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Phenibut Withdrawal & Detox Guide

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/25/2020

Number of References: 19 Sources

Phenibut has been increasing in popularity in recent years and, contrary to popular belief, is capable of producing dependence, addiction, and withdrawal symptoms. The symptoms of phenibut withdrawal can be very uncomfortable, both physically and psychologically, and withdrawal may even be dangerous in some cases. Here, we will look at the way this drug works, the phenibut withdrawal symptoms, the timeline involved, and when a phenibut detox center may be particularly beneficial.

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Phenibut Pharmacology & Addiction

Phenibut is a member of the gabapentinoid family which is a group of drugs that are structurally similar, or analogs, of the neurotransmitter GABA. This class of drugs exhibits inhibitory neurological effects that may include anticonvulsive, anti-anxiety, and euphoric properties. Originally developed in the USSR in the 1960s, phenibut is an anti-anxiety medication that also produces mild cognition-enhancing, or nootropic, effects. Commonly marketed in the US as a “nutritional supplement” this drug is proving to be very dangerous, especially when the risks and dangers of using it are not made clear. When prescribed by a doctor in countries like Russia, the risks and benefits may be properly weighed, but when it is abused, it can produce very uncomfortable and potentially deadly withdrawal symptoms. 1, 2, 3, 4

The way phenibut works is very broadly similar to more commonly abused GABA agents such as gabapentin or pregabalin. While the exact mechanism of action is different from these more common drugs, the end result is somewhat similar. Phenibut works indirectly as a GABAB and to a lesser degree GABAA neurotransmitter agonist, or stimulator, through its primary action on α2δ calcium channel receptor subunits. Through interaction with these subunits, GABA signaling is intensified, thereby producing a calming effect throughout the brain. Phenibut also increases dopamine signaling in the brain, although the exact way this happens is unclear. This complex mechanism of action is responsible for phenibut being used as both an anti-anxiety medication and a nootropic drug, as it can calm some processes while speeding up others. 5, 6, 7, 8

Through chronic and heavy phenibut use, the brain will begin to make changes in an attempt to maintain balance. Due to the increased levels of the neurotransmitter GABA produced through phenibut use, the brain will perform a process known as “downregulation” to GABA receptors that essentially turns down their sensitivity to GABA. If phenibut use continues, so will GABA downregulation which will, over time, build a tolerance to phenibut, and someone will require larger amounts of the drug to produce the same effect. Another change made by the brain is known as neurological remodeling, and this begins shortly after downregulation although it takes some time to produce noticeable effects. Remodeling is a process of structural changes made by the brain in response to downregulation. Other changes made in the brain due to phenibut use include downregulation to dopamine receptors and remodeling to dopamine systems, particularly in the limbic system. Once downregulation and remodeling have occurred, someone will begin to experience symptoms of phenibut withdrawal when they go too long without using the drug. 7, 8, 9, 10

Symptoms Of Phenibut Withdrawal

The symptoms of phenibut withdrawal can be thought of as opposites of the effects produced by using the drug. While phenibut use produces relaxation, anti-anxiety effects, euphoria, and anticonvulsant properties, withdrawal from phenibut produces hyperactive neurological and psychological symptoms. These symptoms can range from simply uncomfortable, to potentially life-threatening depending on someone’s phenibut use habits and several other factors. Additionally, physiological dependence on phenibut can develop fairly quickly; sometimes within days to weeks of consistent use. This means that after using phenibut for just a few weeks, someone may experience fairly severe withdrawal symptoms once they quit using the drug.

Some of the symptoms of phenibut withdrawal include:

  • Intense Anxiety
  • Deep Depression (with or without suicidal ideation)
  • Anhedonia (reduced ability to experience pleasure)
  • Mood Swings
  • Intense Cravings for Phenibut
  • Tremor or Shaking
  • Myoclonus (muscle spasms)
  • Diaphoresis (constant sweating)
  • Nausea and Vomiting
  • Stomach and Muscle Pain
  • Increased Irritability or Aggression
  • Psychosis
  • Confusion and Delirium
  • Hallucinations (visual, auditory, tactile, or a combination)
  • Seizures
  • Tachycardia (increased heart rate)
  • Hypertension (elevated blood pressure)
  • Hyperthermia (elevated body temperature or fever)
  • Hyperreflexia (exaggerated reflexes)
  • Insomnia
  • Cognitive Deficits (problems with memory and reasoning)

These symptoms can cause some very serious complications if they are left untreated. In the case of delirium, psychosis, and hallucinations this is especially so, as someone may hurt themselves or others without realizing it. When these symptoms are coupled with increased irritability and aggression, it is possible that someone may hurt others intentionally, even if they are normally non-violent and peaceful people. These risks of directed harm are very serious, and that is not even mentioning the increased risk of seizures during phenibut withdrawal. A seizure can easily result in dangerous complications, such as direct neurological complications or due to injuries sustained secondary to the seizure. Phenibut withdrawal poses a variety of risks to someone’s health and life, and entering a phenibut detox center is highly recommended if someone is expecting to undergo phenibut withdrawal. 11, 12, 13, 14, 15

Post-Acute Phenibut Withdrawal Symptoms

The post-acute phase of phenibut withdrawal can be much longer-lasting than the acute, or immediate phase, although the symptoms are usually much less intense. While they rarely pose a direct physical danger to someone’s health, there are secondary complications that may arise.

Some of the symptoms of post-acute withdrawal from phenibut include:

  • Depression (with or without suicidal ideation)
  • Anxiety
  • Mood Swings
  • Fatigue and Lethargy
  • Cravings for Phenibut
  • Insomnia

These symptoms can persist for weeks, months, and sometimes even years after phenibut use ceases. Depression is of particular note, as the risk of suicidal thoughts, or even suicide attempts are a real danger during post-acute withdrawal. These symptoms will fully resolve with continued abstinence from phenibut, but medications and therapy may be able to help reduce their intensity while neurological recovery occurs.

Phenibut Withdrawal Timeline

The timeline for the symptoms of phenibut withdrawal can vary quite a lot between individuals. This has to do with someone’s unique genetics, their phenibut use habits, co-occurring mental health issues, and liver function. While the total timeline may vary, the progression of phenibut withdrawal symptoms is fairly standard and roughly mirrors the withdrawal syndrome and progression from benzodiazepines.

Phenibut has a fairly short half-life of around 5 hours in a healthy adult, so someone will begin to experience withdrawal symptoms within 10 hours of the last phenibut use. Symptoms may begin mildly and then escalate over the first few days before stabilizing and then slowly resolving. The acute phase is roughly a week long and will transition into the post-acute phase, the duration of which shows substantial variability between individuals.

While the phenibut withdrawal timeline has not been well studied, a broad generalization of the phenibut withdrawal timeline may look something like:

First Week

Within hours of the last phenibut use, withdrawal symptoms will begin to emerge. The first symptoms are usually increased sweating, anxiety, and shaking. By the end of the first day, these symptoms will have intensified and will often be joined by irritability, muscle pains, mood swings, and confusion. Insomnia often appears the first night of withdrawal, and the next few days will exhibit and intensification of these symptoms. Around the middle of the first week, hallucinations, delirium, and the risk of seizures are the most prevalent. These three symptoms usually resolve towards the end of the week, but the rest of the less directly dangerous symptoms often remain at fairly intense levels.

Second Week

The beginning of the second week may start off quite rough, as the acute withdrawal symptoms are still fairly close to their peak intensity. As the days pass, however, the physical symptoms typically resolve substantially, with an almost complete remission by mid-week. The psychological symptoms, on the other hand, have usually shown little improvement during the second week, and often leave the week at about the same severity as they entered it. The psychological symptoms may seem more intense by the end of the week, but this is usually due to the fact that as the physical symptoms resolve, they are no longer present to distract from the psychological symptoms, thus making them seem more intense.

Third Week

By the third week, insomnia may begin to resolve and the psychological symptoms may see some improvement as the week progresses. Getting more sleep each night will help the body and brain recover from the often traumatic first week of phenibut withdrawal symptoms, although it will still take some time for someone to feel somewhat normal again.

Fourth Week and Onwards

The fourth week often shows the first signs of hope for someone undergoing phenibut withdrawal. The physical symptoms are usually a distant memory at this point and the psychological symptoms may have shown a good deal of improvement. That being said, the challenge is not over as relapses tend to occur during or shortly after withdrawal has concluded. The post-acute symptoms of depression, fatigue, anxiety, and phenibut cravings are usually still present and may continue to be for quite some time. After a detox program has been completed, it is highly recommended for someone to seek further treatment and care if they have not done so already.

Physical Effects Of Detoxing From Phenibut

The physical effects of phenibut detox can be extremely uncomfortable and even dangerous in some cases. The prevalence of GABA in a variety of physical processes means that dysregulation to GABA receptors can produce a wide range of effects. Here, we will take a look at some of these effects on a system-by-system exploration:

Neurological Effects

The neurological effects of phenibut detox may not seem like physical effects, but these can have profound and severe physical consequences. GABA performs many different functions depending on where it is found, and in the brain, it can help raise the seizure threshold through its calming and inhibitory effect on nerve signals. When downregulation occurs to GABA receptors, the influence of GABA on keeping the seizure threshold high is reduced, meaning it becomes more likely for a seizure to occur. Seizures are essentially storms of neurological activity in the brain and do not always produce convulsion. By having an increased risk of seizure, the risk of brain damage is also increased. In the case of absence or convulsive seizures, the physical risk of injury is increased as well, since someone can suffer an injury caused by a seizure if they are standing, or even lying in bed when a seizure occurs. 15

Gastrointestinal Effects

While GABA plays a role in inhibitory brain functions, it also plays a similar role in the gastrointestinal tract. The calming effects of GABA are responsible for moderating and synchronizing intestinal muscle contractions. Once GABA downregulation has occurred, the ability of GABA to slow and calm digestion is disrupted. This can produce hyperactivity in the gastrointestinal tract and lead to diarrhea and stomach cramps. While these do not seem severe, diarrhea, in particular, can increase the risk of complications, especially if someone had a pre-existing health condition. Frequent diarrhea can promote dehydration, and if someone had cardiovascular health issues or diabetes, this could put them at increased risk of a negative outcome. 16

Psychological Effects Of Detoxing From Phenibut

The psychological effects of phenibut detox can be extremely disruptive to someone’s life and continued recovery. They may also pose substantial risks to someone’s safety and mental health in general. The severity of these symptoms and their oftentimes prolonged duration can present unique challenges, and getting help is often necessary to overcome them without relapse or other negative outcomes.

Some of the psychological effects of phenibut detox include:

Psychosis, Hallucinations, and Delirium

These effects, while being different in presentation, are caused by similar imbalances in neurotransmitter function due to phenibut addiction and withdrawal. These effects are not necessarily common, but they can present increased risks to someone experiencing them. The exact way that phenibut works is still somewhat unclear, so the way these psychotic states may be produced is not well understood. It is known that these effects do occur, but the specific causes are not currently known.

Both of the neurotransmitters GABA and glutamate play a role in cognition and mental states. GABA is an inhibitory neurotransmitter and glutamate is an excitatory neurotransmitter, and in normal brain function, these two can help to keep each other in check. During phenibut withdrawal, GABA has reduced impact and therefore, a reduced ability to moderate glutamate signaling. This results in hyperactive neurological functions that can lead to delusional thinking, endorsed hallucinations, and profound confusion to time and place. While these effects are usually fairly short-lived during phenibut detox, they can present severe risks to the safety of the one experiencing them as well as others.

Depression & Anxiety

Depression and anxiety are very common effects of phenibut detox. Both of these effects can have neurological and behavioral causes, and they may sometimes be quite long-lasting. These can also make it very difficult to begin building a life in recovery, as depression can reduce motivation and desire while anxiety can promote stress and discomfort when meeting new people. Both effects can be challenging to overcome, and medications and therapy are sometimes needed to give someone the help they need to achieve successful, long-term recovery.

Neurologically, both depression and anxiety can be results of neurotransmitter downregulation and remodeling. While the most intense, short term effects are mostly due to downregulation, the longer-lasting effects are due more to neurological remodeling that occurs after prolonged phenibut use. In the short term, the downregulation to dopamine systems in the limbic system can lead to anhedonia, or an inability to experience pleasure. This can lead to depression, as someone will find little or no satisfaction in life without using phenibut. This will improve with time, but to permanently resolve, continued abstinence from phenibut is required. Anxiety can be attributed to GABA downregulation and the reduced calming effect that GABA has in the days and weeks after ceasing phenibut use. Remodeling can cause these symptoms to persist for long periods, as the brain has undergone structural changes after downregulation occurred. The process of remodeling will begin again after phenibut use ceases, but this is a slow process, and the return to pre-phenibut levels of function may take some time.

Psychologically, both depression and anxiety can result from the loss of such a powerful, although unhealthy, coping mechanism as phenibut use. Often beginning as a cognition and performance-enhancing supplement, phenibut use can quickly become a way to deal with stress and as a seemingly harmless way to relax. After downregulation begins, and even more so once remodeling occurs, phenibut use can become the primary way someone is able to deal with stress. Eventually, it becomes someone’s only way to cope with life. Once this is suddenly removed, it is not uncommon for someone to feel alone, helpless, and hopeless. With someone’s usual way to relax and reduce stress unavailable to them, a depressed mood and increased anxiety is a frequent result. Both of these will resolve with time, but this may be a slow process.

Cravings

Cravings for phenibut are also very common and, similar to depression and anxiety, have both neurological and psychological causes. Neurologically, dopamine downregulation is a major contributor to cravings. When dopamine receptors become downregulated, the normal levels of dopamine released by the brain in response to usually pleasurable stimuli, such as food or sex, will be unable to stimulate dopamine receptors enough to produce feelings of pleasure. This can lead someone to feel that phenibut use is the only thing that is capable of making them feel good, and after chronic use, this can actually be the case physiologically. Combined with the sometimes severe discomfort produced during phenibut detox, it is very common for someone to reminisce about and yearn for phenibut use again. Psychologically, the causes are very similar to anxiety and depression. Cravings during detox also can arise from the loss of a coping mechanism, as phenibut use was someone’s go-to means for relief. When this is taken away, the powerful relaxation that phenibut use produced can seem very attractive, leading someone to crave its use.

When Is A Phenibut Detox Center Recommended?

Phenibut withdrawal and detox can introduce and increase a wide range of risks to someone’s health and life. The risk of seizure, suicidal ideation, and harm to others can be greatly increased during this time, and depending on certain factors, these risks may be increased even more. Here are some of the situations that may indicate a phenibut detox center is especially important:

A History of Seizures or Epilepsy

Due to the increased risk of seizures during phenibut withdrawal, if someone has a history of seizures or a seizure disorder such as epilepsy, then it is highly recommended for them to enter a phenibut detox center. The seizure threshold is lowered during phenibut withdrawal due to the dysregulation of GABA systems, and this can increase the risk of seizures in general. With a pre-existing risk of seizures, this is even more of a risk.

Poly-Drug Addiction

If someone had issues with other drugs, they may be at increased risk for serious and potentially dangerous outcomes. In particular, concurrent alcohol or benzodiazepine use with phenibut can greatly increase the risks of potentially fatal complications. Benzodiazepines and alcohol also work on the neurotransmitter GABA, although in a different way. When chronically abused alongside phenibut the withdrawal symptoms of these drugs can compound and amplify each other, leading to more severe symptoms. Other co-occurring drug use may also contribute to increased risks, but alcohol and benzodiazepine use alongside phenibut can greatly increase risks during phenibut withdrawal and detox. If someone were using phenibut with other drugs or alcohol, it is very highly recommended that they enter a phenibut detox center when undergoing withdrawal. 11, 12, 13

Co-Occurring Mental Health Issues

The psychological symptoms of phenibut withdrawal can be severe even if someone had no prior history of mental health issues. If they did have a pre-existing mental health issue, then they may be at increased risks for potentially dangerous outcomes due to the prevalence and intensity of the psychological symptoms of withdrawal. In particular, the risk of suicide may be greatly increased in those with a history of depression or anxiety. Additionally, the emergence of psychosis, hallucinations, and delirium may be more likely if someone were to suffer from certain mental health issues, such as schizophrenia. The co-occurrence of mental health issues and phenibut withdrawal symptoms can present great danger, and if someone were to have pre-existing mental health issues, it is highly recommended that they enter a phenibut detox center when going through withdrawal.

Getting Help

Phenibut addiction can be devastating to someone’s life, state of mind, and chances of happiness. While it may not seem like it at times, recovery is possible. It will take work and sustained effort, but with help, it can be a reality. All that it requires is the courage to reach out and ask for help and the willingness to receive that help. Don’t wait, recovery is possible and it can start today.

References For This Article

  1. 1 FDA: Phenibut in Dietary Supplements
  2. 2 CDC Morbidity and Mortality Weekly Report: Notes from the Field - Phenibut Exposures Reported to Poison Centers in the United States, 2009–2019
  3. 3 Maryland Poison Center: Phenibut - Wonder Drug or Unsafe Supplement?
  4. 4 The American Journal of Medicine Blog: Phenibut - Buyer Beware
  5. 5 Pharmacology Research & Perspectives: Mechanisms of the Gabapentinoids and α2δ‐1 Calcium Channel Subunit in Neuropathic Pain
  6. 6 Expert Opinion on Investigational Drugs: GABA-B Receptor Agonists and Antagonists - Pharmacological Properties and Therapeutic Possibilities
  7. 7 Proceedings of the Japan Academy, Series B - Physical and Biological Sciences: Diversity of Structure and Function of GABAB Receptors - A Complexity of GABAB-Mediated Signaling
  8. 8 CNS Drug Reviews: Phenibut (β-Phenyl-GABA) - A Tranquilizer and Nootropic Drug
  9. 9 New Zealand Medicines and Medical Devices Safety Authority: Classification of Phenibut
  10. 10 British Journal of Anaesthesia: Analgesic Mechanisms of Gabapentinoids and Effects in Experimental Pain Models - A Narrative Review
  11. 11 BMJ Case Reports: Phenibut Dependence
  12. 12 Case Reports in Psychiatry: Phenibut (β-Phenyl-ᵧ-aminobutyric Acid) Dependence and Management of Withdrawal - Emerging Nootropics of Abuse
  13. 13 Cureus: Phenibut Addiction in a Patient with Substance Use Disorder
  14. 14 Journal of Clinical Psychopharmacology: Dissociative Intoxication and Prolonged Withdrawal Associated with Phenibut - A Case Report
  15. 15 Bosnian Journal of Basic Medical Sciences: Acute Phenibut Withdrawal - A Comprehensive Literature Review and Illustrative Case Report
  16. 16 Frontiers in Pharmacology: A Gut Feeling About GABA - Focus on GABA-B Receptors
  17. 17 Clinical Toxicology: Phenibut - One Poison Center's Experience
  18. 18 International Journal of Medical and Pharmaceutical Case Reports: An Uncommon Case of Phenibut Toxicity in an Intensive Care Unit
  19. 19 Clinical Toxicology: Acute Behavioural Disturbance Associated with Phenibut Purchased via an Internet Supplier

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