5/17/2016

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Intro

Reducing withdrawal symptoms using

a simple 3 phase program

Lars Wiinblad – NADA-Danmark

This talk is about The NADA protocol and

• Benzodiazepiner (BZ)

• Cyclopyrroloner

(new generation of hypnotica)

------------------------------------------

• The new types of antidepressive drugs (SSRI and the new combinations )

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Same protocol for SSRI and BZ

42 severe withdrawal symptoms from BZ have been

described in the last 50 years.

37 of these are also associated with SSRI.

The pattern of the withdrawal symptoms from BZ and SSRI are complicated and quite similar.

Addiction is seen after few weeks of treatment.

Major Depressive Disorder and GABA

GABAertic dificits are in many studies connected to major depressive disorders. • Brain concentration of GABA decreases. • The GABA receptor alterates. • Stress and mood changes increases

B. Luscher, Q. Shen and N Sahir. Mol. Psych. 2010

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Why should we pay attention?

• Two of the most used drugs worldwide

• Addiction is very often seen

• Developing chronic physical and mental diseases due to the medication

• Often hospitalized or consulting G.P.´s

• Social problems and decline

• Increase use of medication in general

• Few patients benefit from the medication

First article:

”Benzodiazepines

cause anxiety”

The Nurses Magazine

in Denmark

”Sygeplejersken” May

1996 (nr. 28)

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The NADA protocol and BZ

• 1997 – First treatments with the NADA protocol

• 1999 – The protocol soon became part of our treatment program for withdrawal symptoms.

• 96,4% of the patients stopped taking BZ

and cyclopyrrolones in our unit.

• From 2000 - The protocol starts to get known.

• The number of programs have increased ever since.

2013

The Danish Social Board advertice for the NADA Protocol as a complementary strategy.

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Severe rebound and withdrawal symptoms.

Withdrawal symptoms are often similar to the symptoms people experienced when the medication started.

Addiction is often seen after a few weeks. 33% describe withdrawal symptoms one year after they have stopped taking BZ/SSRI.

Most seen BZ withdrawal symptoms:

• Anxiety and panic disorders

• Sleeping problems

• Cognitive problems

• Anger, aggression and agitation

• Depression

• Change of personalty

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Anxiety and restlessness (starts slowly)

Fear of taking bus and trains

Fear of shopping go to town

Fear of social activity

Anxiety in general

Panic

Anxiety and long term treatment with benzodiazepines

Benzodiazepines and sleeping patterns

• Benzodiazepines decreases REM and the deep sleep phases.

• Tolerance is often seen after one week of treatment.

• After one month the positive effects of the drugs are gone. Mostly withdrawal symptoms are seen at this point.

Awake Superficial Deep sleep REM

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Cognitive changes due to BZ

• Lack of memory (”Pot hole anamnesia” etc.).

• Less ability in learning.

• Lack of concentration.

• Pseudo dementia.

• More than 35% can´t cope with emotions and they will not benefit from theraphy in the withdrawal phase.

Kilde: Jens Frydenlund,

Amtshospitalet Nykøbing Sj.

45 mg Alopam a day

in three years

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Strategy is needed

A three phase program

1. ”Get ready” phase

2. Withdrawal phase

3. ”Slowly back to life” phase

Can be adabted to all kinds of settings

One method fits all

• Homeless programs

• Street programs

• Addiction programs

• Psychiatric Hospitals

• G.P.´s

• Treatment centers

• Shelters

• Community settings

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Society – community setting

This setting in Holbæk is run by local inhabitants twice a week

Important guidelines

• Never increase the dosis of medication!

• Cut down one drug at a time

• No competitive drugs

• Avoid alcohol and coffeine

• Take the time needed

• Support – not theraphy!

• Medication must be supervised by a doctor

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A program in three phases for SSRI

and BZ withdrawal symptoms

1. ”Get ready” phase

Phase 1 (”Get ready”)

• Acupuncture twice a week (or more).

• Reduce coffeine and alcohol.

• Stop the use of p.n. medication.

• Reduce the daily dosis of medicine 10%.

• Write down your withdrawal symptoms.

• Network, proper food, physical exercise etc.

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Program in three phases for SSRI

and BZ withdrawal symptoms

2. Withdrawal phase

Withdrawal symptoms

•25% •25%

•25% •25%

No symptoms

Few symptoms

Moderate and many symptoms

Severe and many symptoms

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Phase 2 (withdrawal phase)

• Continue acupuncture

• Sleeping tee mix

• Reduce medication max. 5-10% at a time.

• With 50% of the cases the withdrawal symptoms will get worse after 2-3 days.

• If this happens:

When withdrawal symptoms increase

• Increase acupuncture treatments and drink 5 cups of sleeping mix tee each day.

• When symptoms start to reduce, go back to acupuncture twice a week.

• After a couple of weeks medication can be reduced with another max. 5-10%.

• Increasing medication never an option.

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www.nada-danmark.dk

Aftrapning af Benzodiazepiner under dække af øreakupunktur.

10

5

0

? uger

BZ/SSRI withdrawal symptoms

Time

Acupuncture treatments (intensityf)

Program in three phases for SSRI

and BZ withdrawal symptoms

3. ”Slowly back to life” phase

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Phase 3 (”Slowly back to life”).

• Continue acupuncture 1-2 times a week

as long as needed (6 weeks is normal).

• Slowly reduce acupuncture to zero.

• Magnetic ear beads can be used in this

phase.

Attention: 50% still has withdrawal

symptoms after stopping taking medication.

Withdrawal and rebound

Kilde: TUB-projektet Warberg Kommune 1993-1996

Start

Inpatient program 6-10 weeks

Medication

reduced to

zero

Withdrawal symptoms start

Fear and anxiety

No sleep

Home

Life returns, intensive happiness – watch out:

Rebound Break-down

Problems and daily life returns

6 months Later - unstable

One year later

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Phase 3 (”Back to life”)

• 50% still has withdrawal symptoms after stopping taking medication.

• Keep supporting and watch out for rebound!

• Continue working on stress management.

• Peer support and networking.

• Therapy (if appropiate) can start in this phase.

Never take up the same medication again.

Summary

1. ”Get ready” phase

(Acupuncture twice a week, focus on exercise and food, stress management, network, stop medication p.n.)

2. Withdrawal phase

(Increase acupuncture, beware of caffeine and nicotine, support and network, never increase medication)

3. ”Slowly back to life” phase

(Acupuncture twice a week, social peer support, never start on the same medication again, perhaps therapy)

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NADA in Denmark 2016