Dependence, Withdrawal and Rebound With Stimulant and GABA-Acting Supplements

If this is happening now

Call 911 if someone is unconscious or has trouble breathing after using a product like these. [1] Poison Help (1-800-222-1222, US) connects you to your local poison center. [1] If you are in the US and having thoughts of harming yourself, call or text 988. Do not stop or change a prescribed medicine on your own; ask the prescriber or a pharmacist first. If you have used a GABA-acting product such as phenibut every day and want to stop, talk to a clinician or pharmacist before stopping, because the case reports below describe severe withdrawal. Poison centers outside the US are listed on Poison Help by country.

The terms in plain words

On this page, dependence means the body has adapted to a substance so that stopping causes symptoms. Withdrawal means those symptoms. Rebound means a problem such as poor sleep or anxiety coming back stronger than before. The sources we read describe withdrawal in detail. They do not separately measure rebound, so we do not claim it.

What the sources say, substance by substance

Caffeine: usually unpleasant, not usually dangerous

MedlinePlus says caffeine withdrawal symptoms usually go away after a couple of days. [7] The FDA says withdrawal is not considered dangerous but can be unpleasant, and that people who want to cut back should do so gradually. [8] The review above found symptoms even after stopping amounts as low as 100 mg a day. [2] For more, see Caffeine half-life, tolerance and withdrawal.

Phenibut: withdrawal can need hospital care

A review of 62 cases of phenibut toxicity or withdrawal found the most common withdrawal symptoms were anxiety, irritability or agitation, insomnia and psychosis. [9] Another review of 25 reports (all case reports or conference abstracts) found withdrawal symptoms as quickly as two hours after the last dose, and 11 of the 25 patients (44 percent) were admitted to intensive care. [5] Many cases also involved other substances, mainly benzodiazepines and alcohol. [9] A pharmacology review said there are no comparative studies of withdrawal treatment. [10] Treatment is therefore decided by clinicians case by case. Phenibut is never prescribed in the United States, and there are no official guidelines for its use. [11]

Tianeptine: an antidepressant with opioid-like action

The review above describes tianeptine as an atypical tricyclic antidepressant with mu-opioid receptor activity. [6] The FDA has received severe reports of seizures and loss of consciousness leading to hospitalization after use of some products labeled as containing tianeptine. [1] More on the FDA warnings is on Phenibut, tianeptine and kratom.

Who should talk to a clinician first

• Anyone using phenibut or tianeptine regularly who wants to stop, or who has had seizures, confusion or hallucinations.
• People who also use alcohol, benzodiazepines or other sedatives. [9]
• People with anxiety, depression or sleep problems, since anxiety and insomnia are themselves listed among phenibut withdrawal symptoms. [9] Also see Nootropics safety quick reference and medication interactions.