post questions on the blog and please do share your SSRI or benzodiazepine taper and withdrawal story so we can all be better informed.

PS. Both Kelly Brogan and myself will be presenting at the Mindd Conference in Sydney in May. We’ll also be presenting at IMMH/Integrative Medicine for Mental Health Conference in September in Washington DC. Come along to those events, and you can hear Kelly Brogan speak live, and you can hear me speak live as well.