Drug Use

The use of any medication—whether prescribed or not—has the potential to impact the EEG and neurofeedback training. The following is commentary the impact of medications on training.

1. Your brain operates with its own chemicals–neurotransmitters–that change how we think, feel and act. The brain’s chemistry is directly related to its energy states. For example, when a brain produces strong alpha rhythm in the back (especially with eyes closed) it releases lots of serotonin–a chemical that keeps us calm and positive. When a person’s brain does not produce the calm, resting rhythm of alpha, there is little serotonin released, and the client may feel anxiety, have difficulty falling asleep, etc. When it produces an alpha rhythm that is too slow, the person experiences fogginess, depressive feelings, low energy, difficulty waking up/staying awake.

2. About 30 years ago, Western culture began its love affair with “better living through chemistry” as drugs were developed and marketed to change our mental and emotional states. These worked by artificially changing the levels of the natural chemicals occurring in the brain. What we’ve learned is that these artificial changes in levels have a temporary effect on the things they are supposed to change–and a much more lasting effect on things we DON’T want them to change. For example, taking an anxiety/depression drug to change functional levels of serotonin does so for a short time, but it also leads the brain to make more permanent changes. The brain is no dummy! It recognizes that there is little alpha being produced but more than the expected level of serotonin, so it starts closing receptor sites for serotonin–essentially working against the drug from the outside. If you suddenly stop taking the medication, your brain will be in a MUCH worse place than it was before you started (unless and until it’s able to re-open those receptors).

3. There have always been chemicals people have added to their brains. Recreational drugs like alcohol, pot, etc. usually “help” people get into a state of relaxation and disinhibition that they don’t normally achieve on their own. Enlightenment drugs (psychedelics, peyote, etc.) are expected to take the brain someplace it can’t get to on its own. In most cases, an occasional experiment with such substances will not disturb the brain’s function, and it can guide us to a recognition that there are more capabilities in our brains than we usually experience. Finding a calm, present alpha state by smoking pot until you get a “high” can result in someone deciding to start brain-training or meditation to teach the brain to get to that state on its own. Or it can lead a person to start smoking (or drinking alcohol, which also often shifts the brain toward alpha after 1-3 drinks) regularly to get there.

4. Just as the medications, used over time, result in undesired changes in the brain which actually make it HARDER for us to get to the state we want on our own, so regular use of alcohol, pot, or other so-called “recreational” drugs does the same thing.

5. People who chronically smoked marijuana–especially those who started before age 23–over a period of years–EVEN IF they have stopped for years–produce a brain pattern easily recognized in an assessment. There is a LOT of alpha, but:

–the alpha is too slow; instead of being at 10 Hz, which relates to the calm, present, observer state–a consciousness state, or the so-called “zone”–without thinking or trying, it tends to be down around 9 Hz or below. That state is consistent with hypnosis: a state in which clear cognitive processing is very difficult, awareness of things outside our own heads is fuzzy.

–the alpha is all over the head, instead of focused in the rear and on the right side. The result is a sense of low-energy, depression, emotional flatness and again cognitive fogginess.

–the alpha doesn’t go away, as it normally should, when the eyes are opened and (more importantly) when the brain has a job to do. The ability to get in gear and do work is dramatically reduced.

–the alpha shows strongly in the prefrontal cortex, where it should NOT be, resulting in low motivation, lack of ability to organize and plan, reductions in working memory and other damaging issues.

6. When I have worked with people attracted to marijuana or alcohol, I ask them to commit to giving me one month without smoking/drinking. My challenge is that I bet they will find they are able to get the good things they get from smoking/drinking on their own, without the substance, and that they’ll begin to recognize the ability to stay in that state automatically when it’s appropriate. Using the drugs during training short-circuits the training effect. You’re wasting time. But of the people who’ve made the commitment I requested, at the end of the first month (though they were not finished training) only one of more than a dozen decided he was better off with the drugs.

Brain Chemistry and Clients

The first question I always ask, whether the drugs are “medicinal” or “recreational”, is how well the strategy is working. It’s amazing how many people come for training who are taking 3- 5 or more psychoactive medications. They may be taking a stimulant, an anti-depressant/anti-anxiety, an anticonvulsant and an antipsychotic at the same time, plus one or more to help deal with the “side-effects.” What are their goals for brain-training? To pay attention better, feel less anxiety or depression, become more stable emotionally, sleep better, etc. In other words, they want to fix the same problems they are taking all these drugs to resolve (or cover over).

Do they “get” the irony that, with this massive amount of invasive chemistry they are dumping into their brains, they have the same problems–and sometimes worse–that they had before they started?

The important recognition to begin with is that energy drives chemistry–not the other way around. Specific frequencies of electrical pulses activate synapses that release specific neurotransmitters. Chemical interventions don’t generally change the chemistry except by manipulating it artificially. SSRI drugs, for example, don’t increase the brain’s release of serotonin, which is often low in anxious people. What they do is that they artificially inhibit the reuptake the name of these chemicals. Normally certain frequencies of electrical activity (e.g. alpha) activate networks which squirt tiny amounts of a chemical (.e.g. serotonin) into the connections between neurons (the synapses). Then, within milliseconds, the chemicals bind to receptors on the receiving neuron which are specific to serotonin and any excess is vacuumes out of the synapse to make room for the next message. That’s called “re-uptake”. So a “selective serotonin reuptake inhibitor” (SSRI) simply reduces the power of the reuptake process. Whatever Serotonin is in the synapse is NOT removed quickly, increasing the chance that more molecules of it will get to a receptor. It’s a way of fooling the brain into thinking that there is more alpha being produced than there really is.

But brains are not dumb. It appears they recognize that something is causing the level of serotonin to appear greater than it actually should be based on electrical patterns. So, they close down receptor cells on the receiving neurons–so the apparent level of alpha goes back down. You have to keep adjusting the dose of the SSRI to keep achieving the false effect, and the brain keeps adjusting to that. Why is it so hard to get off these drugs? Well, when you start reducing the dosage, the reuptake process gets stronger again, reducing the false appearance of more serotonin. But now the brain has closed a lot of receptor sites, so even going back to your pre-med level of serotonin (already low), even LESS of it gets to the receiving neuron, so anxiety is paralyzing. You hope that the brain will eventually start re-opening receptors, but that takes time and is very unpleasant while it’s happening.

But what happens if something actually helps the brain to produce functional alpha in the right places at the right times? The serotonin release increases naturally. The level of anxiety (excessive thinking) is reduced and becomes stable without causing side-effects.

Brains establish habitual patterns in their energy economies, and those patterns (encoded by experience) drive the chemical environment of the brain. Brains are self-reinforcing systems, so they do not change easily–like any habits–but we know that they can change if they receive novel feedback–something that is new. That’s the power of neurofeedback: the brain receives inputs from its senses that directly reflect in objective and immediate ways the energy patterns it is producing. Given that new information, the right (novelty) hemisphere of the brain awakens and can learn new patterns, which get moved to the left hemisphere–the rule-book–and become new habits.

But when DOESN’T that happen? When the brain is so soaked with external chemistry that training it is like trying to dig a ditch in a swamp. The drugged-out brain–whether the drugs came from a doctor or a dealer–is no longer in control of itself, so it can’t change what it does very well.

The good news is that, if a client is motivated to change–recognizes that the current strategy is enslaving rather than liberating–there is a way out. If one starts reducing the drugs at the same time they are training the brain, energy patterns can begin to change so that, in our example above, the brain starts producing appropriate alpha which increases the release of serotonin–and gives the brain the message that it’s there for a reason. Continued, more rapid, reduction of the external juice can occur without the pain of the brain having to transition on its own back to a state that wasn’t ideal when it started.

I explain this to a new client and ask them how motivated they are to make the change. One interesting technique for helping them make this decision is to ask them to consider two alternatives: One, you don’t change paths but stay on the current one; two, you commit to cutting cross-lots to get from the road you have gone down to another that will make your life more what you dream it could be. If the client isn’t willing to take the second path, then I basically tell them it’s a waste of their time and money to try training their brain. If they are willing at least to make an effort and try changing, then we can go ahead. I ask them to commit to stopping or cutting way back on the drugs during one month. They train intensively during that period, sometimes daily, with a focus on dealing with the detoxification process. In many cases, when you do the initial assessment, you will find a brain that shows few if any of the expected patterns related to their symptoms. After 10-20 sessions, as they have begun to stabilize without the chemicals, I often do a second assessment and see a totally different brain. That’s the one that was buried in the swamp, and our training can focus on changing those patterns.

Medications and Training

If you begin training while a client is on meds, as most of us do, you don’t need to stop while the brain is working off the chemicals. Whatever is the brain and whatever the drugs, that’s the brain you have to train. I believe you can assess–and train–whatever brain comes before you. In the US, if we didn’t train people who were on medication, there would only be about 150 people in the whole country we could do neurofeedback with!

The key to clients on medication is to ask them to learn from their doctor what the symptoms would be of over-medication and watch for those. If you begin to see them, then the client works with the doctor to start reducing her dosage until, hopefully, it is all gone.

Most anti-depressants cause changes in the way the brain works chemically, and stopping them–especially cold turkey–can often have severe negative effects. With SSRI’s, as the client began to produce posterior 10Hz alpha, natural release of serotonin increased and they were able to back off the medication without the usual related pain. I’ve also seen low-alpha clients who did not reduce the meds as they began to be able to hold the alpha state themselves and went from being anxious and unable to sleep to being depressed and unable to get out of bed.

There’s very little research on the EEG effects of individual drugs–which of course no one ever receives anymore–much less the combined effects of the huge number of potential combinations of drugs.

Any neurotransmitter or other chemical in the brain has a range of blood levels within which they support high function. When the level of that chemical is either too low or too high, performance falls off, though often in different ways. A brain that produces little EC alpha, for example, probably shows low levels of serotonin. Taking an SSRI drug will artificially increase availability of serotonin in the synapses, hopefully into the desired range. Training the brain to increase its ability to produce alpha will also have an effect increasing serotonin–since it is a normal result of increased alpha. Either one by itself could be very helpful in terms of performance, but doing both at the same time, it would be easy to push past the peak performance level. They you can either stop doing the neurofeedback, if the client really wants to keep taking the med, or start cutting back on the dosage of the SSRI.

Toward the end of my time working with clients in Atlanta, we began to screen out of training clients who came in on four or more psycho-active medications, because we simply didn’t have much success with them. I know of others who do work with even more heavily medicated people. In my opinion, if a client is on three (e.g. stimulant, anti-depressant, anti-convulsant), few–if any–physicians can tell you anything about how they interact, because there’s simply no literature (at least there wasn’t when I was looking) on such a combination. They are the equivalent of a chemical baseball bat.

I would not include chemotherapy in the same category with other medications. Chemotherapy is a slow poisoning of the body, and it slows the brain significantly. I guess if I were going to train someone doing chemo, I would focus on trying to keep alpha peak up and reducing slowwave amplitudes.

Reducing medication

When a client comes for training while on medication, getting off the meds should almost always be a high-priority goal. I explain to clients that, if the medication has had a positive effect, it has changed brain activation. However, because chemical intervention has a temporary effect and doesn’t produce lasting changes in the brain’s energy patterns, neurofeedback is a better option. One result of training is that, as the energy patterns become more functional, the chemistry of the brain changes automatically. As that happens, the brain goes from having too little of something to having too much. As the brain produces parietal alpha, for example, levels of serotonin increase naturally.

I usually suggest that the family or client (or sometimes the trainer) check with the physician, a pharmacist or on the internet or the pill package and make a list of the things to watch for in the client that could indicate over-medication. When these appear, the family should approach their physician to get a plan for titrating off the medication. In some cases, when a physician is rigid about the dosage, families may choose to work off of it themselves.

QEEG expert Jay Gunkelman wrote an article on QEEG Support about the effects of a wide variety of drugs and medications on the EEG. You may find his article here: Drug exposure and EEG/qEEG findings by Jay Gunkelman

Cynthia Kerson et al compiled a bibliography of studies conducted on the effects of drugs on the EEG. It was published in June 2023 and may be downloaded here: Drug Effects on the EEG 2023

Other links that contain information on drugs, including Peniston and Kulkosky’s famous study on alcholics, may be accessed here:

α‐θ Brainwave Training and β‐Endorphin Levels in Alcoholics, Eugene G. Peniston and Paul J. Kulkosky
Self-regulation of the dopaminergic reward circuit in cocaine users with mental imagery and neurofeedback, Kirschner, Sladky, Haugg, Stampfli, Jehli, Hodel, Engeli, Hosli, Baumgartner, Sulzer, Huys, Seifritz, Quednow, Scharnowski, Herdener
Neurofeedback for addiction, Tamara Roth, PhD