Iatrogenic Practices in Psychiatry: Kindling

16
2021
Editor’s Note: This article originally appeared on Mad in Italy. The author, Laura Guerra, is the author of the book Stopping Psychotropic Drugs: How and Why and has translated books by Joanna Moncrieff and Peter Breggin. She has a degree in biological sciences and a PhD in pharmacology from the University of Ferrara.

Some psychiatric practices can have very painful and destabilizing consequences, sometimes of enormous suffering, for the person undergoing pharmacological treatment, such as “kindling” or neuronal sensitization.

Kindling is a neurological condition that occurs as a result of repeated episodes of withdrawal and reinstatement of various psychotropic drugs, alcohol, and recreational drugs.

Following each episode, withdrawal symptoms worsen and may also manifest in convulsions, psychosis and/or death. Essentially, the development of this hypersensitivity can cause abnormal reactions when the same drug or a different drug is reintroduced.

Premise

In our information we always emphasize that psychotropic drugs do not have a specific action on mental problems or psychopathology, but only on their symptoms. Mental problems have relational, cultural and social origins and should be addressed from this point of view, primarily with psychotherapeutic and social interventions, limiting the use of psychotropic drugs to very short periods, when strictly necessary.

Psychopharmacology teaches us that psychotropic drugs act on the symptoms of mental suffering as psychoactive substances by altering cognitive and emotional functions, sedating and creating emotional dullness or an artificial increase in mood.

To clarify this concept better, “psychosis”, “depression”, “anxiety”, “bipolar disorder”, “ADHD” and more are not disorders of organic or genetic origin, caused by “imbalances” in brain chemicals, and psychotropic drugs do not have the function of restoring any balance.

Indeed, they themselves create a chemical imbalance, which will be responsible for the phenomena of tolerance and addiction. As a consequence, after a certain period of time they will no longer give the desired effect and it will not be possible to discontinue them too quickly, because otherwise you would experience withdrawal symptoms, which are sometimes very dangerous.

As already mentioned, psychotropic drugs can be useful in the short term to manage acute states of mental suffering, but then they should be safely suspended, under expert medical supervision, with good psychotherapy to address the causes of the suffering itself.

Long-term treatments, in fact, are counterproductive as they could cause the symptoms to become chronic and also have significant side effects, thus compromising the quality of life as well as shortening its course.

Despite this, the adoption of the organic model by the vast majority of mental health centers both in Italy and in other economically developed countries has caused a massive use of psychotropic drugs to the detriment of psychotherapeutic and social interventions, which would instead serve to address psychological suffering adequately.

Potentially dangerous practices in psychiatry: Kindling

Many psychiatrists, not yet expert and prepared to deal with the process of withdrawing psychotropic drugs safely, in an attempt to suppress the symptoms of mental suffering or the withdrawal effects caused by poorly managed suspensions, add and remove within a short space of time, different psychotropic drugs, not respecting the protocols for their safe suspension.

This practice, widely used, can have very dangerous consequences and cause enormous psychophysical suffering, as a consequence of sensitization¬†of the receptors of the nervous system‚ÄĒor “kindling”.

Because of kindling, some people who have had little difficulty stopping a drug the first time, when reintroduced or switched to another drug, may have much worse withdrawal symptoms when they try to come off it again.

In fact, the nervous system, due to multiple withdrawal events and the adverse effects of drugs, becomes destabilized and sensitized.

Furthermore, when you take and stop multiple psychotropic drugs, you may find yourself facing an even more complex situation which consists of the withdrawal reaction to the drug superimposed on the sensitization or kindling reaction.

Furthermore, during the kindling phase, hypersensitivity can also develop towards psychoactive or activating substances, such as caffeine, vitamins, supplements, particular foods, alcohol, etc., which can cause unwanted and sometimes dangerous reactions.

A description of this phenomenon can be found in the book Stopping Psychotropic Drugs: How and Why, from which the following section is taken:

Avoid skipping doses during suspension: kindling phenomenon or sensitization

Sometimes, to reduce psychotropic drugs, inexperienced prescribers recommend skipping doses of the drug, for example every other day or every two or three days. This method is¬†highly discouraged as it causes fluctuations in the concentration of the drug in the blood and therefore in the nervous system, even in the case of drugs with a long half-life such as fluoxetine (Prozac). When treatments take on an irregular pattern like the one described above, the person is predisposed to sensitization or kindling reactions and to so-called “treatment resistance”. Sensitization or kindling can be defined as the amplification of the response to repeated and intermittent exposures to a stimulus (Bell et al. 1999).

Sensitization is therefore a consequence of repeated episodes of abstinence and reintroduction of the psychotropic substance and when it is triggered it leads to an exacerbation of the adverse reactions that occur with changes in dosage or the introduction of other substances.

This condition can last over time and can sometimes be permanent. Due to the sensitization phenomenon, each withdrawal reaction leads to more severe withdrawal symptoms than previous episodes.

Sensitization occurs especially¬†in people who have already tried to stop taking drugs several times¬†and to whom the doctor has prescribed¬†aggressive pharmacological treatment,¬†confusing¬†withdrawal symptoms¬†for a¬†relapse of mental distress,¬†for the appearance of a¬†new disorder¬†or for a¬†‚Äúfailure to respond‚Ä̬†to pharmacological treatment.

To avoid this phenomenon, when psychotropic drugs have been stopped suddenly or too quickly,¬†the drug should be reintroduced in small doses. If withdrawal symptoms improve but not significantly, the dose can be increased a little. In the event that the reintroduction of the drug generates a worsening of the symptoms, the reaction could be contained using a small dose…”

The book then lists methods to avoid or limit the damage caused by kindling.

Generally, sensitization or kindling causes overstimulation reactions, such as a sensation of internal electrical discharge, anxiety, depression, nervousness, insomnia, panic and in extreme cases akathisia, which includes the need to move continuously to relieve intense internal agitation and which is sometimes so unbearable that you want to die.

The underlying mechanisms of kindling are not yet clarified, but in the case of benzodiazepines, the substances most studied together with alcohol for this effect, some studies hypothesize a role of the excitatory glutamate system, implicated in the regulation of anxiety and seizure threshold together with GABA, the benzodiazepine target receptor. Kindling that occurs following subsequent attempts to withdraw benzodiazepines may therefore lead to an increase in the severity of anxiety and a lowering of the seizure threshold.

Bibliographical references

M. Maviglia, Laura Guerra, M. Gandolfi. Suspending psychotropic drugs: how and why – Building a personalized and effective path. The Sign Factory (2024)

Suspending psychotropic drugs: how and why ‚Äď Building a personalized and effective path ‚Äď Mad in Italy (mad-in-italy.com)

P. Breggin. The suspension of psychotropic drugs, a manual for prescribers, therapists, patients and their families. Fioriti Editore (2018)

The suspension of psychotropic drugs, a manual for prescribers, therapists, patients and their families ‚Äď Mad in Italy (mad-in-italy.com)

A. Framer. What I have learned from helping thousands of people taper off antidepressants and other psychotropic medications. The Adv Psychopharmacol. 2021 Mar 
doi: 10.1177/2045125321991274.
Michael P. Hengartner ,  Lukas Schulthess  , and  Adele Framer. Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum. Sage Journal (2020)

Surviving Antidepressants (2022). Hypersensitivity and Kindling

Hypersensitivity and Kindling ‚Äď Symptoms and Self-Care ‚Äď Surviving Antidepressants

Niki Gratrix. Kindling/Limbic Ignition: Hard Wiring/The brain’s wiring for hypersensitivity and chronic fatigue syndrome. Studies and Research (2018)

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16 COMMENTS

  1. Important topic. If only the risks from these kindling processes were widely understood two or three decades ago. My own understanding of this type of issue came slowly; both from personally experiencing adverse reactions, treatment resistance, and then putting into together with having reading some of the literature. So then I was able to make some sense of what happened at the beginning of my experience with psych treatment, likely due to sensitization.

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  2. We’re all mad in America. We are all homeless people, refugees. If you believe there are insane vs sane people then there is no hope for you my friend. Mental health is just an example of the human catastrophe that is total, and psychiatry just one of many species of this grave social violence. Life is a landslide ready to sweep all away. The truth is something to be seen: otherwise by definition you knowingly live in darkness and prefer to keep it that way. Thus we betray our children out of our fear and self-interest, the very same fear and self-interest that has destroyed the Earth while watching a quarter of humanity go to bed every night hungry.

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  3. I run to read these descriptions of what I experienced, feeling validated… yet it triggers me into a state of deja-vu & agitation-heart rate, light-headedness, moaning, grinding teeth. Fight or flee X 100.
    The electrical zaps are back.
    My only tool is Qi Gong & it’s just not effective much these days.

    It’s never truly over.
    My seizure-like events have also started seeping thru the cracks 5 years after they had stopped…I thought.
    The medical response (It’s scary to trust ANYONE on this topic) is to see ‘someone’ about the PTSD.
    Like who exactly?

    A mental health professional?

    They want me to stop bringing it up…’it’ being my medical history…the drugs and ADR’s.

    There is no safety. I hold the dread at arms length.

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  4. One of the reasons to start another psychoactive drug or reinstate the initial drug is the misinterpretation of withdrawal symptoms. Treating it inappropriately as if there is a relapse.

    Hyperbolic tapering, including stabilisation on the dose if symptoms occur and doctors who know to distuiguish witdrawal from relaps is in my opinion very important to bring down the cases of kindling.

    Another concern that comes to my mind; how many patients with kindling will get ketamine as a last resort against so called ‘treatment resistant depression’?

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  5. “Hyperbolic tapering, including stabilisation on the dose if symptoms occur” does seem to be the internet censuses approach to withdrawal from the psych drugs.

    My psychiatrist weaned me off his neurotoxins over three years, after he stopped listening to the lies of my former psychologist, and blamed her for the misdiagnosis of “brain zaps” as “bipolar.” But none of the doctors apparently even knew that withdrawal from the “safe smoking cessation meds” could cause “brain zaps” until 2005.

    https://www.researchgate.net/publication/247806326_'Brain_shivers'_From_chat_room_to_clinic

    But what is “professional” about claiming one is ignorant of the systemic sins of one’s industry? And what is ethical about all doctors claiming to be ignorant about anticholinergic toxidrome, when they were all taught about it in med school?

    https://en.wikipedia.org/wiki/Toxidrome

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  6. All good info, but it (and all subsequent comments) fail to address the issue of exactly HOW to taper at ANY schedule when the drug manufacturers provide these drugs in only very limited dosages. For example, with Cymbalta (duloxetine), the drug is only available in 60, 30, and 20 mg capsules. So, if the patient were to taper @ 5% increments of the previous dose, they are required to open individual capsules and either weigh a 95% dosage (usually with a jeweler’s scale) or actually count out individual beads. Manufacturers should and MUST be required to offer more alternatives to make the process feasible and minimize cases of kindling. Advocacy by researchers, medical professionals, and policy makers needs to take place to change this state of affairs (see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970174/).

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    • You bring up a major obstacle! All leaflets contain the advice ‘to taper gradually’, but pharmaceutical companies fail to produce the neccessary low doses.

      And I don’t know of any doctor who demands these manufacturers to make suitable doses.

      I researched the problems of tapering duloxetine; in contrast to the beads in efexor capsules, the duloxetine beads in one capsule are not equally dosed. That makes both counting and weighing in principle inaccurate.

      In order to make a somewhat reliable dosage, it will be necessary to calculate how much dose difference there may be based on the number of beads in different capsules. This may not be a problem during the first tapering-steps.

      In the Netherlands we have a compounding pharmacist who planned to make low doses of duloxetine. He already do this for more than 50 psychoactive drugs. Efexor for example is available up to 0,5 mg He delivers worlwide. (www.taperingstrip.com)

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  7. some great comments here. Tragic to see the impact of kindling and long term effects on several of my family and friends. Without a doubt the second or third reduction/withdrawal from the same drug is far worse. Currently tapering sertraline (Zoloft) down to 2mgs from 100mgs over the past year has been horrendous.The last few tiny decrements have had the worst impact extremely incapacitating
    Worldwide having only one manufacturer for properly tapering drugs ie tapering.org is ridiculous but thank God for them. Every country prescribing this poison should be legally obliged to also have a fully funded,completely free to the person tapering manufacturing system that is accompanied by intensive non judgemental professional 1:1 support.And separate from those with the power to incarcerate you.
    Big pharma and the drug dealing psychiatrists could jointly fund the service!! What a dreamer I am a wild and hopeless vision.
    Meanwhile we just do the best we can with limited resources and complete self reliance and a fighting spirit and at the end of the day that is a victory in itself.

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