Interest in benzodiazepine alternatives has skyrocketed as the benzo crisis looms ever larger.6 Typically women are taking twice the amount of anti-anxiety medications compared to men,7 but women and men from all walks of life have been embroiled in this battle. Finding ways to safely extricate oneself from this insidious epidemic is needed now more than ever.
Benzodiazepines are in a class of drugs where someone can actually die withdrawing from them, when attempted in an unsupported way.8 Though death is a real possibility, it is relatively rare. More common is when protracted withdrawal inflicts a struggle for extended periods of time, even years, with some pretty horrendous fallout.9
Does Your Diagnosis
We invite you to look over our published evidence on helping our clients implementing alternatives to benzodiazepine drugs. For those who have had difficulty stopping benzos, we provide neurochemistry support through rehabilitating neurochemistry naturally. We are aiming for better natural mental health without drugs. These are sometimes goals that require time and patience, but we have helped thousands of clients and can likely help your situation as well.
15 Years Experience by Professionals Who Understand Your Journey.
David Fiellin, MD, internal medicine and addiction medicine specialist at Yale Medicine published a study showing that between 1996 and 2013, the number of adult prescriptions for benzodiazepines climbed by 67% to 135 million prescriptions per year, and that the actual pill volume of benzos prescribed per person more than tripled during that time frame. He also noticed that doctors get into a hurry prescribing these medications. He also notes that primary care doctors may lack the training to prescribe benzodiazepines but do so anyway. But they often fail to do a full history and ask in-depth questions, and may not get a chance to educate the patients on the risks of these medications.6 Drug overdose deaths involving benzodiazepines rose from 1,135 in 1999 to 11,537 in 2017, often in combination with other drugs.10 And the American Journal of Public Health notes that benzodiazepine overdose deaths in the span of a decade have seen a 5-fold increase from 1999-2010.11
Benzodiazepine Protracted Withdrawal
Heather Ashton, from the Department of Pharmacological Sciences at the University of Newcastle upon Tyne, England, has published and documented the struggles of benzodiazepine protracted withdrawal for people coming off of benzos. Withdrawals lasting much longer than the pharmacological withdrawal period, indicate that possible neuronal damage may have occurred.9
Benzodiazepine Alternatives that Actually Work
Alternative to Meds Center recognizes that benzodiazepine alternatives may offer better, safer resolutions for mental health problems that are superior to taking benzodiazepines for life.
Many people struggle with anxiety or other related disorders and cannot tolerate benzodiazepine side effects, risks of addiction, or are non-responsive to treatment with these drugs. Benzodiazepine alternatives, if delivered skillfully, may be able to avoid these problems. At Alternative to Meds Center, we have seen how benzodiazepine alternatives help people to endure benzodiazepine tapering and transition into using natural alternatives to benzodiazepines.
For many reasons, like insomnia, panic, and anxiety, doctors prescribe benzodiazepines.13 The therapeutic value or relief of symptoms is generally pretty profound, especially in acute anxiety.14 But prescribing guidelines indicate that the prescription should be limited to 2-4 weeks and rarely longer in extreme circumstances.12 Beyond a certain time frame, the medication often becomes problematic in various ways, including benzodiazepine dependence which occurs in an estimated 30-45% of chronic users.15 We feel that the original symptoms are generally masked by drugs, rather than fixed. At Alternative to Meds Center, we are most focused on fixing the things that benzodiazepines cannot actually correct, such as psychological issues, dietary factors, medical issues, neurotoxic body burden, and lifestyle. We work to find and correct the underlying reasons that are causing the symptoms which resulted in being medicated. Using non-toxic methods and natural substances, our studies have shown that this is achievable long-term for 87.5% of the participants.
Natural Alternatives to Benzodiazepines
Natural alternatives span various methodologies. Talk therapy and counseling have been proven effective for many patients experiencing anxiety disorders such as GAD, panic disorder, social anxiety, acute stress disorder, PTSD, and OCD.16
Good sleep hygiene including blue-blocking devices and shutting off the Wi-Fi and other forms of EMFs at night can provide insomnia relief.17,18 Mycotoxin (mold) issues have also been attributed to depression and anxiety,19-22 as have other forms of neurotoxicity such as glutamatergic dysregulation.23 Supplemental support in the form of vitamin therapy also has shown efficacy.1
Natural Alternatives to Benzodiazepines include:
Talk therapies, i.e. CBT16
Reduce exposure to EMFs and Wi-Fi17
Invoke good sleep hygiene including blue light blocking18
Reduce exposure to mold in the home and diet19-22
Eliminate MSG, and limit other glutamate containing foods23
Test for and address heavy metal and other neurotoxic accumulations in the body.25-27
Relaxing environment with thermotherapy or massage28
Passionflower (Passiflora incarnata)31
Kava (Piper methysticum)32
L-lysine and L-arginine38
Eat organic food51
Use organic hygiene products52
Valerian extract (valerenic acid) – safe and effective for anxiety.57
Dietary and Hygiene Considerations as Benzodiazepine Alternatives
The Environmental Working Group found in excess of 2,000 chemical additives, preservatives, artificial colors, and other chemicals, many of which are considered toxic, are used in conventional packaged foods. Many of these chemicals are poorly regulated and create a toxic burden that the body then has to deal with. Eating organic can significantly reduce these chemical exposures.52
A good rule of thumb is “if you can’t eat it, don’t put it on your skin.” Much of what we put on our skin ends up in our body and can act as hormone mimickers, endocrine disruptors, neurotoxins, and affect our energy metabolism. A shortlist includes phthalates, PCBs, parabens, fragrance, propylene glycol, triclosan, and literally thousands of others.51 An excellent resource for learning more is the Environmental Working Group’s website called Skin Deep that catalogs the chemical profile of over 77,000 different hygiene products, and provides toxicity profiles including the physiological targets of these poisons. Becoming aware is the first step to making better choices as consumers.
Glutamate Containing Foods
In 2015, published in the Biomolecules journal, researchers discussed the role of glutamate neuropathways as it relates to depression and anxiety. Reviews of the existing evidence led to a novel hypotheses of “glutamate dysregulation.” One aspect of the study noted that the total brain concentrations of glutamate are elevated in the cerebral spinal fluid of those afflicted with OCD. Glutamate is a component of MSG.23
Find out where it is hidden in food products and don’t buy or consume such products. Research the various names that MSG may be disguised by in common processed foods.53
The artificial sweetener Aspartame has been known to cause behavioral and cognitive issues. Some of the physiological problems include migraines and other headache types, learning deficits, and even seizures. Psychiatric symptoms can include anxiety, depressions, insomnia, and unstable mood presentations. This is likely due to aspartame’s effects on increasing phenylalanine and aspartic acid levels in the brain.50
There are many ways to modify and improve the daily diet for mental health as well as physical health.24 At Alternative to Meds Center, we prepare our foods with mostly organic, nutrient-dense, and unprocessed foods that support mental wellness. Supplementation is another pillar of healing in all our programs.
Influence of Toxic Heavy Metals in Psychiatric Symptoms
Lead and Cadmium Involved in Anxiety Pathogenesis
The North American Journal of Medical Sciences published an article in 2014 reviewing the effects of lead and cadmium on mental health. Of the over 400 articles on the subject they reviewed, 60 met the inclusion criteria. They found that increased bone lead concentrations in middle-aged and elderly women led to an increase in depressive and phobic anxiety markers. They also found cadmium followed these same psychiatric involved trends. They discovered that cadmium exposure in utero had been sufficiently documented to cause depression, anxiety, mood disorders, and even schizophrenia. And of particular interest, they found lead debilitated the production of energy in the mitochondrial biochemical cascade. These mitochondrial impairments then manifested as psychiatric disorders including depression and anxiety and skewing of the hypothalamic-pituitary-adrenal axis, (HPA). The HPA is the primary nervous system and endocrine system interface and helps regulate how these systems function in relation to stress responses.25
Can Mercury Cause Anxiety, Insomnia, and OCD?
At Alternative to Meds Center, we have noticed a clinical correlation between mercury burden on a provoked chelation challenge, and the incidences of anxiety, OCD, and insomnia. Mercury is a known neurotoxin, suspected to possibly debilitate the serotonin-melatonin pathway. In animal studies using adult zebrafish, researchers may have found such a correlation and published their findings in 2011 in the Journal of Neurotoxicology and Teratology. The zebrafish were subjected to an acute insult of methylmercury. They were subsequently tested by two separate methods for anxiety. Even at low doses, the zebrafish showed high anxiogenic markers in both test types. Curious to us, these effects were accompanied by a decrease in extracellular levels of serotonin, and tryptamine-4,5-dione, which is a serotonin metabolite.26
Toxicological Sciences in 2001 published an article about long-term mercury exposure in human populations. They noted that long-term exposure to mercury has been attributed to impairments of the central nervous system, particularly memory loss, depression, and anxiety. Human subjects possessing the V66M polymorphism, which is involved in the gene encoded brain-derived neurotrophic factor (BDNF), were particularly vulnerable to the psychiatric neurobehavioral impairments inflicted by mercury.27 A 2000 article in Industrial Health discusses what is called “mercurial erethism,” a set of behavioral changes in response to mercury that includes memory loss, insomnia, and abnormal mental excitement and irritability.44
Physical Treatments for Anxiety and Insomnia
The American Massage Therapy Association describes a small clinical study on the effectiveness of massage for 8 patients afflicted with (GAD), generalized anxiety disorder, and noted that subjects experienced decreased anxiety.28
Acupuncture and Traditional Chinese Medicine
Acupuncture in medicine: The Journal of the British Medical Acupuncture Society in 2007 reported positive findings for acupuncture while treating generalized anxiety disorder and anxiety neurosis but felt there was insufficient evidence within the research for definitive conclusions to be drawn. The authors performed a systematic review of what they could find of the relevant research regarding acupuncture in the treatment of anxiety disorders.30Medical Acupuncture’s published findings in 2013 were based upon illustrative cases that traditional Chinese therapies (TCM) including acupuncture did provide relief for anxiety and depression as well as sleep disorders and PTSD.29
Supplements Used as Benzodiazepine Alternatives
The Nutritional Journal published an article in 2010 where authors claim that “based on the available evidence, it appears that nutritional and herbal supplementation is an effective method for treating anxiety and anxiety-related conditions without the risk of serious side effects.”15 This truly encapsulates the basis of our work in benzodiazepine and other medication alternatives.
In 2001, the Journal of Clinical Pharmacy and Therapeutics compared passionflower (Passiflora) extract to the benzodiazepine oxazepam and found that both were equally effective. The oxazepam created an impairment of job performance whereas Passiflora had a low to non-existent impact. The researchers concluded that Passiflora extract was effective for the management of generalized anxiety disorder, and even had an advantage over the benzodiazepine due to Passiflora’s low incidence of impairment.31
A Cochrane review of seven randomized clinical trials (RCTs) using kava for the treatment of generalized anxiety found a significant reduction of anxiety on the Hamilton Anxiety Rating Scale for kava compared with placebo. The mechanism may be because of its effect on modulating GABA. They note that this medicinal plant from the South Pacific is “a non-addictive, non-hypnotic anxiolytic with the potential to treat GAD.” The evidence for the efficacy of kava for treating anxiety has been affirmed through clinical trials and meta-analyses.32
Abdou et al’s study on GABA for treating anxiety showed that GABA reduced anxiety and increased relaxation in humans.54Frontiers in Neuroscience’s 2020 review also showed that there was low to moderate evidence for GABA’s ability to produce a reduction in stress.33
In a 2019 rat study published in Redox Biology, researchers found that taurine demonstrated a protective role against anxiety, Specifically, taurine reduced the stress makers dopamine, 5-hydroxytryptamine, and noradrenaline and reversed elevated glutamate and corticosterone levels.34 Henry Emmons MD, as stated in Natural Mental Health, identifies taurine as an amino acid that increases inhibitory glycine and GABA to ease anxiety. He notes that it also protects against anxiety by reducing the neurotoxic effects of excess glutamate.56 And the Journal of Physiology, in a 2002 article, describes how β-Alanine and taurine assist the inhibitory glycine receptors in the in vitro hippocampus of rats.35
In 2009 the Neural Plasticity Journal, researchers followed one chronic OCD and body dysmorphic disorder (BDD) patient being administered high dose glycine for a five-year period. They found a large reduction in OCD/BDD symptoms while the patient was properly adhering to the treatment, and that relapses in symptomatology would resume when he would stop the glycine therapy. They discuss the mechanism of glycine and its profound anti-anxiety properties. Inhibitory receptors for glycine occur throughout the CNS and spinal cord and brain stem areas and are equally distributed throughout mammalian tissues. Glycine also suppresses the release of norepinephrine, an excitatory neurochemical, thus mitigating anxiety, and panic.36
Hospital News in 2005 concludes that niacinamide (a niacin variant) has anti-anxiety effects comparable to the benzodiazepine class drugs. They claim that niacinamide appears to express this anti-anxiety phenomenon by modulating neurotransmitters that are commonly unbalanced in anxiety.37
L-lysine and L-arginine
A 2007 Biomedical Research study describes a week-long oral treatment using slightly over 2.5 grams of L-lysine L-arginine in one hundred eight Japanese adults. The results showed that lysine was effective in reducing chronic anxiety. This was a randomized, double-blind, placebo-controlled study that further validated earlier findings that a combination of L-lysine and L-arginine were useful dietary interventions in humans experiencing high subjective levels of mental stress and anxiety.38
Nutrients in 2017 published a systematic review examining previously published evidence for the efficacy of magnesium supplementation for the alleviation of stress and anxiety in subjective evaluations. They found that the evidence suggests that magnesium exerts a beneficial effect on anxiety and stress responses.39
Neurotherapeutics in 2015 published what they called “strong evidence” supporting CBD as a viable treatment for multiple anxiety disorders including generalized anxiety, panic disorders, social anxiety disorder, OCD, and PTSD. Very few medications cover such a wide range of approval for multiple anxiety presentations.40
Garzon et al’s study on the effects of melatonin on the elderly showed that melatonin worked better than a placebo sugar pill to improve sleep and decrease symptoms of depression and anxiety. The results of this study suggest that melatonin administration significantly improves sleep and behavioral disorders in the elderly and facilitates discontinuation of therapy with conventional hypnotic drugs.41
Tryptophan & 5-HTP
5-HTP is a clinically effective precursor to serotonin, according to Birdsall, published in the 1998 Alternative Medicine Review. In other clinical studies, researchers published a double-blind placebo-controlled clinical study of 45 DSM-III diagnosed anxiety patients in International Clinical Psychopharmacology. This study demonstrated that 5-HTP showed a moderate reduction of anxiety and related symptoms on the 90-item symptoms checklist (SCL-90) and the State Scale of the Spielberger State-Trait Anxiety Inventory. The results provided support for the theory that serotonergic pathways are involved in the development of anxiety and panic disorders including agoraphobia.43,45
Toxic Mold Syndrome
Bill Rea, one of the true godfathers of environmental medicine, published results of a 100-person clinical trial in the 2003 Archive of Environmental Health. Results showed that mold exposure had affected 80% of participants who tested positive for abnormal T and B cells. A sub-group of 67 participants suffered respiratory dysfunction such as wheezing, and 70% of the participants suffered from a neurological impairment such as short term memory loss and deficits in hand-eye coordination.20 People who reside in mold environments tend to have more depression, as found in a study of 5,882 adults, published in a 2007 issue of the American Journal of Public Health.11 The Amen Clinics, on the subject of toxic mold syndrome, claim toxic mold exposure has also been attributed to severe long-term problems like memory loss, insomnia, anxiety, depression, confusion, and inability to concentrate.21 More on the subject can be found by reading Mold Warriors: Fighting America’s Hidden Health Threat by Ritchie C. Shoemaker.19
Good Sleep Hygiene
Harvard Business Review article in 2020 covered a research method for blue light blocking glasses. Randomized subjects spent one week wearing blue light filtering glasses for two hours before bedtime, and then spent another one week wearing “sham” glasses lenses that did not filter out blue light. The glasses were identical in appearance and subjects did not know which glasses they were wearing during the study period. During the week in which people wore the blue-light-filtering glasses, subjects reported getting 11-14% higher quality sleep.18
Healthy sleep habits include*
Go to and get out of bed at the same time, even on weekends or during vacations.
Get to bed early enough so that you can get at least 7 hours of sleep.
Only go to bed when sleepy.
If you are unable to sleep after 20 minutes, get out of bed.
Establish a bedtime routine that evokes relaxation.
The bed is for only sleep and sex, not other activities especially work or fighting.
Design the bedroom to be relaxing and keep it at a cool, but comfortable temperature.
Limit being exposed to bright lights in the evenings.
Turn off phones, WiFi, and other electronic devices in the home at least 30 minutes before bedtime.
Avoid eating a large meal before bedtime. Eat a light healthy snack instead.
Maintain a healthy diet
Avoid caffeine in the late afternoon or evening.
Abstain from alcohol before established bedtime.
Do not drink a lot of fluids before bedtime.
* Source: American Alliance for Healthy Sleep17
Targeted Nutritional Therapy as a Benzodiazepine Alternative
Focusing on diet and nutrition provides effective benzodiazepine alternatives treatment, including drinking plenty of water and avoiding sugars, refined carbs, and caffeine. Nutrient deficiencies contribute to mental disorders such as anxiety and depression. As blood sugar issues can cause symptoms resembling “mental illness,” learning how to manage blood sugar is a vital piece of knowledge.46,47 Our classes offer instruction in this and other pertinent areas for those recovering from benzos. Excellent nutrition, adequate vitamins, minerals, and other supplements can make big differences in how we feel.1,2
Herbal remedies, orthomolecular medicine, and natural therapies are often beneficial for people with anxiety, insomnia, depression, and other mental health conditions. Alternative to Meds Center combines the necessary aspects of traditional medicine with the commonly overlooked aspects of holistic treatment to provide an integrative mental health approach. Unlike drug-based doctors, practitioners who focus on the gut-brain axis are more likely to be better equipped to recommend the right alternative mental health treatments. Benzodiazepine alternative treatment often includes more than just one therapy. There are many tools that can be utilized as natural benzodiazepine alternatives that can help people overcome anxiety without prescription drugs. Complex treatment programs are customized for each client’s success.
Talk Therapy and Benzo Recovery
Talking with a counselor, or support group, to openly discuss your feelings and find empowerment will encourage you to stay positive and allow you to comfortably connect with others with whom you can verbally express your feelings. Through counseling, you can start to challenge your anxiety, rationalize your negative thoughts and fears, and overcome uncertainty.
Through cognitive-behavioral therapy (CBT), you can learn how to undo negative and anxious thinking patterns and replace them with more positive and rational outlooks. Published in a 2011 Dialogues in Clinical Neuroscience article, researchers found that CBT was efficacious in randomized controlled trials for the treatment of adult anxiety disorders.16 When you start to feel anxious or get into a negative thought pattern, you can ask yourself “Is there a better way to look at this situation?” Studies have shown that CBT has a superior therapeutic value than drugs, and the positive results last much longer.4,5
Learned Relaxation Techniques
Other important parts of benzodiazepine alternatives include learning how to relax, and methods of relieving stress in healthy ways, and there are many easy, positive ways to learn how to achieve relaxation. Meditation, for example, is something we all do every day whether we realize it or not, as everyone practices meditation in their own way. This is undoubtedly a wonderful exercise to practice on a conscious level regularly. Meditation is calming, balancing, and tends to put things in perspective. Fortney and Taylor’s review of the literature on meditation describes it as a healthy mind-body practice widely known and accepted in the scientific community as well as by the public at large for its many health benefits.55
Natural Integrative Benzodiazepine Alternatives
We use natural, scientific, and drug-free approaches to balance brain function.4,5 We provide the following benzodiazepine alternatives: lab testing, biotransformation, and chelation (removal) of toxic body burden, supplements as discussed earlier on this page and others, customized and guided by a naturopath, plus glutathione nebulization, medication tapering, neurotransmitter rehabilitation using oral and IV infusions including NAD, peer support, yoga, massage, acupuncture, sauna therapy, counseling, dietary adjustments including all organic gluten and dairy-free diet, colonics, physical fitness instruction, and much more which can be read about on our services page. Through counseling, lab testing, and alternatives to psychiatric methods, we can discover where your anxiety stems from and help you get rid of anything that no longer serves you. The benzodiazepine alternatives treatment that is commonly most successful is one that finds the real underlying reasons that cause symptoms of anxiety and personalizes treatment on an individual basis.
Effects of Toxins On CNS Chemistry
Underlying causes of anxiety can include neurotoxins, toxins that can build up in an individual’s system over their lifetime. The toxins can produce overstimulated nervous system effects.25-27 A good example is pesticides. Pesticides like organophosphates are created to kill insects — think grasshoppers — and work in the following way: the toxin is absorbed into the exoskeleton, and then it finds its way into the nervous system. A pesticide will cause acetylcholine nervous system channels to remain open, not allowing the channels to be closed. Acetylcholine is a neurotransmitter that is stimulating, so it will cause a grasshopper to jump. The pesticide creates a constant release of acetylcholine and this puts the grasshopper into catatonia and death. This is the way pesticides kill pests. Accumulation of this toxin occurs very similarly in humans, as the human nervous system uses acetylcholine for stimulation also.48,49 Other toxins such as heavy metals, molds, MSG, mycotoxins, aspartame,50, and literally thousands of other s in processed food and hygiene products have similar effects. One of the best benzodiazepine alternatives is to reduce the toxic body burden so that the body can self regulate.
Our goal is to teach clients to be their own experts on mental health.
We’ve Been Down This Road, We Know What Works
Our benzodiazepine alternatives may be diverse for this specific type of medication, but they include very careful medically-supervised benzodiazepine weaning and titration techniques, neurotoxin removal, peer support, natural substances to create neurochemical support, orthomolecular nutrition, and many beneficial alternative mental health treatments such as acupuncture, massage, and sauna which are designed to induce relaxation and stability.
We find that in the majority of cases of chronic anxiety, there is an accumulation of neurotoxins. Typically these include toxic heavy metals in the anxious individual. Until purged, these trapped toxins may overstimulate the nervous system. Add to that other stressors such as increasing demands at work, floundering relationships, financial or other upheavals. All of it can be too overwhelming. Often this is when a person goes to the doctor who prescribes anti-anxiety medication. Benzodiazepines are our most common class of medications we address. Coming off benzos without support can be extremely difficult. We can help you get off benzodiazepines with less discomfort and provide many newly learned skills so that you can live without ongoing anxiety or the need for medication.
Alternatives to Benzodiazepines at Alternative to Meds Center
Our programs are delivered in a pristine, comfortable inpatient social setting. The camaraderie found in a group of like-minded individuals can provide support and confidence in persevering through to a successful outcome. Although the therapeutic and clinical aspects of the programs are all about precision, bear in mind that mindful relaxation and positive focus are also important ingredients to healing.2,3,5 For example, the center’s locale offers many opportunities for easy walking trails in the beautiful red rock mountains, stunning photo ops, visiting the shops and galleries of Sedona’s artisan-based community, and so many other pleasant excursions to choose from.
Our scientific approach to discontinuing benzodiazepines and stabilizing brain function has helped thousands of people become mentally healthy. Whether you are young or old, in-between or “ageless,” our wide range of therapeutic options, including art and music therapy, equine therapy, and so much more, holds the potential of healing and positive changes for every one of our clients.
46. Acute Hypoglycemia Presenting as Acute Psychosis Tanveer Padder MD, Aparna Udyawar MD, Nouman Azhar MD, Kamil Jaghab MD From the Department of Psychiatry, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow NY 11554 USA.First Published December 2005. [cited 2021 Jan 7]
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.