Functional Treatments for Antidepressant Drug and Alcohol Withdraw
By David A. Arneson, NMD.
Correcting Neurotransmitter Deficiency Syndrome
Special note: This information is not intended to convince you that you need, or don’t need, antidepressants or other mind altering drugs in your life. These are individual choices that are up to each individual to make for themselves. It is true that there are those that find a sense of balance and a higher quality of life with the use of psychotropic medications. Yet, there are those that don’t and this information is intended to clear the waters and educate those that are looking for answers not forthcoming from the doctors that prescribe these medications. It is noted in The Carlat Psychiatric Report, a respected psychiatric monthly report, that 85% of the patient’s that end up on these drugs would have never been included in the original studies. Another study done implies that 80-85% of you don’t need to be on these medications—that you need alternative services—which basically means counseling, nutritional intervention, and other means to treat your depression. What most need, in my professional opinion, is a doctor who cares enough to listen to you. My first question to all of my patients is, "why do you think you are depressed?" Most of you know exactly why you are depressed…and most of you can work your way through the process without medications. If we insist on prescribing these medications like candy and refuse to listen to the patient—then little will be accomplished…and the side effect profiles of many of these mediations will cause great harm.
Psychotropic Drugs - Anti-depressants, Anti-Anxiety Drugs, and Alcohol
ALL drugs, illegal or otherwise, that affect brain neurochemistry have some level of withdrawal syndromes. This includes anti-depressants, anti-anxiety, and other drugs of the psychotropic classes. All drugs that affect brain neurochemistry also can elicit dependency for that drug. This is now known to be true even for anti-depressants. The level of signs and symptoms of this withdrawal are different in respect to the following conditions:
- 1) Type of drug
- 2) Amount of drug taken
- 3) Duration of drug use
- 4) Genetic make up of each individual
Regardless of which drug is taken, if that drug affects brain neurochemistry, protracted withdrawal syndromes are common. This has been recognized with heroin and is called the "protracted opiate withdrawal syndrome". Protracted withdrawal does not just incorporate the elimination of the drug from the human body it also involves the repair of the brains neurotransmitter system. We know from past research that this may take up to 3 years for some. The time for full recovery is dramatically shortened (my clinical experience) by focused nutrition, exercise, and sleep. More importantly, one must approach the dependency of any drug and alcohol from the holistic approach. The body-mind-spirit must be brought back into balance for true recovery. Any professional who approaches addiction with less of a mind set will see many chronic relapsers.
Understanding Neurotransmitter Deficiency and Anti-Depressant Withdrawal
In order to come to some understanding of the neurotransmitter deficiency/anti-depressant withdrawal syndromes it is important to grasp some basic concepts and truths, or at least what we know and don’t know. Maybe more importantly what we think we know and don’t know. Many factors can cause deficiencies in neurotransmitters. These factors may include genetics (the inability to produce neurotransmitters in sufficient quantities), inadequate diet and vitamins, drugs, alcohol, use of prescription psychiatric medications, and emotional events just to name the primary causes. Diseases such as hypothyroidism and anemia can also cause depression. Before one is diagnosed with depression a good physical and basic lab work is a necessity. However, in the doctors rush to get you in and out of his office (average time interacting with the standard medicine physician is now 4-7 minutes), the diagnosis is rapid and many times over looks the obvious. Depression and anxiety are common symptoms of withdrawal and recovery from alcohol and street drugs…we’ve been on a high so long…when we quit we are left with decreased production and utilization of the basic neurotransmitters that we depend on for sanity and emotional balance. It takes time to "remodel the house" so to speak. Research now shows, if we do little, that it takes 6 months to 3 years for this repair and the return of normal brain function.
Many standard medical professionals argue against the notion of an anti-depressant withdrawal syndrome. Frankly, in my practice and experience, anti-depressants can cause withdrawal syndromes that comparable to the withdrawal from methadone and benzodiazepines. These are harsh withdrawals for many. Yet the biggest fallacy about the use of antidepressants is the notion that they can help us to correct brain dysfunction associated with neurotransmitter depletion (regardless of its cause). Anti-depressants only use what you can produce—they in themselves do not increase the production of neurotransmitters. Also, recently there has been some suggestions that anti-depressants can cause dependency—another set of studies has indicated that 85 % of the people on psychotropics in the US don’t need to be on them…what these people need is other alternative therapies. As a culture we are over medicated. It is far cheaper, in the long term, to medicate patients then it is to supply good quality counseling, nutritional guidance, or good quality health care.
Treating the Causes Not the Symptoms
I t would be impossible to address every psychotropic medication utilized to treat the symptoms of neurotransmitter depletion, i.e., depression and anxiety. Yet generally, that’s all these medications do…treat the symptoms. They rarely address the cause. Drugs such as the selective serotonin re-uptake inhibitors [SSRI’s]--(Prozac, Celexa, Paxil—just to name a few)…do not increase the production of serotonin. They use what you can produce which is commonly a deficient amount. When nerves propagate signals they release neurotransmitters in the space between two nerves (the synapse) and SSRI’s keep the neurotransmitter in the synapse (the area between two nerves) longer so the action of the neurotransmitter is prolonged. There are also drugs that inhibit the re-uptake of epinephrine and nor-epinephrine. However, most anti-depressants have multiple actions--being a strong re-uptake inhibitor of one neurotransmitter and weak re-uptake inhibitor of others. Drugs such as these don’t "heal" anything. They may make it possible for you to get through a rough time, but sooner or later, they start failing to work. The reason for this is clear. The mind has a very tight regulatory system in controlling the amounts and times that neurotransmitters are available for use. Anything out of sync with this control…and the mind tries to find a way to bring function back into balance. So the cells in the brain start producing an enzyme monoamine oxidase. After the neurotransmitter is released from one cell to act on the receptor of the next cell (propagation of the signal)…one of two things happens…1) there is a rapid uptake into the original cell, or 2) monoamine oxidase breaks down the neurotransmitter. The time it takes to do either function is in milliseconds…or measured in some part of 1/1000 of a second. This further disrupts normal functioning nerve cells and increases the depletion of neurotransmitters which, in all probability, were depleted already. This is also why, commonly, these psychotropic drugs stop working over time. It is common for someone to start on one drug…suffer through increased dosing…then get switched to other related type medications, or to have other drugs added to the dosing regime to try and get the patients brain function back to "normal". This is one of the reasons for high relapse rates to street drugs for many of these patients. People will self-medicate to try and reach some state of normalcy.
Anti-Depressant Drug Effects - Unknown and Under-Researched
Several facts and truths about psychotropics are never told to the patient. This information is readily available to the doctor. First, we have no clear understanding how these drugs actually work in the brain. As one example, if we review the drug Prozac in the Physicians Desk Reference (PDR) we’ll see under the listing—mechanism of action—"UNKNOWN…but is thought to be…" This is true for over 90% of all psychotropics used today including anti-anxiety medications. Secondly, research on these medications, for approval from the FDA, rarely have study groups larger than 400-600 patients and rarely exceed 4 months in length. In fact, if one looks at the PDR, the manufacturer of these drugs rarely approves their use beyond 4-6 months. Yet when the patient goes to the doctor they are commonly told that they may have to be on these medications the rest of their lives. Thirdly, medical professionals have absolutely no idea of the long term affects of these medications…and it is interesting that there is some research that indicates that the suicide rate in the US has risen consistently since the advent of Prozac in the early 1990’s.
The Brain Builds-Up a Tolerance to Psychotropic Drugs
We typically think of withdrawal as attached to the use of street drugs and alcohol. There is no doubt that street drugs cause changes in brain neurochemistry, or frankly, people would not do them. All street drugs, and alcohol, increase the release of a neurotransmitter called dopamine. This is the feel good neurotransmitter…the more that is released the better we feel. Increased levels are seen also with exercise…such as the runners high. This increase in dopamine is also coupled with an increase in the natural bodies opiates—enkephalins and endorphins. However, long term use of any street drug or alcohol leads to what is called tolerance…this is simply the body/mind self-regulation that does several things…
- Cuts back on the production of the neurotransmitter.
- Reduces the number of receptors the transmitter has to act on; or,
- Increases the production of monoamine oxidase to break down the excessive neurotransmitter--thereby trying to bring an abnormal condition back into some level of balance.
Unfortunately, the increased release of dopamine also affects levels of other neurotransmitters. When the brain senses too much of the dopamine it increases monoamine oxidase which also breaks down other monoamines (neurotransmitters) such as serotonin. And since dopamine goes on to produce epinephrine (adrenalin) and nor-epinephrine it down regulates these two essential neurotransmitters as well.
One Thing Must Be Made Clear
Any drug that has an effect on neurochemistry has the potential to create emotional/physical dependency. This is also true for most prescription medications currently in use to treat chronic depression, anxiety and drug dependency. In fact, some of the most dynamic withdrawals I’ve ever seen come from detoxing patients from drugs such as Effexor, Paxil and Prozac. Generally, the longer the drug is taken, the more severe and long-term the withdrawal syndrome. The same applies to street drugs and alcohol, yet I find those infinitely easier to treat. It would behoove the physician that chooses to assist his patients in these pharmaceutical detoxes to read books such as Prozac Backlash (Joseph Glenmullen, MD) and Your Drug May Be Your Problem and Toxic Psychiatry (Peter Breggin, MD). These psychiatrists are writing about their own profession. Any drug that has an effect on neurochemistry changes the way the bio/neurochemistry normally functions. All street drugs, including alcohol, negatively affect the "normal parameters" of bio/ neurochemistry, down-regulate the production of neurotransmitters and lead to what is termed "neurotransmitter deficiencies." Even chronic depression and anxiety have been shown to deplete neurotransmitters and the receptors that they act on … literally, all antidepressants and psycho tropics serve to down-regulate neurotransmitter function over time. In fact, the research shows that the use of SSRIs will damage dopamine neurons over time (Glenmullen, 2001). I fully expect in the next five to 10 years that we will see an increase of Parkinsonism, "of unknown etiology." One-sided treatment of any neurotransmitter creates changes in the other associated systems. As a result, I use comprehensive amino acid formulas to treat both the monoamines (serotonin and dopamine) and the catecholamines (norepinephrine and epinephrine) at the same time.
Rebuilding Normal Brain Function
If we truly want to treat the deficiencies created by the use of alcohol and drugs, illicit or not, then we need to understand one thing clearly – like a house that has been damaged in a storm, we need proper building and repair materials. The body/mind house only knows nutritional building materials. One cannot say absolutely that all will respond completely to such nutritional treatment regimes. Yet in our experience, well more than 80% do respond favorably to such nutritional focus. The reason for this is quite clear: The only way to repair the damage, or to facilitate the return to normal function, is to utilize the knowledge of nutritional biochemistry. In holistic medicine, this is known as functional medicine, molecular medicine or cellular medicine.
In addiction, other factors play into the decrease production of these essential neurotransmitters. Poor diet and dehydration are the most common factors in the decreased availability of these transmitters. Other factors which can affect the production, release, and availability of neurotransmitters is stress; whether that stress is generated through our actions, or by chronic disease states—which all addictions are now considered. Adrenal fatigue is common because the adrenal gland releases epinephrine, nor-epinephrine, cortisol (our natural body steroid) in response to the increased level of stress. After all these are known as the "stress hormones". If stress is prolonged the adrenal glands eventually "fatigue," releasing less and less over time. This creates tiredness and feelings of malaise. Once again these are common symptoms in the first year of sobriety. It is not uncommon for the adrenals to take up to a year to come back to normal functioning.
Nutrition: The Foundation of Brain Chemistry
It is clear that psychotropic drugs affect the production, release, and utilization of brain neurotransmitters. Although the mechanism of action of these medications is commonly different than that of street drugs and alcohol, they still affect the same neurotransmitters leading to prolong dysfunction of brain neurochemistry. So the primary question that needs clarification--if prescription drugs cannot enable us to return to some sense of normalcy what can? Quite simply nutrition. Nutrition is the foundation of all body biochemistry, including that of neurochemistry. Nutrition supplies us with the basic repair supplies which include proteins (amino acids from proteins are the building materials for neurotransmitters), carbohydrates and fats. Also essential are the vitamins and minerals which act as the co-enzymes and co-factors which facilitate the movement of the human biological system back to normal function. In fact, many vitamins and minerals serve as co-factors and co-enzymes for the production of neurotransmitters from amino acids. How important amino acids are in body/mind health is apparent by the numerous roles they play in the health of any individual.
The Essential Roles of Animo Acids
- DNA, the blueprint, serving as the master control for proper biochemical processes in the body consist of amino acids
- RNA consist of amino acid chains.
- All enzymes necessary for the conversion of amino acids to essential processes and products in the body are formed from amino acids.
- All receptors, that enzymes and neurotransmitters bind to, are amino acid complexes.
- All neurotransmitters are formed from amino acids
- Amino acids may be converted to Glucose during times of starvation. Glucose is the only form of energy that brain cells can utilize
- Branch chain amino acids are essential for proper immune system function.
So it’s easy to see why supplementing amino acids in the treatment of drug and alcohol detoxification and recovery is essential. It is also critical in the treatment of those who have been on anti-depressants and wish to discontinue the medication. Yet amino acids are not enough. The co-enzymes (vitamins and minerals) are essential in increasing the efficiency of the enzymes that convert amino acids to neurotransmitters among other products. Without these essential co-enzymes nothing can happen in biochemistry, or neurochemistry.
It is true that there is much we don’t know about the roles of the essential co-enzymes. Magnesium alone has over 300 roles as an essential co-enzyme in human biochemistry. Vitamin B-6 is known to be an essential co-enzyme in over 130 different reactions (both, by the way, are essential for the production of neurotransmitters). When we stop and consider that nature gives us some 100,000 phytochemicals that we interact with through our lives—and we choose approximately 45 essential ones to work with—there is no possible way to know how all these work separately, or in synergism with each other. Yet we must start somewhere.
Traditional Medicine Overlooks the Functional Effects of Nutrition
The basic philosophy of modern medicine, especially in the treatment of brain dysfunction, is to utilize man-made chemistry to bring one back into balance, yet modern medicine insists on treating the symptom rather than the cause, and scorn professionals that utilize nutrition as the basic tool to help the body/mind heal. No one knows this better than Dr. Peter Breggin, a psychiatric MD, author of Toxic Psychiatry, which is a must read for anyone even considering psychotropic therapy. He is also the author of, Your Drug May be Your Problem—How, Why, and When to Get off Your Psychiatric Medication; and The Antidepressant Fact Book. It is unfortunate in our medical system that 70% of the MD’s and DO’s have absolutely no nutritional education in medical school. For the other 30% nutritional education consists of a 14-20-hour block that is considered an elective. How many of the remaining 30% take advantage of the elective is unknown. Some studies indicate the only about 5% of the standard medical doctors in this country have any nutritional biochemistry in medical school. These are indisputable facts. And we wonder why we have such a dismal record treating people with mental disorders and those in recovery.
Bill Wilson, of Alcoholics Anonymous, knew something was missing from the picture. He often wondered why "some just didn’t get it". He was frustrated at the dismal relapse rate. Even in those with a year or more of recovery. He commented on the fogginess that pervades the recovering mind over time. He begged his doctor friends to study the phenomena and figure out what was going on. The medical establishment--bent on changing basic human biology--came up with Prozac and numerous other drugs and drug cocktails to address these issues. It has never worked well and it never will. The simple fact is that all drug addicts and alcoholics suffer from some level of neurotransmitter deficiency early in recovery. Furthermore, all recovering addicts and alcoholics suffer from some level of nutritional deficiency or the effects of profound biochemical anomalies created by poor diet during their active use of these chemical substances.
The lack of interest and the basic ignorance of good oral nutrition by the "best medical system" in the world is beyond belief and comprehension. The only way the body/mind can truly heal, to the level it is capable of correcting itself, is by the very nutrients you take in everyday. This is not discounting that some have genetic problems severe enough to require modern chemistry. We see these people in crisis management and typically they are danger of self or the community at large. As was stated earlier, 15 % of the patients on psychotropics probably need to be there. The other 85% need other alternative therapies. Yet even in those that need chemical therapy it rarely works well. We managed, more that anything, to utilize the medications as chemical straight jackets. And rarely do we even consider nutritional therapy. In my four years working with the severely mentally ill in crisis stabilization I never once saw a person allowed to do a multiple vitamin with the exception of the occasional pregnant female who was allowed folic acid. In fact, if the patient came in with vitamins there were ceased as contraband and return only on their discharge from the facility. There are cases where supplementing a B-complex vitamin has totally reversed the symptom-logy of bi-polar disease. There are studies now that show the addition of Vitamin B-12 and folic acid makes Prozac more effective in those that don’t respond well to the medication. The question should be why we didn’t start with the B-12 and folic before the Prozac since it is common scientific knowledge that deficiencies in B-12 and Folic are found in some cases of depression.
The basic knowledge the public at large needs to facilitate their health and recovery is often buried by those who profit from the sale of pharmaceuticals. No pharmaceutical company can profit from everyday simple therapy. Furthermore, it is more than just a little interesting the same month tryptophan (the amino acid that produces serotonin the brain neurotransmitter) was banned by the FDA—Prozac was approved by the FDA. Unfortunately, there are also many in the business of manufacturing vitamins and supplements that produce poor quality supplements. The FDA has little control of the level of quality of any vitamin produced in this country. The patient has added responsibility to educate self and to find trustworthy sources for their supplements. The patient also has the responsibility to find health care professionals that specialize in nutritional treatment—
I invite you to go to www.naturopathic.org for such a professional in your area.
All this being said I’ll leave you with the basic nutritional protocol for movement back to mental health. Two things must be understood before starting…
- Keep it simple. Movement from the simple therapy to the complex therapy will allow the physician, or patient, to move to the level of complexity needed in any particular case without overwhelming the patient
- Stay the course. Many get discouraged because they want to be "well" now.
Ask yourself, "how long did it take me to get here…" and more importantly, "how long am I willing to commit to this process of recovery?" I have my patients commit to 6-weeks of intensive nutritional therapy. We assess every two weeks and change what is necessary. At 6-weeks, I ask for another commitment of 6-months to one year. 65-80% of those who make the initial 6-weeks make the longer commitments. Remember, it takes time to reestablish and correct adequate neurotransmitter function, one day at a time.
Intra-Venous Nutritional Therapy:
In patient or out-patient, especially in detox stage—but also for continued nutritional support for those most challenged. Typically every day for the first 3-6 days, than once or twice per week for the first 6-weeks or until the symptom-logy has subsided. These nutrient bags can contain proteins, vitamins, electrolytes, and other elements necessary for the body-mind to heal. The advantage of IV therapy is that all essential cofactors bypass compromised gut function. Only when the recovery occurs will the symptoms of withdrawal disappear totally.
Oral nutrition: Increase the right proteins. Proteins are the building blocks for neurotransmitters and neurotransmitter receptors, as well as the building blocks for you natural opiate receptors.
For 3 weeks you must remove all red meats from your diet. Red meat has chemical components that increase inflammation and pain. Fish, chicken, eggs are good sources of protein. If you are having a hard time taking in solid foods go to a health food store and buy protein powders that can be made into smoothies or drinks. You absolutely must have increased protein intake. Proteins are the building blocks for all enzymes, neurotransmitters, and enzyme receptors in the body. No chemical works in the body without receptors. Just like opioids have to have opioid receptors—which are down regulated during methadone use—this is the reason people have long-lasting pain and aggravation coming off methadone, and also long-term affects from protracted use of anti-depressants or anti-anxiety medications.
Increase you intake of raw fruits and vegetables. You get little or nothing from canned foods. Fresh fruits and veggies are loaded with fiber which help bind and remove toxins from your body. They also normalize gut function. Powdered "green foods" can be done with smoothies or in capsular forms
Stay off candy, and other sugar heavy foods.
Drink lots of good water, green teas are good for the antioxidants and anti-inflammatory properties. No cokes or soda waters for three weeks
When capable you must start exercising. Swimming is best because it is low impact exercise. Yoga. Tai chi. Walking daily. Detoxing or otherwise. Exercise is a normal component of good health.
Supplements: Some need less and some more. Remember the efficacy of all nutrition and supplement use is ultimately guided by your genetics. And we are all different to some degree. This is the value of seeing a good Naturopathic physician in the state you are in…The fact is that very few Medical Doctors know anything about nutrition…70%-75% of the standard medical schools in this country have absolutely no nutritional classes what-so-ever…in the other 25 %--nutrition is often a 14-20 hour block of education and this is commonly an elective…Naturopathic physicians that are educated in a medical school environment are taught nutrition extensively with the associated biochemistry.
Multivitamin with a strong mineral component: in gel caps only…an excellent quality multivitamin is absolutely necessary…remember that vitamins and minerals are cofactors/coenzymes for repair, normal function of the body…most times I have patients double up on multivitamins for the first 3-4 weeks
Mineral complex: see above
Flax seed oil: necessary for repair and proper function of cellular membranes…anti-inflammatory. These need to be mixed omega 3, omega 6, omega 9 oils—4 caps per day. Although some can be purchased as liquids and mixed with your smoothies.
Proteins—amino acids: If you don’t do the drinks. Get proteins as free amino acids. These are balanced formula’s with all essential and non-essential amino acids in capsules or tabs. Double up for the first 2-3 weeks from the suggested dosing. A new product which looks promising is a product called Tyrosine Plus and tyrosine with Mucuna. This product was designed to address the issues of neurotransmitter depletion and deficiencies. The product contains the essential amino acids, tyrosine, 5-HTP, glutamine, methionine, and with the Tyrosine with Mucuna the L-dopa needed to energize the dopamine pathways.
If one cannot find the stand alone product above than the following amino acids are necessary for the recovery of neurotransmitter function and balance
L-Glutamine 500mg caps. At least 2000-3000 mg per day. Split the dose so that your doing it at least twice per day. This helps correct the gut and the building blocks for GABA. The primary inhibitory neurotransmitter. Helps slow things down. GABA is the neurotransmitter that is affected with the use of benzodiazepines like Ativan and Xanax.
L-Tyrosine 500 mg caps. Two twice per day. In the morning and at noon…
5-Hydroxytryptophan. 50-100mg. One or two in the morning, and two at bedtime to start.
Valerian Root 450 mg: Botanical that reduces anxiety and helps one to sleep. Kava, Jamaican Dog Wood, Lemon Balm, Avena are all nervine botanicals which can be used together or by self. Use as directed
Melatonin. Dosages vary. This is a hormone released from the pineal gland in the human body at night time for sleep. This is essential for those coming off any drug or psychotropic. In my experience as little as 1 mg to 30 mg has been effective. Do what you have to do. I’ve had addicts coming off 100.00 a day habits sleep 4 hours the first night. Start low and add 3-5 mg every half-hour till sleep. Take only at night when you would be going to bed at the regular time. The room must be dark. That’s the way this hormone is released in the natural state. Research on healthy volunteers show no appreciable side effects of high dose melatonin—I’ve used up to 30 mg per night on patients in withdrawal and seen no other side effect other that a feeling of lethargy the next day.
Full Spectrum Antioxidants: relieves inflammation and helps normalize inflammatory pathways and reduces damaging molecules (free-radicals) present in the system while detoxing
Vitamin C: 2000-3000 mg per day divided doses…
Reduced L-Glutathione 300mg per day: Helps liver detox metabolites of most drugs that are metabolized through the liver. Detoxing agents can be found in many products, most in combinations.
Milk Thistle with alpha-Lipoic Acid is one combination that I use extensively---for liver repair and detoxification
This is the basics. There is absolutely no way to eliminate all the problems associated with withdrawal from any drug—since this is unique to each individual, one must have a supportive environment and often with daily visits from a compassionate health care provider. This will not kill you. It will be a miserable event. What kills most is the movement back to street drugs to ward off the side effects of withdrawal. I wish you all luck on this endeavor. My compassion and empathy goes out to you. Ultimately, I know that you can do this. After all… it has to be done.
Author David Arneson is a licensed naturopathic medical doctor in the state of Arizona.
Physical Activity, Exercise Limits Depression
Physical activity has been linked to the reduction in blood serotonin after exercise, similar to the effects of selective serotonin re-uptake inhibitors (SSRI). PubMed - Scandinavian Journal of Medicine & Science in Sports
Research published by The American Medical Association concludes, "findings are consistent with a beneficial effect of physical activity on feelings of sadness and suicidal behaviors in Hispanic and non-Hispanic white boys and girls. PubMed - Archives of Pediatrics & Adolescent Medicine
The American Psychological Association has more on how stress affects us