Paradoxical Symptoms, Tolerance and Kindling

Mikhaila Peterson mentioned that Dr Peterson had experienced paradoxical symptoms.

Paradoxical symptoms are those that are the opposite of what we would desire from a medication, so in the case of Klonopin, they would likely include severe agitation, akathisia, mood destabilisation and many more. Only a small percentage of benzodiazepine users experience these symptoms..

It appears as though these symptoms occurred when he tried to reinstate the medication after a failed cold turkey attempt.

What we see in the recovery community, time and time again, is people who experienced a central nervous system shock from a rapid taper or a cold turkey, reinstate, only to find that the medication no longer works as expected. This seems to be the case with Dr Peterson. This process is informally known as ‘kindling’ and also occurs with alcohol withdrawal, which also has a big effect on the GABAa receptor sites that benzodiazepines bind to.

As the Benzodiazepine Information Coalition stated in their excellent video, this is one of the toughest situations a sufferer can be in. They are essentially between a rock and a hard place and the path to navigating successfully through to a state of health is extremely difficult.

Mikhaila Peterson stated that Dr Peterson had even tried to ‘taper’ and ‘micro-taper’.

Tapering is the process of lowering the dose of a medication, usually between a period of months and years, often in 4 week decrements or similar.

Mico-tapering achieves the same goal in smaller, more frequent decrements. Patients will often shave off their pills with razor blades and cut a tiny amount each day using a scale, or they will use a liquid solution to withdraw small amounts every or most days.

The fact that Dr Peterson was unable to do this speaks to the level of his suffering. What we must understand however, is that for many patients, not just those with paradoxical symptoms, tapering itself can be a long, brutal and life changing process.

The statistics on those who find tapering particularly hard are not easy to get hold of, but the number of people who are members of Facebook support groups and sites such as BenzoBuddies attests to the fact that a highly significant minority of people who have taken a benzodiazepine for more than a few weeks often struggle to taper and find their health and financial security highly compromised.

The World Benzodiazepine Awareness Day Website states that

“An estimated 50-80% of people who have taken benzodiazepines continually for many months or longer will experience withdrawal symptoms when reducing the dose; a smaller percentage may experience severe withdrawal. People who have been taking benzodiazepines regularly for many years (and sometimes for shorter periods) can have symptoms of withdrawal most of the time, even when they have not reduced the dose— tolerance and/or interdose withdrawal. They can experience a phenomenon referred to as “medication spellbinding”, and do not connect that their poor physical and mental health is related to their long-term use of the benzodiazepines (or in the case of other prescribed drug dependencies, other psychoactive medications).”

Withdrawal Symptoms

Dr Peterson was said to have experienced akathisia and suicidal ideation, along with becoming critically ill with pneumonia. These are some of the most serious symptoms sufferers can experience.

As the Benzodiazepine Information Coalition pointed out, pneumonia is often treated with fluoroquinolone antibiotics, which block benzodiazepines from binding the GABAa receptors and thus can make withdrawal many times worse and should be avoided at all costs.

Benzodiazepines are also respiratory depressants and can make people more susceptible to conditions such as pneumonia.

Mikhaila Peterson stated that this was the most scary thing her family had had to ever deal with, even more so than his wife’s cancer diagnoses in 2019 and their combined autoimmune issues.

This is something many in the recovery community can relate to and we have every sympathy with the family and Dr Peterson.

Protracted Withdrawal and Detox Centers

Experience has taught us as a community to avoid detox centres in almost all cases.

In their initial video back in September 2019, the family talked about the detox centre they had elected to send Dr Peterson to.

At the time, the strategy was to use Ativan to taper from Klonopin. The idea was, according to Mikhaila Peterson, to use a shorter acting benzodiazepine to help get off a longer acting one.

Looking at the table again, we can see that Ativan has a much shorter half-life elimination time than Klonopin.