WHAT IS HAPPENING IN YOUR BRAIN DURING BENZO WITHDRAWAL Written by a member of BenzoBuddies This will hopefully be an encouraging email to make you feel SAFE and ENCOURAGED. Some of you may know that my degrees are in speech-language pathology (B.A and M.S.) As part of my Masters study, many of my classes were in neuroanatomy and physiology. I learned firsthand how to look at a person who had just undergone a stroke or brain injury and read the symptoms, the radiology reports, the doctors notes, and based on those symptoms, to form an image in my mind of what was affected in the brain injury - as well as how to formulate a treatment plan to help that person rehabilitate. For a therapist in a hospital, it is much more than speech and language. It is about reteaching a person how to swallow, eat, rebuild memory, rebuild concentration and attention, rebuild focus, rebuild executive functioning skills (planning and acting on a plan) pretty much ANYTHING that is involved in thinking that helps you get OUT of a coma, OUT of a hospital, and back to home, work, or school. I had NO idea I would ever personally undergo a brain injury. But in so much as I have now experienced one, I have often laid awake while in a wave and attempted to analyze and decipher what was happening in my brain as I healed. I thought you all might like to read this. It gives potential answers to all the WHY? questions we have about what is happening to us physiologically and mentally. First of all, a TRUTH that we must learn to accept is that WE HEAL. I have seen people emerge from comas who cannot remember who they are – go on to HEAL. -They cant remember how to walk (we do). -They cant write their names (we can). -They cannot tell you the year or the president (I was SO bad I was unsure of this at times, but generally, I was oriented to this). -They often cannot remember family members (we can -our D/R can be hideous, but we remember them). -THEY have to work through many hours of therapy to heal. But most of them do - and from TRAUMATIC PHYSICAL brain trauma that can tear tissue and tear nerves. -We have none of that. We dont have to undergo therapy. We simply have to wait. Most of us, me included, didnt expect the temporary brain injury we got when jumping off benzos. But I started to realize through my own experience and my educational background, that there is a PURPOSE in every symptom we have. I have had months and months to analyze what is likely going on in the brain at a gross level - and I want to attempt to explain certain symptoms in a way that we can visualize - so that they are less scary and more telling of the healing that is happening. First off - lets start with GABA and Glutamate. Most of you may know how this works by this point. But for those that dont, we have a huge nervous system of millions of nerves (neurons). They dont touch each other. They are separated by a tiny space in between. However, they communicate via chemicals. The 2 MAIN chemicals in the entire nervous system are the BIG GUNS. They are GABA and Glutamate. They are BOTH at work at ALL times in the CNS. It isnt like one is working and then the other is working. They are BOTH ALWAYS working in tandem to control every aspect of movement, sensation - everything. They take the incoming information and appropriately pass it along - they trim up the information appropriately so that we can process it. They are like the steel structure of a building. The entire building needs a steel structure to stand. GABA is inhibitory. If a nerve releases GABA - it is to Inhibit function - this could be to slow it down or it could be to limit the sensory input so that we can process it. In the same way, GABA might be released to help steady your hand while doing something like painting a very detailed painting. GABA helps to shore up movements to make them more fluid. Thats just in a nutshell. Of COURSE it does a lot more than this, but the idea is that GABA is present in the ENTIRE CNS and ALWAYS working to balance every sensation, movement, etc. Likewise, Glutamate is the balance to GABA. It is the excitatory transmitter. It fires to speed things up - to initiate action - to make things go. Theres a lot more to it, but Glutamate is kind of the opposite of GABA. BOTH are required to work at all times. Neurons are ALL ALWAYS firing off GABA and Glutamate on a endless cycle all throughout the nervous system. Its quite amazing really. What does a benzo do? If a person is anxious - they may be so stressed that they cannot overcome a very traumatic event or anxious situation. If a doctor prescribes a benzo - the benzo comes in and sorta holds the door open for ALL the GABA in the system to FLOOD into the nerves - even when that is not what the nerves would actually want to occur. The immediate effect is that EVERYTHING ni the body SLOWS DOWN and is inhibited. This might be helpful during surgery, for anesthesia, for a seizure disorder. Yes - the benzo - by definition - will act on GABA and slow everything down. And yes - the net effect of this is that a person may feel drowsy, calm, less anxious... everything is being inhibited. And in general, taking a benzo for one day is okay. When the benzo is gone, the body just reverts back to regular operation. HOWEVER, if a person takes a benzo day after day, while indeed the person feels less anxious, the body begins to realize that it cannot DO the things it needs to do in this very slowed-down neuron state. It cannot make hormones. It cannot create enzymes. It cannot digest correctly. It cannot keep a heart going efficiently. It cannot get enough oxygenand on and on. The body NEEDS to run at normal speed - not this inhibited speed all slowed down. But what can the body do? It cannot remove the benzo from the system. The only choice the body has to maintain a regular speed is to do two things; it can TURN OFF its own GABA receptors - thereby rendering those benzos unable to affect the GABA in the system and it can grow MORE excitatory Glutamate receptors to counteract the slowdown. And that is pretty much what happens.... Only - this isnt true balance either. The body does the best it can - but over time, things begin to suffer. The body cannot make enough serotonin in this state. Or dopamine. Some things get made in excess - and other things do not get made enough! During this time, a person may not be aware this is all going on. He may not be able to perceive any difference. But ONE day - the person may wake up sad - or not sleeping well - or unable to remember things fully - or his vision doesnt look right...and it becomes apparent the person has hit tolerance. The body is taking the same amount of drug -but try as it might, it just cannot overcome what has occurred. It can take weeks, months or years to hit tolerance. (I did. - it took me 9 months to hit tolerance. But it was fast. Once I hit it, I could not sleep more than 6 hours on all that Klonopin AND Ambien! I couldnt remember things last week. I was crying all the time... something was wrong.) The process to reverse this takes a while. GABA receptors have to UP regulate and effectively reopen or grow back. Glutamate receptors must DOWN regulate, or effectively turn off or prune back. And IN this mix, all the smaller monoamines (neurotransmitters like serotonin, dopamine, norepinephrine) must somehow find a way to synthesize in the mix. Through weeks and months the body is rebuilding millions of neurons, and changing pathways, rebuilding GABA, down-regulating Glutamate, rebuilding serotonin, rebuilding dopamine, rebuilding norepinephrine. And ALL the enzymes and hormones that need to be made are attempting to be made while this is going on. Basically- you have a building where the MAJOR steel structures are to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work. It would be like if the World Trade Center Towers hadnt completely fallen - but had crumbled inside in different places. Imagine if you were to rebuild the tower - WHILE people were coming and going and to work in the building! Youd have to set up a temporary elevator - but when you needed to fix part of that area, youd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. Youd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves. The windows are where the body has got it right for a day or so - but then the building shifts and the brain works on something else - and its chaos again while another temporary pathway is set up to reroute function until repairs are made. And just like the Twin Towers- its possible - but the buiding is a major effort -and it takes a good year or more sometimes. (Now look at the new Tower that stands at Ground Zero! Its taller and a symbol of freedom. JUST like you will be! ) So - okay - what is happening in that chaos? What parts of the brain are responsible for these symptoms? Now, I dont know the following based on research, because not enough research has been done yet - but based on my studies in neuroanatomy and my own withdrawal experiences, here is how I have analyzed what is happening during wave symptoms. Remember, I have had to look at radiology reports of brain damage and estimate what a patient might present with - so this is very similar. Instead of a radiology report showing me what has been damaged, Im using my own brain symptoms to surmise what is going on. Let me first list brain structures and their functions. This will help you understand where things happen in the brain and when symptoms occur, what may be happening. BRAIN STRUCTURES Amygdala - This is the FEAR center in the brain. Its a tiny part in the middle of your brain. Fear is protective and its GREAT if you need to assess something that is dangerous and to ACT - like if a rabid dog were chasing you. - but its hard in recovery when its all you feel for months! But the FEAR is not truly in your MIND. Its in your BRAIN. There is too much glutamate acting here in the amygdala and not enough GABA. So the nerves are firing off in the fear center when nothing scary is really there in your environment. It is normal for that to happen given the circumstance physiologically. But it feels awful, doesnt it? I know. But its just a brain structure. This can account for fear, agoraphobia, fear of water, fear of anything. Its not that youre really scared of the moon - its that youre in almost constant fear because this brain structure is healing. The glutamate is pruning back. The GABA receptors are opening back up. It may or may not continue for a while. It will abate. Then come back. But eventually, the brain will get it right. Hippocampus - This is the memory center of the brain. It ties in old memories to emotions. The same thing is happening here that is happening in the amygdala with GABA and Glutamate. So - voila. You get intrusive memories from ALL times in your [...]. Its wild and wicked and wooly. But it cant hurt you. And if you can learn to visualize this as what is happening - then you can learn to be objective and realize its normal. And like the amygdala - it will come and go and frustrate you, but it will go away when the physiology is restored. Hypothalamus - This is the structure that is responsible for regulating body temperature. In early withdrawal, my body temperature would drop to 96 degrees in waves! Then 3 hours later, it would return to normal. Id literally freeze in terror in bed for hours. It is more complicated that JUST the hypothalamus, but I could picture this part of my brain retuning and restructuring, and it was less scary that way. The following structures in the brain are part of the gray matter or the cortex and what we consider to be the higher brain- the thinking and processing parts: Frontal Lobe - This is the part of the brain behind the front of the skull. It is responsible for planning things. For making decisions. For inhibiting emotions appropriately. It is the part of the brain you need if you want to make a sandwich and need to get out the ingredients and actually make the sandwich. I have seen people with brain injury be able to TELL you how to make a sandwich - but when they are standing there in front of all the ingredients, they cannot actually move to act to make it! They have frontal lobe damage. They can TELL someone how to make it. But they cannot themselves initiate doing it! As you can imagine, with therapy, and time to heal, this goes away. And we are a lot like this - but it goes away for us, too. I could not organize my childrent toys just 4 months ago. Not a simple room of toys. I didnt know where to start and I literally could not mentally do it. I imagine this is partly why. No frontal lobe GABA. And too much Glutamate. But now, check out this post I’m typing. Obviously that changed. This calms down and these things come back. Occipital Lobe - This is the vision center. ts at the back of your skull. In recovery, my nerves have been all wacked here. I see things as too bright - possible due to this lobe - and/or the actual visual nerves in the eyes. But no doubt people see things that arent there. Vision is distorted. Things go blurry. Colors are totally off. Brightness is off. There are a hundred symptoms possible in vision alone! But again - its a matter of time. Vestibular System - This is the system of semi-circular canals in the inner ear that are responsible for making you feel balanced in space. When this is off or damaged temporarily, you feel dizzy. Oh man, was I dizzy. Early off - I felt like I lived in a funhouse. Over time, a combination of this vestibular system and my damaged visual system made things look like they were leaning. To this day, one eye sees things correctly and the other eye sees things as SLIGHTLY leaning. And its not that the eye itself is seeing them that way. 6 The healing vestibular system is working WITH the eye to tell the brain that that object looks like it is moving left-wards or leaning. But it isnt. In waves, this can happen bad - and then be GONE - poof - in a window. This is just the vestibular system healing. Its gotten WAY better. Temporal Lobe - These lobes are on the side of your brain on each side near your ear. It makes up the whole left and ride side of your brain. This is where auditory information is processed, including hearing itself, but also the Meaning of what we are hearing, as well as part of speech and language, emotion, and a bunch of other stuff. In early recovery, someone was talking to me and I couldnt tell you what they said past the first sentence. My auditory processing was ALL messed up. I couldnt picture what a person was saying to me in real time - and by the time I caught up to them, I was lost and they were talking about something else! Also - When I was laying there in bed, I could hear things that werent there in the noise of my box fan. Id hear the fan blowing -but I also heard like sickening circus music. I believe this is because there is noise coming into my ear - but my brain cannot adequately prune what it is hearing at different frequencies because there is not enough GABA to inhibit it to create something meaningful. There was all this noise and my brain was just firing off glutamate. So instead of actually processing the noise - it was firing off ideas about what it was hearing - and they were ALL wrong. I would be hearing what sounded like circus music - and at the same time, my poor brain was looking through my hippocampus to find all the memories I ever had of being at the circus - and then Im reliving those memories- and at the same time, my amygdala is getting fired upon - so Im in fear. So Im a quivering mess of a person laying in the bed hearing and seeing things and remembering times in my childhood and scared to pieces. Seriously? Yes - I felt crazy. But not in my MIND. It was my BRAIN. Its the BRAIN. And its normal. The structures in the brain are obligated to work this way. That brings me to my next point... WHY do all of us in benzo recovery have generally the same symptoms? Well - it may make you feel calmer to realize that our brain structures are NOT broken. They are doing EXACTLY what they are supposed to do under the circumstances. And all of our perceptions of what we are seeing, feeling, hearing- are normal because the parts of our brains that are firing off are doing so because a) They DO work. b) They work just as they were intended to. c) They are actually healing as all this firing is going on. Why the depression and anxiety? Its so complicated, but this WHOLE system is interdependent. At that SAME time as ALL this stuff is going on, the entire body is to heal in every place GABA and Glutamate naturally act (uh - and that would be - EVERYWHERE). The intestines, stomach, eye balls, skin, toenails - seriously - where do we NOT have nerves? Anything we didnt have as a pre-existing condition is fair game for being affected by the recovery that takes place. This includes the bodys own ability to make serotonin that is required to feel balanced and happy. And you guessed it. This is not being made very efficiently in a building that is under major construction. So - you may get a day or so of feeling good - and then - boom - thats gone until you can make enough serotonin. Oh - and by the way - serotonin HELPS TELL THE NERVES WHEN TO RELEASE GABA AND GLUTAMATE! Ha! So on top of needing GABA to make serotonin, you need serotonin to regulate the release of GABA into the system! How much more interconnected can you get? God - its a wonder it knows how to heal at all! But it does! Amazing to me, really. This is just some limited information to give an idea of what is going on in neurophysiology. Obviously this is very cursory and not super detailed. But there is a bigger point here than “what parts of the brain are affected. The point REALLY is - IF YOU KNOW that symptoms are tied to parts of a NORMAL brain under reconstruction, then you can begin to rest a little more easy in your mind that under the circumstances, the symptoms themselves are a GOOD sign. Without intrusive memories - as awful as they are - especially when mixed with fear - but without them, your memory itself would not heal. It IS healing - and when you are having intrusive thoughts, try to think of it that way. Tap your finger to your temple and say to yourself, I know what this is. This is my hippocampus healing! Ha! Because it IS. And if it were NOT healing, you would not be having those symptoms. ANY part of the brain or body that needs to heal is going to experience something in the form of symptoms - and you are going to notice that. But it is part of process that is inevitably returning to the balance that it could not achieve while we were putting those pills in our mouths. (And if youre tapering, this is happening - just likely with less trauma than with what happened to me when I cold-turkeyed.) So - when you have symptoms - know that symptoms themselves are a way for you to know that healing is taking place. And finally - realize that the DRUG is GONE. This is withdrawal - yes - okay -we call it withdrawal - but its really recovery. The benzos are gone. The evil drug is no longer there. The symptoms that are left are not the enemy. Thats our brains doing the EXACT right thing. Whats happening to our brain at this point is not the benzo beast - Its OUR BRAIN recovering. Not to degrade anyone who calls it the benzo beast - I get that. But just so you know - youre not really fighting a beast. You dont even need to fight it. Just wait it out. All that reconstruction is happening on your building. And soon - the frame will be back standing, than before. The furniture will be inside. The elevators will go all the way up to the top again. And the people can come and go and work like a well-oiled machine. Dont feel you need to fight the reconstruction. Its just healing! Hope this helps somebody a little - or maybe a family member. And if you ARE a family member, please realize that those of us in recovery are no more in control of how we feel or what we experience than people who have undergone brain trauma in a car accident. Please be patient with us, because our brains are healing and we are in the process of reconstruction - and our function is temporarily enabled, then disabled, then enabled, then disabled again. And that is totally normal and expected. We can no more help that than a person can want to wake up out of a coma. It happens when the brain is able - and not out of sheer will. But it does happen. So please stand by us and say loving things and reassure us every day. Notice our improvements and tell us what they are. Encourage us when we feel good. And when we dont, just hold us and hug us and tell us it will be okay. Anything you would say or do for a family member that had had a car accident and a brain injury - please do that for us. And be patient... we are getting there.
Posted on: Sat, 15 Nov 2014 02:24:19 +0000
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