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The Ashton Manual Supplement - Dr. Heather Ashton

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💫 Short Summary

\"Benzodiazepines: How They Work & How to Withdraw\" discusses the overprescription and misuse of benzodiazepines, the challenges of withdrawal and lack of adequate support, as well as the unresolved questions about potential long-term effects and permanent brain damage caused by these drugs. In the video, it is discussed that benzodiazepines act on GABA receptors in the brain, and prolonged use can lead to changes in gene expression and a decreased sensitivity to GABA, resulting in heightened central nervous system excitability and increased stress sensitivity. The existence of natural benzodiazepines, which modulate GABA activity, has been proposed, and certain substances called "osines" have been found to interact with GABA receptors in the brain. Recurrence of benzodiazepine withdrawal symptoms can be triggered by environmental stress, and individuals with a history of benzodiazepine use may have a lowered tolerance to stress even after stopping the drug. Benzodiazepine Withdrawal: Reinstatement, Abstinence, Nutritional Supplements, and Metabolism" discusses the challenges of benzodiazepine withdrawal, including reinstatement after withdrawal, the ineffectiveness of nutritional supplements, and the variations in drug metabolism among individuals. It emphasizes that most long-term benzodiazepine users can recover from withdrawal with time, but may experience protracted symptoms that decrease gradually.

✨ Highlights
📊 Transcript
Benzodiazepines are still being overprescribed globally, often in excessive doses and for too long.
00:00
Prescriptions for benzodiazepines and similar Z drugs are increasing in many countries.
Availability of benzodiazepines on the internet has led to their use as self-medication in the general public, who are often unaware of their adverse effects and potential for dependence.
There is limited clinical knowledge and expertise in the management of benzodiazepine withdrawal.
01:22
Many doctors lack knowledge of benzodiazepine withdrawal and psychological support is hard to obtain.
Detoxification centers are not suitable for prescribed benzodiazepine users as they tend to withdraw patients too rapidly and provide inadequate support.
Clinical research on optimal benzodiazepine withdrawal methods is limited.
02:04
Meta-analyses of clinical trials are difficult to interpret due to different withdrawal rates, psychological support methods, and adjuvant drugs.
There are no studies examining the long-term effects of benzodiazepines, including potential permanent damage to the brain or other systems.
The Ashton manual's advice for prescribed benzodiazepine users and their doctors remains relevant and requires little updating.
03:11
Supplement provides further information in response to frequently asked questions by benzodiazepine users during and after withdrawal.
Personal factors like personality, genetic makeup, dosage, duration of use, and present symptoms affect benzodiazepine withdrawal outcomes.
There is no conclusive evidence that benzodiazepines cause permanent brain damage.
03:49
Studies using brain scans have not found consistent abnormalities or structural damage in long-term benzodiazepine users.
Functional changes in brain activity and cognitive performance have not been extensively studied in long-term benzodiazepine users.
The question of whether benzodiazepines cause brain or other organ damage remains unanswered.
06:48
Alteration in the activity of benzodiazepine receptors in brain GABA neurons may be involved in long-term effects of benzodiazepines.
Downregulation of receptors with chronic use and the subsequent changes in gene expression could contribute to long-term effects.
Long-term use of benzodiazepines can lead to changes in the brain, making it less sensitive to GABA and more sensitive to stress.
08:00
Receptors for benzodiazepines and GABA in the brain may be reinstated in a less efficient form after drug withdrawal.
Changes in gene expression can make some individuals naturally more prone to anxiety.
Decreased density and subsensitivity of brain GABA receptors are found in patients with anxiety and panic disorders.
Some individuals may have genetically fewer GABA receptors, making them more likely to experience long-term effects of benzodiazepines.
There are natural substances in the body that affect the same receptors as benzodiazepines, suggesting the existence of natural benzodiazepines.
10:00
Many psychotropic drugs act on receptors for natural neurotransmitters in the body.
Natural benzodiazepines have been found in plants and animal tissues.
These natural benzodiazepines, called osines, modulate GABA neurotransmission in the brain and have a calming effect.
Recurrent symptoms after benzodiazepine withdrawal are signs of GABA underactivity and can be triggered by increased environmental stress.
12:00
Recurrent symptoms are a result of increased output of excitatory neurotransmitters due to GABA underactivity.
Environmental stressors, even unrecognized ones, can trigger recurrent symptoms.
Factors like infection, surgery, stress, and aging can contribute to the recurrence of symptoms.
Some people with a history of traumatic benzodiazepine withdrawal may experience post-traumatic stress disorder (PTSD) when stressed.
Increasing age, long-term worries, and buried unresolved thoughts can make the brain less efficient at coping with stress.
13:00
The brain's decreased efficiency in coping with stress may be due to aging and long-term unresolved worries.
Some individuals, especially those with a history of benzodiazepine treatment, have a lower tolerance to stress even after stopping the drug.
Adverse effects from new drugs or drugs previously tolerated may be experienced due to general hypersensitivity of the nervous system.
The dilemma faced by some people during benzodiazepine withdrawal is whether to increase the dose, reinstate the drug, or continue with the withdrawal process.
15:00
If intolerable symptoms persist after withdrawal, some people may consider increasing the dose or reinstating the drug.
Reinstating the drug and starting the withdrawal process again is a difficult decision.
💫 FAQs about This YouTube Video

1. What are the concerns associated with the overprescription of benzodiazepines?

Benzodiazepines are still overprescribed globally, often in excessive doses and frequently for too long, leading to concerns about adverse effects and dependence potential. Many doctors have little knowledge or expertise in the management of benzodiazepine withdrawal in long-term users.

2. Why is there a tendency to prescribe more potent benzodiazepine agents?

There is a tendency to prescribe more potent benzodiazepine agents, leading to an increase in prescriptions for drugs such as clonazepam, alprazolam, and zolpidem, which can contribute to the growing problem of benzodiazepine overuse and dependence.

3. What challenges exist in the withdrawal and management of long-term benzodiazepine users?

Challenges exist in the withdrawal and management of long-term benzodiazepine users, including the lack of proper psychological support and the difficulty in finding specialized withdrawal clinics. Many doctors also lack the knowledge and expertise in managing benzodiazepine withdrawal.

4. What are the concerns about the lack of clinical research on benzodiazepine withdrawal methods?

The lack of clinical research on optimal benzodiazepine withdrawal methods contributes to the challenges in managing long-term users. The limited understanding of the long-term effects and the lack of comprehensive studies further add to the concerns surrounding benzodiazepine withdrawal.

5. Is there any evidence of permanent brain damage caused by benzodiazepines?

The question of whether benzodiazepines cause permanent brain damage remains unanswered by science. While some long-term users report irreversible psychological and physical symptoms, the potential for permanent brain damage is still not fully understood and requires further research.

6. What are the long-term effects of benzodiazepines on the brain?

Long-term use of benzodiazepines can lead to a decrease in the number and sensitivity of GABA benzodiazepine receptors in the brain, resulting in heightened central nervous system excitability and increased sensitivity to stress.

7. Is there a natural benzodiazepine that modulates the activity of GABA receptors?

The existence of natural benzodiazepines that modulate the activity of GABA at GABA benzodiazepine receptors has been suggested, with potential sources found in plants and animal tissues.

8. What are the potential reasons for the recurrence of benzodiazepine withdrawal symptoms?

The recurrence of benzodiazepine withdrawal symptoms can be attributed to factors such as decreased GABA activity, increased output of excitatory neurotransmitters, and heightened central nervous system sensitivity, often triggered by environmental stress or individual susceptibility.

9. How can the long-term use of benzodiazepines affect an individual's tolerance to stress?

Long-term use of benzodiazepines may lead to a lowered tolerance to stress even after the individual has stopped taking the drug, making them more vulnerable to new or recurrent stresses.

10. What dilemma do some people face during benzodiazepine withdrawal or after withdrawal?

Some people face the dilemma of whether to increase the benzodiazepine dose or reinstate benzodiazepines after withdrawal due to intolerable symptoms that persist, posing a challenging situation.

11. What are the challenges of reinstating benzodiazepines after withdrawal?

Reinstating benzodiazepines after withdrawal can be challenging as the original dose may not work and some may require a higher dose, leading to a prolonged withdrawal process.

12. Are nutritional supplements helpful in benzodiazepine withdrawal?

There is no evidence to support the use of nutritional supplements in benzodiazepine withdrawal, and excessive use of certain supplements can be harmful.

13. What are the potential risks of increasing the benzodiazepine dose during withdrawal?

Increasing the benzodiazepine dose during withdrawal can further strengthen dependence, prolong withdrawal, and lead to protracted symptoms.

14. How do individual differences in drug metabolism affect benzodiazepine response?

Individual differences in drug metabolism, such as being a poor or slow metabolizer, can affect benzodiazepine response and may require lower doses for certain ethnic groups.

15. What is the outlook for individuals recovering from benzodiazepine withdrawal?

The majority of long-term benzodiazepine users can recover from withdrawal, but it may be followed by a prolonged period of convalescence for the body and brain to heal.