What is happening in the brain!

Detailed Explanation of GABA, Glutamate and Brain Structures.

This is important to understand exactly what is happening to the brain and CNS and hence every aspect of a person’s body and mind, with benzo use, withdrawal and protracted symptoms.

Posted by Rosalind Jones on Beating Benzos group. This was written several years ago by a member of Benzo Buddies and very informative on the brain and its structures.

First off – let’s start with GABA and Glutamate. Most of you may know how this works by this point. But for those that don’t, we have a huge nervous system of millions of nerves (neurons).  They don’t “touch” each other. They are separated by a tiny space in between. However, they communicate via chemicals. The 2 MAIN chemicals in the entire nervous system are the BIG GUNS.  They are GABA and Glutamate. They are BOTH at work at ALL times in the CNS.  It isn’t like one is working and then the other is working. They are BOTH ALWAYS working in tandem to control every aspect of movement, sensation  – everything. They take the incoming information and appropriately pass it along – they “trim up” the information appropriately so that we can process it.  They are like the steel structure of a building.  The entire building needs a steel structure to stand.  

GABA is inhibitory.  If a nerve releases GABA – it is to Inhibit function – this could be to “slow it down” or it could be to “limit the sensory input” so that we can process it.  In the same way, GABA might be released to help “steady” your hand while doing something like painting a very detailed painting.  GABA “shores up” movements to make them more fluid.   That’s just in a nutshell. Of COURSE it does a lot more than this, but the idea is that GABA is present in the ENTIRE CNS and ALWAYS working to balance every sensation, movement, etc.

Likewise, Glutamate is the balance to GABA. It is the “excitatory” transmitter. It fires to speed things up – to initiate action – to make things “go”.  There’s a lot more to it, but Glutamate is kinda the opposite of GABA.   

BOTH are required to work at all times.  Neurons are ALL ALWAYS firing off GABA and Glutamate on a endless cycle all throughout the nervous system. It’s quite amazing really.

What does a benzo do?  If a person is anxious – they may be so stressed that they cannot overcome a very traumatic event or anxious situation.  If a doctor prescribes a benzo – the benzo comes in and sorta “holds the door open” for ALL the GABA in the system to FLOOD into the nerves – even when that is not what the nerves would actually want to occur. The immediate effect is that EVERYTHING ni the body SLOWS DOWN and is inhibited. This might be helpful during surgery, for anesthesia, for a seizure disorder.  Yes – the benzo – by definition – will act on GABA and “slow everything down”.  And yes – the net effect of this is that a person may feel drowsy, calm, less anxious… everything is being inhibited.    And in general, taking a benzo for “one day”  is okay. When the benzo is gone, the body just reverts back to regular operation. 

HOWEVER, if a person takes a benzo day after day,  while indeed the person feels less anxious, the body begins to realize that it cannot DO the things it needs to do in this very slowed-down neuron state. It cannot make hormones. It cannot create enzymes. It cannot digest correctly. It cannot keep a heart going efficiently. It cannot get enough oxygen- and on and on. The body NEEDS to run at “normal” speed – not this “inhibited speed” all slowed down.  

But what can the body do? It cannot “remove the benzo” from the system. The only choice the body has to maintain a regular speed is to do two things ..  It can TURN OFF it’s own GABA receptors – thereby rendering those benzos unable to affect the GABA in the system. And it can grow MORE excitatory Glutamate receptors to counteract the slow-down.  And that’s kinda exactly what happens….

Only – this isn’t true balance either.  The body does the best it can – but over time, things begin to suffer.  The body cannot make enough serotonin in this state. Or dopamine. Some things get made in excess – and other things do not get made enough!  During this time, a person may not be aware this is all going on. He may not be able to perceive any difference. But ONE day – the person may wake up sad – or not sleeping well – or unable to remember things fully – or his vision doesn’t look right….and it becomes apparent the person has “hit tolerance”.  The body is taking the same amount of drug -but try as it might, it just cannot overcome what has occurred. It can take weeks, months or years to hit tolerance. Some people do and some don’t before trying to get off benzos.  (I did. – it took me 9 months to hit tolerance.  But it was fast.  Once I hit it, I could not sleep more than 6 hours on all that klonopin AND Ambien! I couldn’t remember things last week. I was crying all the time… something was wrong.)

The process to reverse this takes a while.  GABA receptors have to UPregulate and effectively “reopen” or “grow back”.  Glutamate receptors must DOWNregulate, or effectively “turn off” or “prune back”.  And IN this mix, all the smaller monoamines (neurotransmitters like serotonin, dopamine, norepinephrine) must somehow find a way to synthesize in the mix.  Through weeks and months the body is rebuilding millions of neurons, and changing pathways, rebuilding GABA, downregulating Glutamate, rebuilding serotonin, rebuilding dopamine, rebuilding norepinephrine.  And ALL the enzymes and hormones that need to be made are attempting to be made while this is going on.  Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times – ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn’t completely fallen – but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower – WHILE people were coming and going and trying to work in the building!  You’d have to set up a temporary elevator – but when you needed to fix part of that area, you’d have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You’d have to build, work around, then tear down, then build again, then work around, then build… ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted… ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has “got it right” for a day or so – but then the building shifts and the brain works on something else – and it’s chaos again while another temporary pathway is set up to reroute function until repairs are made.  

And just like the Twin Towers- it’s possible – but the building is a major effort -and it takes a good year or more sometimes.  

(Now look at the new Tower that stands at Ground Zero!  It’s taller, stronger, and a symbol of freedom.  JUST like you will be!  )

So – okay – what is happening in that chaos?  What parts of the brain are responsible for these symptoms?  

Now, I don’t “know” the following based on research, because not enough research has been done yet  – but based on my studies in neuroanatomy and my own withdrawal experiences, here is how I have analyzed what is “happening” during wave symptoms. Remember, I have had to look at radiology reports of brain damage and estimate what a patient might present with – so this is very similar. Instead of a radiology report showing me what has been damaged, I’m using my own brain symptoms to surmise what is going on….

Let me first list brain structures and their functions. This will help you understand where things happen in the brain and when symptoms occur, what may be happening.

BRAIN STRUCTURES 

– amygdala  – This is the FEAR center in the brain. It’s a tiny part in the middle of your brain. Fear is protective and it’s GREAT if you need to assess something that is dangerous and to ACT  – like if a rabid dog were chasing you. – but it’s hard in recovery when it’s all you feel for months! But the FEAR is not truly in your MIND. It’s in your BRAIN.  There is too much glutamate acting here in the amygdala and not enough GABA. So the nerves are firing off in the fear center when nothing scary is really there in your environment.  It is normal for that to happen given the circumstance physiologically. But it feels awful, doesn’t it?  I know.  But it’s just a brain structure. This can account for fear, agoraphobia, fear of water, fear of anything.  It’s not that you’re really “scared” of the moon – it’s that you’re in almost constant fear because this brain structure is healing. The glutamate is pruning back. The GABA receptors are opening back up.  It may or may not continue for awhile. It will abate. Then come back. But eventually, the brain will get it right.  

-Hippocampus – This is the “memory” center of the brain. It ties in old memories to emotions.  The same thing is happening here that is happening in the amygdala with GABA and Glutamate. So – voila. You get intrusive memories from ALL times in your life.  It’s wild and wicked and wooly. But it can’t hurt you. And if you can learn to visualize this as what is happening – then you can learn to be objective and realize it’s normal.  And like the amygdala – it will come and go and frustrate you, but it will go away when the physiology is restored.

Hypothalamus This is the structure that is responsible for regulating body temperature. In early withdrawal, my body temperature would drop to 96 degrees in waves! Then 3 hours later, it would return to normal. I’d literally freeze in terror in bed for hours.  I am sure it is more complicated that JUST the hypothalamus, but I could picture this part of my brain retuning and restructuring, and it was less scary that way. 

The following structures in the brain are part of the “gray matter” or the “cortex “and what we consider to be the “higher brain”- the thinking and processing parts. 

Frontal Lobe This is the part of the brain behind the front of the skull. It is responsible for planning things. For making decisions. For inhibiting emotions appropriately.  It is the part of the brain you need if you want to make a sandwich and need to get out the ingredients and actually make the sandwich. I have seen people with brain injury be able to TELL you how to make a sandwich – but when they are standing there in front of all the ingredients, they cannot actually move to act to make it! They have frontal lobe damage. They can TELL someone how to make it. But they cannot themselves initiate doing it! As you can imagine, with therapy, and time to heal, this goes away. And we are a lot like this – but it goes away for us, too.  I could not organize my children’t toys just 4 months ago.  Not a simple room of toys. I didn’t know where to start and I literally could not mentally do it. I imagine this is partly why.  No frontal lobe GABA.  And too much Glutamate.   But now, check out this post I”m typing.  Obviously that changed. 

This calms down and these things come back. 

Occipital Lobe This is the vision center. t’s at the back of your skull.   In recovery, my nerves have been all whacked here. I see things as too bright – possible due to this lobe – and/or the actual visual nerves in the eyes.  But no doubt people “see things” that aren’t there.  Vision is distorted. Things go blurry.  Colors are totally off.Brightness is off.  There are a hundred symptoms possible in vision alone!  But again – it’s a matter of time.

Vestibular System This is the system of semi-circular canals in the inner ear that are responsible for making you feel balanced in space.  When this is “off” or damaged temporarily, you feel dizzy. Oh man, was I dizzy. Early off – I felt like I lived in a funhouse.  Over time, a combination of this vestibular system and my damaged visual system made things look like they were “leaning”. To this day, one eye sees things “correctly” and the other eye sees things as SLIGHTLY leaning. And it’s not that the eye itself is seeing them that way.  The healing vestibular system is working WITH the eye to “tell” the brain that that object looks like it is “moving left-wards” or “leaning”. But it isn’t.  In waves, this can happen bad – and then be GONE – poof – in a window. This is just the vestibular system healing. It’s gotten WAY better. 

Temporal Lobe  These lobes are on the side of your brain on each side near your ear. It makes up the whole left and ride side of your brain.  This is where auditory information is processed, including hearing itself, but also the “Meaning” of what we are hearing, as well as part of speech and language, emotion, and buncha other stuff.  In early recovery, someone was talking to me and I couldn’t tell you what they said past the first sentence.  My auditory processing was ALL messed up.  I couldn’t picture what a person was saying to me in real time – and by the time I caught up to them, I was lost and they were talking about something else! Also – When I was laying there in bed, I could “hear” things that weren’t there in the noise of my box fan. I’d hear the fan blowing -but I also “heard” like sickening circus music. I believe this is because there is noise coming into my ear – but my brain cannot adequately “prune” what it is hearing at different frequencies because there is not enough GABA to inhibit it to create something meaningful.  There was all this “noise” and my brain was just firing off glutamate.  So instead of actually “processing” the noise – it was firing off ideas about what it was hearing – and they were ALL wrong.  I would be hearing what sounded like circus music – and at the same time, my poor brain was looking through my hippocampus to find all the memories I ever had of being at the circus – and then I’m reliving those memories- and at the same time, my amygdala is getting fired upon – so I’m in fear. So I’m a quivering mess of a person laying in the bed hearing and seeing things and remembering times in my childhood and scared to pieces.  Seriously? Yes – I felt crazy. But not in my MIND.  It was my BRAIN.  It’s the BRAIN.  And it’s normal. The structures in the brain are “obligated” to work this way.

That brings me to my next point… WHY do all of us in benzo recovery have generally the same symptoms? Well – it may make you feel calmer to realize that our brain structures are NOT broken. They are doing EXACTLY what they are supposed to do under the circumstances.  And all of our perceptions of what we are seeing, feeling, hearing- are normal because the parts of our brains that are firing off are doing so because a) They still DO work. b) They work just as they were intended to. c) They are actually healing as all this firing is going on.  

Why the depression and anxiety? It’s so complicated, but this WHOLE system is interdependent. At that SAME time as ALL this stuff is going on, the entire body is trying to heal in every place GABA and Glutamate naturally act (uh – and that would be – EVERYWHERE).

The intestines, stomach, eye balls, skin, toenails – seriously – where do we NOT have nerves?  

Anything we didn’t have as a pre-existing condition is fair game for being affected by the recovery that takes place.  

This includes the body’s own ability to make serotonin that is required to feel “balanced” and “happy”. And you guessed it. This is not being made very efficiently in a building that is under major construction. So – you may get a day or so of feeling good – and then – boom – that’s gone until you can make enough serotonin.

Oh – and by the way – serotonin HELPS TELL THE NERVES WHEN TO RELEASE GABA AND GLUTAMATE! Ha! 

So on top of needing GABA to make serotonin, you need serotonin to regulate the release of GABA into the system!  

How much more interconnected can you get?  God – it’s a wonder it knows how to heal at all!  But it does!  Amazing to me, really.

This is just some limited information to give an idea of what is going on in neurophysiology.  Obviously this is very cursory and not super detailed. But there is a bigger point here than “what parts of the brain are affected”.  

The point REALLY is – IF  YOU KNOW that symptoms are tied to parts of a NORMAL brain under reconstruction, then you can begin to rest a little more easy in your mind that under the circumstances, the symptoms themselves are a GOOD sign.  

Without intrusive memories – as awful as they are – especially when mixed with fear – but without them, your memory itself would not heal.  It IS healing – and when you are having intrusives, try to think of it that way.  Tap your finger to your temple and say to yourself, “I know what this is. This is my hippocampus healing! Ha!” Because it IS.  And if it were NOT healing, you would not be having those symptoms.  ANY part of the brain or body that needs to heal is going to “experience” something in the form of symptoms – and you are going to notice that. But it is part of  process that is inevitably returning to the balance that it could not achieve while we were still putting those pills in our mouths.  (And if you’re tapering, this is still happening – just likely with less trauma than with what happened to me when I cold-turkeyed.)

So – when you have symptoms – know that symptoms themselves are a way for you to know that healing is taking place.

And finally – realize that the DRUG is GONE.  This is withdrawal – yes – okay -we call it withdrawal –  but it’s really “recovery”.

The benzos are gone. The “evil drug” is no longer there.  The symptoms that are left are not the “enemy”. That’s our brains doing the EXACT right thing. What’s happening to our brain at this point is not the “benzo beast”  It’s OUR BRAIN recovering.

Not to degrade anyone who calls it the benzo beast  – I get that. But just so you know – you’re not really fighting a beast.

You don’t even need to fight it.  Just wait it out. All that reconstruction is happening on your building. 

And soon – the frame will be back standing, stronger than before. The furniture will be inside. The elevators will go all the way up to the top again.   And the people can come and go and work like a well-oiled machine.  

Don’t feel you need to fight the reconstruction. It’s just healing. And all that is happening to us is a sign of that.

Hope this helps somebody a little – or maybe a family member.  

And if you ARE a family member, please realize that those of us in recovery are no more in control of how we feel or what we experience than people who have undergone brain trauma in a car accident. Please be patient with us, because our brains are healing and we are in the process of reconstruction – and our function is temporarily enabled, then disabled, then enabled, then disabled again.  And that is totally normal and expected.  We can no more help that than a person can “want” to wake up out of a coma. It happens when the brain is able – and not out of sheer will.  But it does happen. So please stand by us and say loving things and reassure us every day. Notice our improvements and tell us what they are.  Encourage us when we feel good.  And when we don’t, just hold us and hug us and tell us it will be okay.  Anything you would say or do for a family member that had had a car accident and a brain injury – please do that for us.  And be patient… we are getting there.