How I used CBD to get off of benzos (Ativan, Xanax, and Valium)
Let me set the stage for you.
Unfortunately, you probably already know the layout or you wouldn't be reading this.
It was really a perfect storm of hormones dropping from perimenopause (through the floor) and a reaction to oral typhoid vaccines for a trip to Hong Kong.
January of 2017.
By day 7 of the vaccine, I was in the ER with rolling panic attacks.
My doctors then put me on all kinds of blood pressure meds and heart medications to treat the "symptoms" although I never had blood pressure problems till this time.
At that point, I just spiraled further down with side effects to the medications.
I was in a hell of 24/7 anxiety with heart racing, blood pressure spiking, and multiple ER visits.
I went back to the doctor who prescribed Ativan.
Not much discussion of the back end of coming off.
I switched doctors and the new doctor then recommended Valium which I was on for about 6 weeks.
Xanax was prescribed somewhere in there but it's such a haze now.
Towards the end of this merry-go-round from hell, my husband took me into the doctor's office.
I was close to a nervous breakdown and riddled with anxiety.
That doctor put me on klonopin which was like a sledgehammer.
This was more to help me sleep since I was getting shocks of cortisol that would wake me up all night.
By day 4 of the klonopin, I was barely there.
Just sleepwalking through the day.
Let's just say I had a taste of the full range of benzodiazepines.
Another doctor put me on Lexapro (we'll save that for a separate article) and after 3 days of no sleep, an ER visit with a mis-prescribed nausea medication caused a psychotic break.
As I mentioned in my story here, I was negotiating with someone on whether I wanted to be down here any longer.
Just a point of reference...I had never had these thoughts or feelings in my life.
One panic attack when I was 24 and starting a new business but after that, nothing.
Came out of the blue.
I had to stop everything. It was literally killing me.
Break out the pill cutter to wean off and a heavy leaning on CBD.
A big study just came out on how CBD helps with opiate withdrawal (we'll look at that below).
We're not surprised knowing what we know now.
Let look at the science on CBD and benzo withdrawals.
We'll cover these topics below:
- How benzo works for anxiety
- Benzo withdrawals (including which ones are worse for withdrawal)
- Can CBD help with benzo withdrawals
- My (successful) plan for weaning off Xanax, Ativan, and Valium (not to mention Klonopin).
- How much CBD to take for benzo withdrawals
- What kind of CBD to take for benzo withdrawals
Let's start with the pathway that benzo's use for anxiety.
How benzo works for anxiety
We have an entire article on CBD and benzo's here which goes deep into the subject.
We'll get a refresher here.
Benzodiazepines (including Xanax, Ativan, Valium, Klonopin, and others) have a very specific effect in the brain.
They boost GABA levels.
GABA is our brain's natural "brake".
Scientists call this inhibitory but basically it slows down processing across the brain.
It's our main "brake" in the brain but we have quite a few gas pedals.
All three of these are opposing forces and can eat up GABA levels.
Benzodiazepines (BZs) produce most, if not all, of their pharmacological actions by specifically enhancing the effects of endogenous and exogenous GABA that are mediated by GABAA receptors.
You can learn all about how CBD supports GABA signaling here.
Here's the issue...benzo's only work in one direction.
They increase GABA levels.
- Boost it a little and you create calm.
- Boost it more and you create sluggishness and sleepiness
- More and you create hypnotic and amnesia effects
- Even more and you create anesthetic effects
Finally, boost too much and the brain can literally stop processing.
The number of deaths from benzo overdose is only rivaled by the profile of the deaths (Elvis to a slew or new rap stars).
Here's the issue...the effects of benzos are short term and they don't address the underlying of why GABA was low to begin with.
It's a temporary band-aid.
Unfortunately, GABA isn't the only lever that they hit!
Benzo withdrawals and dopamine
The highly addictive quality of benzos is well known (see CBD versus benzos for more info).
Why do we get addicted to benzos and not broccoli?
The benzos have a side-trick shared by almost all addictive drugs.
They pump the dopamine system up as well!
Dopamine is our reward chemical and it's critical in how the brain processes.
It's generally reserved to reward eating, sex, taking a test, and other things critical to our success if not survival.
Benzos directly create a rush of dopamine alongside their effects on GABA.
Here we show that benzodiazepines increase firing of dopamine neurons of the ventral tegmental area through the positive modulation of GABAA receptors in nearby interneurons.
It gets worse from there.
Benzos not only create an immediate (temporary) rush of dopamine, but they rewire the brain circuitry in a specific spot (the VTA).
The net effect of this…
In other words, while these surges of dopamine are temporary actions, they can leave the cells of the body more susceptible to creating greater dopamine surges.
This effect starts from the first usage which is why a good doctor should only prescribe for a short period of time.
The term is plasticity which means that pathways are being created or changed in the brain:
A single intra-peritoneal (i.p.) injection of a BDZ (such as midazolam or diazepam) in mice is also sufficient to induce synaptic plasticity at excitatory glutamatergic synapses onto DA neurons of the VTA
Dopamine makes us feel good and "engaged".
Enthused is a good description.
So why do we have withdrawal if we're boosting a good thing in the brain?
The withdrawal from benzos is caused by 3 things:
- Dopamine surge and brain remodeling (key to all types of addiction)
- GABA boost goes away
- Brain adjusts to GABA boost by reducing baseline
We described the dopamine effect.
The brain is quite reactive.
If you artificially boost something, it will have a direct and opposite reaction.
For example, if we create a surge of dopamine, the brain will respond by downregulating dopamine.
There's a great book, Never Enough by Judith Grisel, which really gets into this A type and B type response.
- Benzo boosts GABA and Dopamine (A response)
- Brain lowers GABA and Dopamine (B response)
It's trying to find balance...always.
That's why a common side effect of benzo withdrawal is intense anxiety (GABA) and even depression (dopamine).
The problem is that our baseline GABA was already low!
That's partially why we had the anxiety to begin with.
We just added withdrawal anxiety on top of our initial anxiety state with a drop in dopamine for neurons that are primed to receive!
You can see where this leaves us.
There are even differences in how the different benzos will affect this dire equation.
Which benzo (Xanax, Ativan, Valium, etc) has worse withdrawals
Benzo's all work on the GABA level but with subtleties that definitely affect withdrawal symptoms.
The general rule is this
- The shorter the half life (how long stays in bloodstream) and
- The lack of metabolites (breakdown chemicals which also have anti-anxiety effects)
Will result in harsher side effects.
There's an interesting correlation there if we're cynical.
The most popular benzodiazepines are:
The half life from shortest to longest:
Xanax and Ativan have no metabolites which can trail off the effects.
They come on the fastest and drop off the hardest.
Check out CBD and benzo for more detail on half-life and metabolites of the common benzos.
In our opinion, putting a person with anxiety on Xanax or Ativan beyond very short durations, is a recipe for disaster which speaks to the rate of addiction on these meds.
This probably speaks to why you can google Xanax street values and it's all over the soundcloud rap scene (not to mention their obituaries).
This brings us to our original question.
Can CBD help with benzo withdrawals?
We went through the above review of benzo pathways for a reason.
We want to clearly show if and how CBD might affect these same pathways not to mention the withdrawal symptoms from benzos such as Ativan and Xanax.
We'll start with GABA although there's so much behind the curtain for why GABA might be low (inflammation, infection, genetics, gut biome, etc).
See CBD and general anxiety disorder for that info.
Benzos don't address any of those so lets focus on where it does act.
What about CBD and GABA?
We have an entire article on CBD's effects on GABA here but some highlights.
First...the direct effect of CBD on GABA:
The maximal level of enhancement seen with either CBD or 2-AG were on α2-containing GABAA receptor subtypes, with approximately a 4-fold enhancement of the GABA EC5 evoked current, more than twice the potentiation seen with other α-subunit receptor combinations.
Let's translate this since it's so relevant to benzos.
2-AG is a naturally occuring endocannabinoid...the most prevalent in the brain.
CBD boosted the GABA "potential" by up to 4 times.
This "current" is a way of saying that a neuron is primed for action.
Maybe more importantly…
The potency of CBD increased and efficacy preserved in binary α1/α2β2 receptors indicating that their effects do not involve the classic benzodiazepine site
CBD doesn't act on the benzo sites of the GABA receptor!
And to sum it up in terms of the effect on anxiety…
Taken together these results reveal a mode of action of CBD on specifically configured GABAA receptors that may be relevant to the anticonvulsant and anxiolytic effects of the compound.
Anxiolytic is a fancy way to say anti-anxiety.
So...part of CBD's benefits for anxiety are due to GABA signaling support.
Speaking of benzos
One study found THC (CBD's cousin in cannabis with very different effects) had negative effects on anxiety while CBD had effects similar to a Valium (diazepam)!:
In contrast to the effects of delta 9-THC, mice treated with cannabidiol and nabilone spent a greater amount of time in the open arm of the maze, an effect similar to that produced by diazepam, the reference anxiolytic agent.
Again, check out the GABA article for lots of detail.
Okay...GABA is the direct lever for anxiety and CBD has an effect there.
What about the nasty dopamine-addiction effect of benzos? Does CBD also have that?
There are three things we want to look at.
- Hedonic (creates feeling of pleasure)
- Addictive (spike dopamine system)
- Normalizing (effects decrease with time)
We've covered a lot of this in our CBD safety page so we'll give an overview here.
CBD, which is non-hedonic, can reduce heroin-seeking behavior after, for example, cue-induced reinstatement.
They're actually using CBD to help with opiate withdrawal and a big study just came out on that.
The dopamine system comes into play here.
In studying CBD's powerful antipsychotic effect to normalize brain region activity, key info came out on dopamine and CBD.
CBD strongly modulates the mesolimbic dopamine (DA) system and may possess promising anti-psychotic properties.
The mesolimbic is the "reward" circuit of the brain which includes the nucleus accumbens...a prime target for addiction activity.
The key word there is "modulate".
Not boost, increase, or spike.
Modulate means to balance which speaks to the endocannabinoid systems role.
Their follow-up point is more to our question:
CBD possesses no known psychoactive or dependence-producing properties.
The third piece:
This speaks to the brain's opposing response to most drugs or chemicals (be it natural or from outside).
CBD's effects do not decrease with time and it doesn't not cause a reset of baseline dopamine activity in the brain.
That's a big cause of benzo's withdrawals.
The brain keeps lowering the bar for GABA so that when the drug wears off, you're worse off then when you started.
Only time away can remediate this effect but it's brutal.
Now THC is a different animal.
It actually creates an increase in dopamine and can be addictive, hedonic, and normalizing.
It basically increases dopamine levels and anandamide levels (the "bliss" molecule)...also an endocannabinoid.
So...first we went with the "do no harm" approach.
We want to make sure that we're not trading one addictive substance (benzos) for another (CBD).
Research backs us there.
In fact CBD is starting to show as a powerful ally for withdrawal from a host of powerful drugs including:
- And yes….cannabis (THC)
Specifically to the question of withdrawal symptoms.
The best proxy we have is the new opioid study for CBD and withdrawal.
Opioids spike both dopamine (which we're familiar with) and our natural opioid pathway (endorphins).
Benzos spike dopamine and GABA.
We discussed GABA (which is anti-anxiety) but the withdrawals mainly come from the same dopamine retraining from both drugs.
What did the new double-blind study find for opioid withdrawal symptoms?:
Acute CBD administration, in contrast to placebo, significantly reduced both craving and anxiety induced by the presentation of salient drug cues compared with neutral cues.
There's the anxiety which is also a key withdrawal symptom for benzos like Xanax, Ativan, and Valium.
Maybe more fascinating was this piece:
CBD also showed significant protracted effects on these measures 7 days after the final short-term (3-day) CBD exposure.
Just to round it out:
In addition, CBD reduced the drug cue–induced physiological measures of heart rate and salivary cortisol levels. There were no significant effects on cognition, and there were no serious adverse effects.
We've covered CBD and cortisol in-depth here.
Cortisol is our main stress chemical and you know its effects all to well.
Quickened heart rate, increased blood pressure, constriction.
Basically the tangible physical effects of anxiety!
CBD has been shown to lower cortisol levels (read more here).
Keep in mind that we're only talking about the positive effects on withdrawal from CBD.
Maybe more importantly are CBD's effects on the root causes of anxiety which caused us to take benzos to begin with!
Maybe the most powerful effect is CBD's result on neurogenesis...building new brain mass and connections within the anxiety circuit.
Check out CBD and neurogenesis in the hippocampus for anxiety as an example.
Okay...that's lots of research.
Let's get practical.
How did I use CBD to offset benzo withdrawals specifically.
My (successful) plan for weaning off Xanax, Ativan, and Valium (not to mention Klonopin)
First, I had purchased a little blue pill cutter.
It is basically a blue clam-like box with a razor blade in it.
I established a schedule over a few weeks and I would slice a sliver off the benzo at the same time each 3-4 days on average.
The goal is to slowly wean off of the benzo rather than face the drop-off!
Xanax and Ativan are especially sinister in this effect.
Don't set yourself up to fail.
In conjunction with this weaning process, I have a regimen of CBD.
My goal was 300 mg per day.
That's a lot but research is showing this is the ideal amount for neurogenesis (rebuilding those pathways that benzos hijacked).
There's interesting research showing that additive medications actually block the brain's ability to unlearn the bad habits here.
More importantly, this gets to the heart of why many people might have anxiety to begin with..
Brain or connectivity loss due to:
- Chronic inflammation
- Infection at key points of development (before birth and after)
- Faulty immune response (think autoimmune)
- Gut dysbiosis - gut bacteria out of whack (they can actually synthesize GABA)
Check out the article on hippocampus neurogenesis and CBD as an example.
Going over 300 mg still has the anti anxiety effect (immediate, short term) but the neurogenesis (long term) effects starts to go down as another pathway is turned on (TRPV).
In the opioid withdrawal study above, they administered 400 or 800 mg daily (one a day).
They may not have known of the trailing neurogenesis dose bell curve (see mg of CBD for anxiety here).
Personally, I take the 150 mg in the morning and 150 before bed.
Cortisol spikes in the morning naturally and the half life for CBD is about 6-8 hours.
Sleep is critical for brain repair and maintenance so I like to split the doses.
If I felt withdrawal symptoms or some outside stress, I might take another dose between my scheduled ones.
I went through all of that with a 14 and 16 year olds in the house so God knows that stress doesn't take a break while you're trying to wean off of benzos.
Some other helpful long term aids I found for benzo withdrawal and anxiety in general:
- Mindful meditation (see effect on neurogenesis in anxiety circuit)
- Exercise (just 30 minutes of anything you like) 4-5 times a week (see effect here)
- Magnesium - 400 mg of glycinate or theorate (good for migraines with aura as well)
- Methylated B's - since I have MTHFR (40% of the population)
- Histamine diet - histamine is excitatory and I have an issue there
- Bio-identical hormones (perimenopause) - progesterone is a huge deal!
I'll cover the SSRI's I had to get off of separately.
Lexapro was brutal!
So where am I now?
Zero benzos, SSRI's, heart meds, blood pressure meds, or any medication.
I'm about 98% in terms of stress response but perimenopause is really hitting me hard.
If you need a powerful example of CBD, check out the article on the woman who can't feel pain or anxiety (or depression for that matter) here.
We don't want to go that far but a little less would be fine!
What kind of CBD to take for benzo withdrawals
When I first started with CBD (after much deliberation and before much research), I tried 3-4 of the biggest brands out there.
They all pitched full spectrum CBD...saying it was better.
Synergistic. "Entourage Effect". More natural. Etc.
I learned the hard way.
First, none of the research (above or online) is on full spectrum.
It's on CBD by itself.
The entourage effect actually speaks to how CBD would offset the negatives of THC (see CBD versus THC for anxiety here).
When I took those brands (very expensive by the way), I had all these side effects which were consistent with an allergy or histamine response.
That's 40-60% of the population!
Higher for women and higher if over age 40.
CBD Isolate in MCT oil (coconut extraction) is the cleanest way to get the benefit of CBD.
We literally crafted IndigoNaturals based on research and this approach.
Since we and our families take it, the following is required:
- Organically grown in the US
- 3rd party tested (twice actually)
- CO2 extraction
- Zero THC
- Pesticide free
- Mold free
- Solvent free
- Heavy metal free
If you read the article on CBD versus benzos, you're probably going to get a little angry.
We know what it's like to so desperately need relief from crushing anxiety.
I've walked into a doctor's office literally coming out of my skin.
Just knowing everything we now know from NIH research, to write a script for Xanax or Ativan which are short term bandaids and addiction bombs is….well...at best suspect.
Especially in light of the research on CBD and anxiety.