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THE TOLERANCE THAT BUILDS IN DAYS
You Already Know How It Starts
A Panic Attack
A Sleepless Week
A Doctor With A Prescription Pad
This Is What The Brain Looks Like After Years Of Having Its Calm Delivered Externally
THIS NEWSLETTER IS FOR INFORMATIONAL PURPOSES ONLY. NOTHING IN THIS CONTENT CONSTITUTES MEDICAL, PSYCHOLOGICAL, OR PROFESSIONAL ADVICE. ALWAYS CONSULT A QUALIFIED HEALTHCARE PROFESSIONAL BEFORE MAKING ANY HEALTH RELATED DECISIONS.
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OKAY BACK FROM INSIDE YOUR CHEST 🫀
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DOWNREGULATION 📉
The Brain Adapts To Everything
That Is Its Greatest Strength
In The Context Of Benzodiazepines
It Is The Source Of The Problem
Every Time A Benzo Amplifies The GABA A Receptor Beyond Its Natural Range
The Brain Interprets This As Overstimulation
It Responds By Reducing The Number Of GABA A Receptors Available
Downregulation
It Also Reduces The Sensitivity Of The Receptors That Remain
The Brain's Natural Calming System Becomes Structurally Weaker
The Braking System That Was Already Insufficient Has Now Been Made Less Capable
The Drug Is No Longer Supplementing The System
It Is The System
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TOLERANCE IN DAYS ⏱️
Most Substances Build Tolerance Over Weeks Or Months
Benzodiazepines Begin Building Tolerance Within Days
The Anti Anxiety Effect Can Start Diminishing Within A Week
The Sleep Effect Often Fades Within Two Weeks
This Is Why The Two To Four Week Guideline Exists
It Is Not Arbitrary
It Is Based On The Approximate Timeline Of When
The Drug Stops Being Medicine And Starts Being Maintenance
Many Long Term Benzo Users Report That Their Current Dose Does Nothing
Except Prevent Withdrawal
They Are Not Calm
They Are Not Sleeping Better
They Are Simply Avoiding The Consequences Of Not Taking The Pill
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INTERDOSE WITHDRAWAL 🔄
Short Acting Benzodiazepines Create A Specific Problem
Alprazolam
Xanax
Lorazepam
Ativan
These Have Short Half Lives
They Leave The System Quickly
For A Patient Taking Xanax Three Times A Day
The Body Begins Withdrawing Between Each Dose
Anxiety Spikes Four To Six Hours After The Last Pill
Racing Heart
Sweating
Dread
This Is Not The Original Anxiety Returning
This Is Withdrawal From A Dose Taken Earlier That Day
Many Patients And Many Doctors Interpret This As Evidence That The Drug Is Necessary
That The Anxiety Is Still There And Would Be Worse Without It
The Drug Is Generating The Symptom It Is Being Used To Treat
The Prescription Continues
PROTRACTED WITHDRAWAL 🕐
Acute Benzo Withdrawal Lasts Days To Weeks
For A Significant Percentage Of Long Term Users
Something Else Follows
Protracted Withdrawal Syndrome
Symptoms That Persist For Months
Sometimes Longer
Cognitive Impairment
Difficulty With Memory And Concentration. Emotional Numbness
A Burning Or Electric Sensation Across The Skin
Sensitivity To Light, Sound, And Touch At Levels That Make Normal Life Difficult
Insomnia That Does Not Respond To Standard Sleep Hygiene
This Syndrome Is Not In Most Medical Textbooks
It Is Not Widely Recognized In Primary Care
Patients Reporting These Symptoms After Stopping A Prescribed Medication Are
Frequently Told The Symptoms Are Psychiatric
That They Need A New Prescription
The Drug That Caused The Condition Is Offered As The Solution To The Condition
THE PATH BACK 🌱
The Ashton Protocol Recommends A Slow Taper
First Switching To A Long Acting Benzodiazepine Such As Diazepam
Which Stays In The System Long Enough To Prevent The Sharp Peaks And Valleys Of Shorter Acting Drugs
Then Reducing The Dose By No More Than Ten Percent Every Two To Four Weeks
For A Patient On A High Dose After Many Years
A Full Taper Can Take One To Three Years
There Is No Medication Assisted Treatment For Benzos The Way Buprenorphine Exists For Opioids
There Is No Fast Route
The Brain That Had Its Calming System Managed Externally For Years Has To Rebuild Its Own
The Receptors That Were Downregulated Have To Upregulate
The Natural GABA Production That Was Made Unnecessary Has To Become Necessary Again
That Process Cannot Be Rushed
The Brain Does Recover
It Simply Operates On A Timeline That Is Longer Than Anyone Is Prepared For
The Drug That Was Handed Over In Under Five Minutes In A Doctor's Office
Takes Years To Undo
