This research and development complexity has been transformed
into an easy to understand, systematic program, which allows an individual to
taper off their medication while alleviating a vast percentage of the
debilitating side effects of withdrawal.
The sequence of this program and the application of each step
is the key to success. Your patient will not begin to reduce a medication until
the pre-taper is complete. The pre-taper is a 7-day process.
A poor metabolizer as well as an extensive metabolizer will
eventually reach the same saturation point; the poor metabolizer much faster, of
course.
If one were to look at the basic structure of the human body,
the chemical structure of psychiatric drugs, and include how psychiatric drugs
are metabolized, how foods, vitamins, minerals, DNA, amino acids, hormones,
glands, proteins, fatty acids and enzymes work, in relation to psychiatric
drugs, you have The Road Back Science.
The following charts detail the P450 enzymes used to
metabolize the most common antidepressants, anti-psychotics, benzodiazepines and
ADHD stimulant medications. An X in the row denotes that the medication utilizes
that specific pathway. Below each chart, you will find other routes of
metabolism if applicable.
How to Use Charts to
Decide Sequence of Medication Reduction
If you have two or more medications sharing the same CYP
pathway to metabolize, reduce the medication that uses the fewest pathways
first.
Example:
Ambien used concurrently with Luvox, Paxil, Prozac, Wellbutrin or Zoloft.
Reduce the Ambien first.
If you were to reduce any of the antidepressants listed
first, the Ambien would be reduced and the patient would experience Ambien
withdrawal without the current Ambien dosage being reduced. Ambien would be
reduced by as much as 43% if the antidepressant were reduced first. (See
Ambien product insert.)
If taking two antidepressants concurrently, or taking an
antidepressant and an antipsychotic, selecting which one to reduce first
would also follow the format outlined earlier in this section. The drug
using fewer common CYP pathways should be reduced first.
If taking two antidepressants or one antidepressant and
one antipsychotic, and the CYP pathways match, evaluate the current side
effects, when each side effect started, when each medication was introduced,
and determine from those side effects which taper schedule to follow.
From time to time, a person will also be taking a drug as
an inducer of the CYP pathways.
Determine if this “inducer” was prescribed to help offset
the inhibitor drug’s effect or is the inducer drug prescribed for
other health reasons not related.
You will generally find that those who are also taking
the inducer medication will be suffering from a wide variety of
adverse side effects. When reducing any medication attached to the same
pathway as an inducer medication, reduce the normal taper speed by one-half
for at least the first 2 months.
You may need to alternate reduction of the inducer drug
and the inhibitor drug every other reduction in order to maintain a balance.
Other medications must be closely evaluated. Lipitor, as
an example, is an inhibitor of the CYP 2C19, 2D6, and 3A, along with
inhibiting the UGT1A3, UGT1A1, P-gp, and intestinal 3A.
Use drug product insert to determine metabolism route or
the Physicians’ Desk Reference.
Example 1:
If taking multiple medications and each medication uses the same metabolic
route, each of the medications is competing for clearance. If one medication
is reduced, the other medications will also be reduced or clear the body
faster.
Decide which medication to taper off first based on:
If patient has used Lexapro for two
years and used Risperdal for 2 months and side effects increased
dramatically once Risperdal was introduced, taper the Risperdal first.
Example 2:
If multiple medications are being taken and all medications can metabolize
through several routes, the impact will be lessened, and selecting which
medication to taper first would not be pathway dependant.
Supplements, Herbs and Foods
Supplements, herbs or certain foods can have a direct
impact on the success of the taper.
Datum:
If a person smokes or drinks coffee before starting the pre-taper, do not
suggest they quit. Cigarette smoke induces the CYP1A2, 2E1, 3A and
UGT2B7. Nicotine inhibits UGT1A1, UGT1A4, UGT2A6, and UGT1A9. If taking
Depakote and starting or stopping smoking, the impact on the medication will
be dramatic
Coffee or caffeine inhibits the CYP1A2, 2E1 and the 3A. A
high percentage of these medications metabolize through these pathways and
caffeine usage will dramatically increase the medication, or if the person
were to quit drinking caffeine, they would begin to go into withdrawal to
some degree because the pathways will begin to metabolize the medication
faster.
The times a person takes medication and when they drink
two cups of coffee can have an impact as well. If the person drinks two cups
of coffee every morning about one hour after their medication, and they
change the time of the morning they drink the coffee, expect a slight to
above average side effect from the medication.
Green tea, with its current popularity is the most
problematic at this time. I am not saying green tea is not beneficial. I am
saying there is a time and place for supplements, herbs and some specific
foods once a person is off all medication for 45 days.
The person’s current daily routine should not be changed.
If they were on a poor diet before starting this program, do not change
their diet drastically. If they did not exercise before starting this
program, do not advise them to do more than a casual walk.
Once off all medication for 45 days, a healthy diet can
be implemented, an exercise program that matches their current physical
condition can be started, the patient can stop smoking, etc.
DNA Drug Reaction Testing and Taper Prediction
For the past several years, DNA drug reaction testing has
been available to determine the patient’s ability to metabolize medication
through the CYP450 enzymes.
I have conducted over 200 drug reaction tests with the
objective of determining how well drug-adverse reactions could be predicted,
and if there were clinical use of this DNA data for tapering.
Prediction of a drug-adverse
reaction: The individuals who were slow or poor
metabolizers or hyper metabolizers experienced drug-adverse reactions faster
than normal or intermediate metabolizers.
However,
the normal or intermediate metabolizers still experienced adverse drug
reactions, but after longer usage of the medication. The metabolism type
of the individual was not indicative of the severity of adverse reactions or
duration. Once the drug had saturated the CYP enzyme used for
metabolism, all the individuals experienced the same side effect profile
regardless of their metabolism speed noted from the DNA drug reaction test.
The test results from the DNA drug-reaction test did not
lead to a worthwhile taper guide. It was postulated; if you were to induce
the enzymes or inhibit an enzyme to match a specific test result and
medication, you would be better able to adjust the metabolism and avoid
withdrawal, or predict the withdrawal sequence. Again, this did not assist
in tapering or eliminating withdrawal side effects in the slightest. This
seems to parallel the results using an inducer drug to counteract the
inhibition of the main drug.
If a DNA drug-reaction test has any use to a physician,
it would be for predicting the dosage of the medication Coumadin. The
initial prescription could be limited to a narrow band, and the correct
therapeutic dosage would be found in a few weeks, instead of several months.
Nutritional DNA Test
Nutritional DNA testing provided this program substantial
information to work with. I tested the ability of over 100 subjects to
metabolize B vitamins, folate, calcium, Omega 3, phase II liver detox genes,
and an assortment of other genetic differences that ultimately determine
overall health and physical well being.
The Road Back Program and all suggested nutritionals used
for medication tapering address the most common genetic variations of the
population at large. Though DNA science is not precise at this date, enough
evidence is available to formulate part of a program to address the highest
percentage of the population.
Hypothalamus-Pituitary-Adrenal Axis (HPA)
Psychoactive medications play havoc with the HPA. While
benzodiazepines usually help with anxiety for a certain time period, the
feedback loop sending incorrect data will eventually cause cortisol levels
to increase, and the result will be increased anxiety in the morning and
mid-afternoon. Insomnia will usually follow the cortisol level increase.
Other psychoactive medications have their own unique side effect profile and
ultimate effect upon the HPA.
First year medical school textbooks describe hypothalamus
as: “Hypothalamus is homeostasis or maintaining the body’s status quo.” As
an example, blood pressure, body temperature, fluid, the electrolyte balance
and body weight are held in a precise value labeled the “set-point.” The
body’s set-point may change over time, but from day to day, the set-point
will remain nearly fixed. With the HPA receiving continual input about the
state of the body and the ability of the HPA to initiate changes, as
anything might sporadically fall out of balance, it is vital for the HPA to
have at hand all necessary nutrients to assist with the compensation.
When the HPA is out of balance, you will have a problem
with insulin, stress, anxiety, weight gain, thyroid problems, fatigue,
unbalanced sexual hormones and countless other body difficulties.
The hormone, ACTH, will eventually become out of balance,
as will the other hormones and adrenals.
Psychoactive medication directly alters specific areas
within the HPA. Examine any patient using psychoactive medication for more
than three months and you will probably find a problem with hormones,
thyroid, adrenals, cortisol and immune system or other areas within the HPA.
However, it will be equally important to move beyond the
normal view of the HPA. Psychoactive medication side effects are quite
varied and diverse. This is not to rehash data from medical school, but to
tie in the knowledge gained in the educational process with psychoactive
medication.
Some fibers from the optic nerve go directly to a small
nucleus within the hypothalamus (suprachiasmatic nucleus). This nucleus
regulates circadian rhythms, and couples the rhythms to the light/dark
cycles.
The nucleus of the solitary tract will collect sensory
data from the vagus and relay the data to the hypothalamus. This data will
include blood pressure and gut enlargement.
The reticular formation receives a vast supply of inputs
from the spinal cord and relays that data to the hypothalamus. Part of that
data will be skin temperature.
Nuclei, circumventricular organs, are unique in their own
right as they lack a blood-brain barrier. They monitor substances in the
blood and have the ability to monitor substances normally shielded by the
neural tissue. Here you will find regulation of fluid and electrolyte
balance, by controlling thirst, sodium excretion, blood volume regulation
and vasopressin secretion. Include in this the area postrema, and you have
the detection of blood toxins and the vomit-inducing center. The OVLT and
area postrema project to the hypothalamus.
The limbic and olfactory systems project to the
hypothalamus. Psychoactive medication side effects, such as eating problems
and reproduction difficulty, will probably be traced to this area.
Ionic balance and temperature will be subject to the
hypothalamus via the receptors, thermoreceptor and osmorecepter.
When the hypothalamus is aware of a problem, it will
assert repair mechanisms. Neural signals to the autonomic system will
attempt to regulate heart rate, vasoconstriction, digestion, sweating etc,
and the endocrine signals to and or through the pituitary.
The pituitary side effects will include one or all six
hormones, to include ACTH and the thyroid-stimulating hormone (TSH).
The repair output attempt, and the psychoactive
medication side effect profile, seem to run near a 50 percent occurrence.
Furthermore, you can directly trace psychoactive medication side effects to
the autonomic nervous system in both the sympathetic and parasympathetic
systems.
The hypothalamus can alter blood pressure; control every
endocrine gland in the body, body temperature, adrenal levels via ACTH, and
metabolism.
The repetition of HPA information in this chapter has
been intentional. Do not be surprised to find a male patient with extremely
high estrogen levels, a female with high testosterone or any other problem
that can be associated within the HPA.
Taper the medication first, wait 45 days after the last
dosage of the medication, reevaluate the patient, and then gradually bring
all parts of the HPA back into balance. The nutritionals used with The Road
Back Program were developed to help the body overcome this imbalance
gradually. Gradually is italicized because this is where most problems
occur with psychoactive drug-taper programs. Either they do not address the
HPA or the program is really a detoxification or heavy metal chelating
program.
The Road Back Program utilizes specific nutritionals to
address the drug side effects and to begin the process of balancing the HPA.
Specifics on each nutritional, what each nutritional is addressing within
the HPA or the body in relation to psychoactive medications, can be found in
The Road Back Program patent when published by the U.S. Patent Office.
Immune System
The immune system and the HPA are in constant
communication and actions within one system will induce response in the
other. The supplements used in this program are designed to also influence
the immune response.
Reducing oxidative stress has been shown to balance
Interleukin-2 (IL-2) as well as Interleukin-6. If you were to test your
bipolar patients IL-2 levels, you will find they will be too high during the
manic phase and IL-6 levels will have shot up high during the depressive
phase. A schizophrenic will have either too high or too low IL-2 levels and
will usually exhibit high IL6 levels constantly.
The supplement ASEA is used to balance the IL-2 and IL-6
levels and reduce oxidative stress, while the Omega 3 is used to help reduce
IL-6.
Titrating Medication
The Road Back has tried titrating medication gradually
without the use of nutritionals with limited success. About 50% of the
people could taper off their medication without using these nutritionals but
they still suffered extreme withdrawal side effects.
Using a gradual titration combined with a basic
detoxification approach had lower than 50% success.
The normal supplements used to remove heavy metal or for
a liver detox produced undesirable results.
A gradual titration with the use of the suggested
nutritionals gives the standard successful results.
The Key to a Successful Taper
With The Road Back Program
Following the pre-taper exactly as described is critical.
The pre-taper is the make or break point for every successful taper.
Most problems occur when:
-
The pre-taper is done too quickly.
-
Patient does not stop
increasing a nutritional once a positive change occurs.
-
Patient changes the time of day
they take medication.
-
Patient changes the time of day
they take nutritionals.
-
Medication is reduced too
quickly.
-
A new medication is prescribed
in addition to existing medication.
-
Patient is switched to a new
medication.
-
Doctor has patient use
additional supplements or vitamins not in this program.
-
Patient begins taking other
supplements.
-
Patient makes a major change to
their daily routine.
-
Patient skips days of taking
medication.
Titrating Psychoactive Medication:
Have the patient compound his/her medication whenever
possible. An exact reduction of the medication each week provides
prediction, no guessing, and the highest chance of success.
In the early days of psychoactive drugs, psychiatry did
not titrate psychoactive drugs up slowly on patients and the results were
catastrophic. Many drugs, other than psychoactive drugs, must be titrated up
as well as down before discontinuing.
There seems to be a medical community consensus that
psychoactive drugs can be reduced quickly, or patients can abruptly be taken
off one psychoactive drug and prescribed another psychoactive drug without
an adverse consequence. This is not the case. Even switching a patient from
a tablet form of a psychoactive drug to the liquid form of the same
psychoactive drug can cause extreme adverse drug reactions.
Dr. Donald E. McAlpine, psychiatrists at the Mayo Clinic states:
"It's important to taper off slowly, extending the taper over several weeks
under your physician's direction. When you stop too quickly, you may
experience so-called discontinuation symptoms, which can masquerade as
relapse."
The discontinuation process and side effects therein can
be confusing to both the patient and physician. Which side effect is coming
from the medication, or is it a return of the original symptom?
With a full pre-taper completed before reducing the
medication, rest assured the side effect starting during the taper is due to
one of the following:
A change made by the patient can be the most difficult to
find. It might be something the patient does not feel is a change.
Years ago, I had a person nearly halfway off Paxil. This
person experienced no withdrawal side effects tapering the Paxil to that
point. When trying to taper off Paxil in the past, the individual had
extreme withdrawal side effects after the first reduction attempt and would
then need to return to a full dosage.
With no valid explanation, this person began to suffer
withdrawal side effect symptoms similar to those earlier. Two weeks passed
and I could not find anything the person had changed. Finally, it was
mentioned to me by the individual he or she had started an all protein diet,
began the diet 3 days before the side effects started.
For this person doing this diet was not a change. He or
she would go on this all-protein diet every six months. I give you this
example to point out that the change a patient makes may not be so obvious.
You may need to dig.
If a patient is keeping a complete Daily Journal these
changes can be spotted more quickly and trouble tapering can be avoided.
Use the Suggested Supplements
If you want the standard results with The Road Back
Program, use the exact supplements suggested. TRB Health, www.trbhealth.com,
(866) 810-3809, has manufactured these supplements to meet our specific
requirements for this program.
Why Are These Supplements Used? Here are a few
examples.
Biotin
Clinical trials show
benzodiazepines will strip the body of biotin and reduced biotin levels can
be one cause of depression. Other symptoms of biotin deficiency include
numbness or tingling of the extremities that is often a side effect of
benzodiazepine usage.
Benefit from biotin supplementation usually requires at least 5,000 mcg of
biotin in the morning and 5,000 mcg of biotin in the middle of the day. At
times, the amount of biotin will need to be as high as 10,000 mcg in the
morning and 10,000 mcg mid-day.
Body Calm
One of the most common
complaints of people trying to come off psychoactive medication is daytime
anxiety and the inability to achieve normal sleep at night. Sleep is an
integral part of life, helps to stabilize mood, foster clear thinking and
assist with reaction time. Sleep gives the body a chance to rebuild.
Without plenty of restful sleep, daily functioning can be miserable for the
patient.
Body Calm is made from
Montmorency cherries and is freeze dried and encapsulated in a veggie
capsule.
The Montmorency cherry
is a Cox-2 inhibitor. Chronic stress precipitates many neuropsychiatric
disorders and alters the various oxidative stress parameters in the brain.
Cyclooxygenase (COX) plays an important role in pathogenesis of various
neurodegenerative disorders including stroke and seizures.
Behavioral analysis
reveals a hyperlocomotor activity and increased anxiety response. Subchronic
stress will decrease the percentage of retention of memory and also cause
hyperalgesia. Biochemical analysis revealed that chronic immobilization
stress significantly increases lipid peroxidation and nitrite levels and
will decrease the reduced glutathione and adrenal ascorbic acid levels.
Chronic treatment with a Cox inhibitor will significantly attenuate the
immobilization stress-induced behavioral and biochemical alterations.
Different from most
prescribed medication for anxiety or insomnia, Body Calm does not knock the
patient out or sedate. Taken during the day, Body Calm should help relieve
anxiety without making the patient tired, foggy or having a feeling of not
being alert. Body Calm taken at night, about an hour before bed, will help
the patient fall asleep naturally. Upon waking in the morning, the patient
will not feel groggy.
Body Calm Supreme
Body Calm Supreme
combines 50 mg Body Calm and 200 mg of Passion Flower.
Passion Flower has
been shown in several clinical trials during the last decade to handle such
things as generalized anxiety, insomnia, and hypertension, withdrawal off
benzodiazepines, withdrawal off opiates, narcotics, alcohol and several
other addictive substances. Every clinical trial was successful. The same
type of Passion Flower used in the clinical trials has been used to
formulate Body Calm Supreme.
ASEA
You can probably test every patient of yours for oxidative stress and it
will be high. Children going through puberty will have a significant
increase in oxidative stress as well as your patients going through
menopause. Diabetics, cardio patients, virtually all of your patients will
an illness or disease will have oxidative stress. Lowering the oxidative
stress is not going to cure a disease or illness but it should be evaluated
by the physician if lowering oxidative stress will help the patient in other
ways.