Some of the most widely prescribed drugs are antidepressants, tranquillisers, sleeping pills and stimulant drugs. You might have been prescribed these drugs because you were feeling depressed, anxious or unable to sleep – and then became addicted to them. Or you might have started taking these drugs to help you deal with the withdrawal effects associated with coming off another addictive substance. But using an addictive substance to relieve the pain of getting off an addictive substance is not the ansr.
It is true that when most people give up using a feel-good substance because it is creating problems for them, they quickly find another substance to relieve the discomfort of abstinence. When alcoholics stop drinking they increase their intake of nicotine, caffeine and sugar. People who give up smoking frequently relieve their stress by eating – usually junk food. In order to control their weight, some sugar addicts take up smoking. Some marijuana users start drinking or increase their alcohol consumption.
Switching one addictive substance for another is not the answer; it is part of the problem. Swapping one drug for another doesn’t unscramble your brain.
The rise of prescription drugs
In recent years, medical professionals have become part of this problem: by prescribing prescription drugs to relieve the pain of abstinence symptoms. Of course they are not aware that this is what they are doing. They believe they are prescribing drugs for depression, or anxiety, or sleeplessness or lack of energy. And frequently the outcome for the patient is trading one addiction for another. Most of these prescribed drugs are addictive, sometimes more so than the original addictive substance.
While these drug approaches may be a short-term stepping stone to staying clean or sober, the need for alternative stimulants or relaxants is a sure sign that your brain chemistry is still out of balance. Substituting one drug for another doesn’t correct the underlying imbalance. Until this fundamental factor is addressed, any approach to quitting any addictive substance, from cigarettes to cocaine, becomes several times harder.
The main point of giving these prescription drugs is to minimise, in the short term, abstinence symptoms. However, as you will see, if these abstinence symptoms can be more effectively reduced by our nutritional approach (using nutrients and amino acids), the need for substitute medications, with their own withdrawal effects, becomes unnecessary, thus removing this curious paradox: using a drug to correct a biochemical imbalance in the brain caused by using a drug.
How mental-health conditions are diagnosed
You might think that a scientific approach would be to check whether a person actually has a biochemical imbalance, and, if so, exactly which neurotransmitters (see Chapter 2) were low. The correct amino acids or other nutrients could then be prescribed to help restore the brain’s chemical balance. But that is not what happens. Instead, the diagnosis of almost all mental-health conditions, addiction being one, is based solely on a checklist of symptoms that doesn’t tell you anything about what is going on with the brain or its chemistry.
Checking neurotransmitter balance
At the Brain Bio Centre, our outpatient treatment centre, one of the first things we check for in anyone experiencing problems with depression, anxiety or sleep is the balance of neurotransmitters. We do this based on the tests first developed by ProfessTapan Audhya, from New York University Medical Center, who found very low levels of serotonin in the blood of depressed patients.37 Noradrenalin levels are also often low in those with depression.
Knowing that this neurotransmitter is made directly from amino acids found in food, Audhya then gave his patients 5-hydroxytryptophan (5-HTP), the amino acid that’s a direct precursor to serotonin. This corrected the deficiency and resulted in major and rapid relief from depression.
The usual route with prescribing
We’re sure you would agree that the above is a logical approach: to identify the imbalance, then provide the brain with the nutrients necessary to allow it to rebalance. But this is not what happens in most medical practices or recovery centres. When the abstinence symptoms (depression, anxiety, insomnia) are severe, many people are given more drugs (antidepressants, tranquillisers and sleeping pills) that compound the problem. Many addicts then get hooked on these. Heroin addicts are given methadone, and then get hooked on that. For many, it’s harder to get off methadone than heroin, and incredibly difficult to get off certain tranquillisers and antidepressants.
In our experience, some of the new drugs on the market, which were launched on the premise that they were less addictive or had fewer side effects, have proven to be just as bad, if not worse. Let’s take a look at these, starting with antidepressants.
Are you addicted to antidepressants?
Depression is an extremely common symptom in those with addiction problems, especially among alcoholics, both while drinking and when sober. One in six people in Britain between the ages of 25 and 44 suffers from depression, according to a report by the Royal College of Psychiatrists.38 If you are, or have been, one of these people, the chances are you will have been offered antidepressant drugs. If you’ve taken them, the chances are you’ll have a hard time getting off them, especially if you are taking one of the more recent generations of drugs.
Understanding antidepressants
Back in the 1980s the most prescribed drugs were called ‘tricyclic’ antidepressants, the most popular being amitriptyline. In the 1990s these were largely replaced by a new class of drug (with new patents affording them higher prices) called SSRI (which stands for selective serotonin reuptake inhibitor) antidepressants, with names like Prozac, Seroxat and Lustral, and SNRI (which stands for serotonin and noradrenalin reuptake inhibitor) antidepressants, like Cymbalta and Efexor. The marketing of these drugs suggested they were safer and more effective. The so-called ‘cessation effects’ (symptoms experienced when you stop taking the drugs) were downplayed until, in 2003, the Medicines and Healthcare Products Regulatory Agency (MHRA) said that these should be called ‘withdrawal’ effects. (In the US, these are euphemistically called ‘discontinuation’ effects.) SSRIs and SNRIs have largely replaced tricyclic antidepressants, although a review of the research in 2005 noted that most studies show little difference in effectiveness.39
SSRIs and SNRIs are more ‘selective’ in the sense that, in the case of SSRIs they only target the enzyme that clears away serotonin, the key mood neurotransmitter; and in the case of SNRIs, they target enzymes that clear both serotonin and noradrenalin. Their major advantage was supposed to be fewer side effects, and it is not as easy to overdose on them as on tricyclics. The most commonly prescribed SSRIs are fluoxetine (Prozac), paroxetine (Seroxat) and sertraline (Lustral, Zoloft); and the most commonly prescribed SNRIs include venlafaxine (Efexor) and duloxetine (Cymbalta). However, they appear, in some ways, to be more dangerous. We have heard of many patients who have failed to quit Efexor because the ‘discontinuation’ effects are so severe.
The side effects
The risk of suicide in both children and adults for many of these SSRIs is, at least, doubled. A major review in the British Medical Journal of 702 studies on SSRI antidepressants showed that people taking an SSRI were more than twice as likely to attempt suicide compared with those taking a dummy pill.40 The researchers also noted that the actual number of suicide attempts is likely to be much higher, because many of the studies did not gather information on suicide. SSRIs can also cause patients to feel ‘fuzzy’ and can cause major sexual dysfunction, resulting in an inability to climax in both men and women. This can prevent the intimacy that might help someone come through depression and addiction. On top of this, research published in 2006 suggests that SSRIs might dramatically increase the risk of death in those with cardiovascular disease.41 Despite these risks, UK doctors wrote out 31 million prescriptions for antidepressants in 2006, at a cost of £291 million.
All these drugs have side effects, such as nausea, headaches, insomnia, sleepiness, dry mouth, dizziness, constipation, weakness, sweating, nervousness and sexual dysfunction. Many people also report memory loss with continued use. But most worrying are the withdrawal symptoms when you need or want to stop taking them. Consider the case of Nancy:
Case study NANCY
‘When I came to treatment 15 months ago I had been on Seroxat for ten years, clonazepan and Adderall for five years each, and smoking marijuana for ten years. Of all the drugs I was coming off, the antidepressant Seroxat had by far the worst withdrawal problems. I had been taking it for so long that my body did not know what to do without it. I experienced severe withdrawal effects such as panic attacks, the feeling of crawling out of my skin, brain zaps, nausea, dizziness and restlessness, as well as uncontrollable emotions (laughter and crying). I tried to stop taking it all at once and my body could not handle it, so Dr Braly and I decided I would taper slowly off it. The thing that helped me the most was taking the amino acids GABA and tryptophan during the day as needed to ease my anxiety and panic.
‘I truly believe that your approach to treating addiction disease is the best out there. I definitely feel that I would not have been able to successfully come off drugs had I not gone through this programme. I’m extremely grateful to have come off the drugs I was on and especially to have given up Seroxatbeefeel great today and I know it’s a result of the treatment I had and my continuing to eat the right foods and take supplements (especially eating fish and taking fish oil supplements), as well as exercising.’
Taking it slowly
In our experience, supported by scientific literature, antidepressants like Seroxat and Efexor are very difficult to come off. It is essential to taper off these drugs slowly, over at least three months, but, for some people, withdrawal symptoms continue for much longer.42 The organisation CITA (see Resources page 484 for details) gives precise, day-by-day, withdrawal charts for all antidepressants and tranquillisers. If you are on an antidepressant and have tried and failed to come off, Chapter 24 explains how to minimise withdrawal symptoms if you want to quit. But don’t try to get off an antidepressant suddenly and do not make any changes in your antidepressant medication without consulting and cooperating with your, hopefully, nutritionally informed doctor.
If you are taking more than one prescription drug it is very important to withdraw them one at a time, with a gap of ideally three months between them.
Benzos, the Zs and the frying pan
If you’ve been consuming large amounts of stimulants – caffeine, nicotine, amphetamines or cocaine – and you stop, it’s often hard to stay awake when you’re awake or asleep when you’re asleep. You might find yourself drinking more alcohol to help you relax and sleep. When you stop drinking you find it hard to switch off the anxiety and go to sleep. As a consequence you may have either been prescribed some kind of sleeping pill or tranquilliser. You are not alone. In the UK over 16 million prescriptions for what are called hypnotic (sleeping) and anxiolytic (anxiety-reducing) drugs were written out in 2004, at a cost of £37 million.
Remember the Rolling Stones’ song ‘Mother’s Little Helper’? Back in the 1960s the new miracle drugs for curing anxiety and insomnia were the benzodiazepines (the Little Helper’ referred to in the song), said to be safer and less addictive than their predecessor, the ‘non-addictive’ meprobamate (Miltown), which was later shown to be as addictive as the old drugs it had replaced. We now know that the replacement ‘benzo’ drugs are among the most addictive, and hard to get off, substances – for many people, harder than heroin.
The benzos
Benzodiazepines include diazepam (Valium), chlordiazepoxide (Librium), clonazepam (Klonopin) and then the shorter-acting alprazolam (Xanax), lorazepam (Ativan) and temazepam. In the UK, 16 million prescriptions are still written annually for these so-called ‘minor tranquillisers’ to treat anxiety, insomnia, seizures and muscle spasms. Their calming effect is due to their action on GABA: by increasing GABA receptors, the most common receptors in the brain. The benzodiazepines dull both awareness and overall brain activity. However, they also have turned out to be nearly as addictive as what they replaced. Addiction to Xanax has been reported to occur in some people in as little as three days. And, in our experience, benzodiazepines may be the most difficult drugs to withdraw from, sometimes taking months.
CAUTION You should never stop taking benzodiazepines suddenly. It is dangerous. Give yourself plenty of time to taper them off gradually.
The Zs
Then (as the patents and consequently the profits run out) along come the Zs, with names such as zolpidem (Ambien), zaleplon (Sonata) and zopiclone (Zimovane). They were introduced in the 1990s amid claims that they were a safe and non-addictive alternative to earlier drugs. Guess what? They too are every bit as addictive.
A major review in 2005 by the National Institute for Clinical Excellence (NICE) concluded that ‘there was no consistent difference between the two types of drug [benzodiazepines and Zs] for either effectiveness or safety.’43 They too can cause tolerance and withdrawal. Dependence can develop after as little as one week of continuous use. Similarly, you are also advised not to take nonbenzodiazepines for more than a few weeks at most. A bulletin regarding the drug zopiclone advises:
This medicine is generally only suitable for short-term use. If it is used for long periods or in high doses, tolerance to and dependence upon the medicine may develop, and withdrawal symptoms may occur if treatment is stopped suddenly. For this reason, treatment with this medicine should usually be stopped gradually, following the instructions given by your doctor, in order to avoid withdrawal symptoms such as rebound insomnia or anxiety, confusion, sweating, tremor, loss of appetite, irritability or convulsions.44
But these are the sleeping pills you are more likely to be offered on prescription these days, especially if you can’t sleep because you’ve stopped smoking or drinking or you have come off a stimulant drug. In 2004, there were close to 4 million prescriptions made for Zimovane (zopiclone) in the UK alone. They will certainly help if you have a short-term problem with sleeping due to a crisis, but in the long term they are not what’s needed. ‘If you have chronic insomnia,’ says Professor Jim Horne of Lough-borough University’s Sleep Research Centre, ‘it’s because you have an underlying problem and just getting an extra half an hour’s sleep, which is about all the drugs give you, is not going to help tackle it.’
Nutrition can create an escape route
Both benzodiazepines and the Zs can be very difficult to come off, and near impossible without the nutritional support we recommend in Chapter 23. In that chapter you’ll find the story of Pauline, who was hooked on Zimovane: ‘I tried so many times to come off it and failed. Once I didn’t have any for three days, couldn’t sleep and drove into the back of a car!’ Pauline finally got free using our nutrition-based approach. ‘To this day I still take these nutrients and I feel great. Goodbye Zimovane!’
We don’t recommend zepines and the Zs, except for very short-term use. It’s a case of out of the frying pan into the fire. Of course, there are newer drugs now on offer, which are claimed to be non-addictive, although this remains to be seen. First in the ring was eszopiclone (Lunesta), licensed in 2005 for long-term use after studies apparently showed no addiction and no need for an increased dose after six months. It is a variation on zopiclone and is little different in effect. In controlled trials, this drug increased the amount of sleep time by between 15 and 21.5 minutes, compared to a placebo. So why risk potential addiction for so little benefit? In the US you can barely turn on the television without seeing ads for drugs such as these vying for the market of an estimated 1.7 million benzo addicts and probably just as many Z addicts. We don’t recommend you join them. If you have already, or you are tempted to because of abstinence symptoms from other substances, the 12 Keys to Unaddicting Your Brain in Part 2 will dramatically reduce your need. If you have already developed a dependency, also read Chapter 23 to find out the most effective ways to get off these drugs.
Methadone madness
Finally, a word on methadone. Many treatment approaches for heroin addiction involve replacing the heroin with methadone, a similar drug that can be, and is, prescribed to the hundreds of thousands of methadone addicts in the UK alone. If your thinking is that heroin addiction is ‘incurable’ and your goal is to keep an addict away from crime and dodgy needles, then switching to a prescribable, controllable substance may sound like a good thing. But if the ultimate goal is to get clean, methadone is not the answer. A methadone user is still addicted. And methadone is usually harder to get off than heroin. Neither the quadrupling of methadone prescriptions in Britain between 1982 and 1992, nor the doubling of them in the US between 1999 and 2001, has had any effect on the scale of the problem of opiate addiction. Many addicts become addicted to both heroin and methadone. Substantial numbers of people are killed by methadone. Between 1993 and 2004 there were 7,072 deaths involving heroin or morphine and 3,298 deaths involving methadone.45 Currently, about 1.5 million prescriptions for methadone are written every year.46 Some doctors recommend switching to other opioid drugs such as buphenorphine, but these carry the same kind, although possibly not the same scale, of risks.47
In Chapter 27 we look at the most effective ways to get off heroin or methadone or any opioid drug for good.
None of these drugs correct the underlying imbalances that lead to addiction and dependence even though they can temporarily relieve the abstinence symptoms. Even if they do get you out of the fire, you’re still in the frying pan.
The way forward
In the next part we explain the 12 Keys to UnaddictingYour Brain, many of which, on their own, have already been shown to be more effective than prescription drugs and, in combination, are substantially more effective without any of the associated risks of addiction and side effects. There is also nothing to stop you doing these keys to recovery while you are still on a prescription drug. And as you start to feel better, duss with your doctor gradually tapering off the drug as it becomes increasingly unnecessary. How to do this is explained for each kind of drug in Part 3.
SUMMARY
Drugs prescribed for depression, anxiety and sleeplessness are usually highly addictive.
These drugs are often prescribed when people are experiencing abstinence symptoms.
Swapping one addictive drug for another – even if prescribed by a doctor – is not an answer.
It is very important to taper off any prescription drug under the supervision of a doctor.
You can begin using the keys to unaddicting your brain listed in the next section while you are tapering off prescription drugs
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