GABA/glutamate system and how it might work with benzodiazepines and Lamictal

pills_lamictalThis post is mostly written by Rhi Griffith on a benzo board we are both on. It’s the discussion between me and her. I’m posting it so that those of you who are so inclined might be able to do more research. It is a small wealth of information already, but certainly it would be nice to understand these issues much more deeply and perhaps if we did we could help people not suffer so much.

The fact is that while I talk about benzo withdrawal a lot lately, I was on six different drugs all of which I had issues when I withdrew from them. Lamictal was markedly the worst along with the Klonopin. All benzos have this reputation if you speak to those in the know. Lamictal, on the other hand, is a relatively new comer in the world of psych drugs and so the sometimes nasty withdrawal syndrome and damage it causes is not as well known — in fact it is virtually unknown.

What this person from the board is talking about is not new information for me, but it’s information that I personally don’t really know what to do with other than it supplying me with some vague rational as to why this particular medication combo: Lamictal and Benzodiazepine is particularly problematic. I don’t have a terribly scientific mind and certainly now in my current condition I can’t do heavy research. I hope others might take this post and the information it provides as a spring board and do some research.

For more info on Lamictal see here.

For info on benzos here.

This is the initial post from the board, by Rhi Griffith:

The more research I do about glutamate, the more I realize its importance in benzo function and withdrawal. For those of you who like to do research I highly recommend taking some time to look into glutamate neurotransmission.

For example, this morning I found the abstract of an intriguing study about chronic unremitting tendon pain and glutamate receptors that made me think of some of the people on this board who have chronic physical pain as a protracted withdrawal symptom.

Also, glutamate levels are altered during exercise in ways that suggest explanations for how exercise can both make withdrawal symptoms better and make them worse.

There is something called “excitotoxicity” that is the main cause of damage to brain cells in traumatic brain injury and stroke, and it’s caused by excess glutamate activity.  (Excitotoxicity is extensively researched and it also causes brain damage in less extreme conditions.)

The reason glutamate is relevant is because it’s the partner to GABA. The two complement and balance each other, like two sides of a seesaw; you never have one without the other. So if one is out of balance, so is the other. If GABA function is screwed up, there’s going to be something screwed up with the glutamate function as well. And the only neurotransmitter that is more used in the body than GABA is–you guessed it–glutamate.

Just a note, glutamate is an amino acid, so if you start Googling glutamate you will find stuff about its role in diet and such.  And there’s something called glutamine that bodybuilders use. Not the same thing.

Another note, for Lamictal users: Lamictal (lamotrigine) acts on glutamate receptors and glutamate release, so if you have both benzos and Lamictal in your system, be extra extra careful about the changes you make, because you’ve got a double jeopardy situation.  When you go off benzos it’s like you’re letting off the brakes on the glutamate system; when you go off Lamictal it’s like you’re pushing down the gas pedal on the glutamate system.  You want to be careful when you’re doing both at the same time.

Okay, enough with the long science nerdly post…

I wrote this response:

I’m familiar with all the stuff you talk about and I was on Lamictal. I had a very very nasty withdrawal from Lamictal as well and in fact all the severe physical symptoms started during the Lamictal withdrawal.

In my research, though not highly scientific given my limitations at this time, I found all those connections one way or another…including hearing from folks like you during the process on my blog.

I know the GABA/glutamate system was covered either in a post or in comments on my site once. I just took a look to see if I could share it with you but I can’t find it. It’s really hard to search comments on wordpress.

Thanks for sharing and reminding me. It’s good to have some scientific understanding to pass on to skeptics.

Again from Rhi Griffith:

Gianna, I was just going to leave you a note about this. You ABSOLUTELY have scientific support to back you up.  There is TONS of stuff out there about the importance of glutamate.  It’s our body’s primary neurotransmitter.  Glutamate and glutamate receptors (which are what Lamictal works on, both of those things) are involved in one way or another in every single bodily function.

Also, the nervous system is incredibly complex, as complex as a forest ecosystem. Anybody who gives you any crap about what’s happened to you is just completely ignorant and nobody who isn’t willing to put in the time to understand this stuff has any right to even discuss the subject with you.  Sorry, I know I’m cranky because I’m having Benzo Morning, but it’s also true. Please tell them I said so.

The only thing one can possibly be skeptical about is that anyone could possibly think you can screw around with the glutamate/GABA system and not expect all sorts of trouble to result.

I think we are going to see some serious consequences from all the overuse of Lamictal right now–it’s being prescribed for everything under the sun just the way Neurontin was for a while, and Neurontin is problematic enough but Lamictal is exponentially more dangerous.  Lamictal is every bit as dangerous as benzos.

And further into the thread Rhi Griffith covers the issue of Monosodium Glutamate (MSG):

Regarding MSG:  Yes, MSG is a big problem.  It is for me, anyway, and I would recommend anyone who is dealing with GABA/glutamate issues–which would be anyone dealing with benzo or Lamictal withdrawal–avoid it.  If you are having protracted withdrawal this is definitely worth being aware of, because it’s everywhere and you’re eating it all the time and it can’t be helping.

MSG is short for “monosodium glutamate”. The sodium isn’t the issue, it’s the glutamate that’s the whole point of MSG.

This article does a good job of explaining it. Russell Blaylock is reputable and respected in the anti-bad-food world.

Briefly, “glutamate” is an amino acid.  (Glutamate is the same as “glutamic acid,” different words for the same thing.)  Amino acids are the building blocks of protein.  Different amino acids are bound together in different ways to make different kinds of protein.  We eat a lot of natural glutamate every day whenever we eat protein.  However, natural glutamate in protein requires time and energy to digest and is only slowly broken down and absorbed by our bodies at a rate our bodies know how to handle.

But we humans have figured out all kinds of ways to process our food, and we use all kinds of tricks to break up proteins (it’s called “denaturing” them) into their component amino acids.  When we do that we are able to free up the glutamate so it’s separate and by itself.  When it’s separate like that it floods into our system rapidly.  Also, the free glutamate that’s added to foods is added in much larger amounts than it would be found naturally.

The reason free glutamate is added to foods is because it’s a flavor enhancer like salt or sugar.  Our tongues actually have special taste buds that detect the taste of glutamate, just like we have taste buds for sweet, salty, bitter, and sour.  We don’t have a word in English for the taste of glutamate but there is a Japanese word for it, “umami.” It’s a taste you get in protein foods, especially when they are cooked, like cooked meat or fish or poultry.  It makes things taste yummy and makes you want to eat more.

But people don’t like to see “MSG” on food labels, so the food processing industry (almost as trustworthy as the pharmaceutical industry) developed other ways to create free glutamate by breaking up protein.  Then they can call it things like “hydrolyzed protein”, “autolyzed yeast”, “yeast protein,” or even (my favorite) “natural flavors”.

A website with lots of information about this is “truthinlabeling.org” (Missy mentioned that one) and another one is “msgtruth”.  They have lists of the dozens of names you will find on food labels that are free glutamate in disguise.  It’s pretty overwhelming at first when you start finding out about it, but really if you just cut out the worst offenders that’s more than half the battle:  avoid anything that says MSG, hydrolyzed anything, autolysed anything, yeast anything, anything glutamate, denatured anything, vegetable protein anything.

You can pretty much count on fast food, cafeteria/buffet food, and restaurant chain food to have free glutamate in some form in it.

Unfortunately there’s often a lot of free glutamate in Asian food even with no MSG added because it’s naturally present in fish sauce and soy sauce and seaweed.

Just one more thing about free glutamate in food: you will hear and read people say that glutamate doesn’t cross the blood-brain barrier.  That’s an old belief that has been proven to be wrong.  Glutamate DOES cross the blood-brain barrier, especially in those parts of the brain most vulnerable to damage by it, unfortunately, like the hippocampus.

I personally have found that glutamate in food makes my symptoms worse.  My daughters call it “being poisoned,” as in “Mom, you’re in tears and curled up in fetal position, did you get poisoned?”

Your mileage may vary of course, but it’s worth looking into.

Two other articles on GABA/Glutamate

For more info on Lamictal see here.

For info on benzos here.

*it is potentially dangerous to come off medications without careful planning. Please be sure to be well educated before undertaking any sort of discontinuation of medications. Do not assume your MD will know how to do it either. They are generally not trained in discontiuation. They don’t always understand that they don’t know how to help either. See: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up

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About Monica Cassani

Author/Editor Beyond Meds: Everything Matters