In SSRI withdrawal, brain zaps go from overlooked symptom to center stage (2023)

https://www.psychiatrist.com/news/brain-zaps-go-from-overlooked-symptom-to-center-stage-in-ssri-withdrawal/

by RicoElectrico • 2 years ago

142 157 2 years ago

wil421• 2 years ago

One of the worst experiences of my life was taking an SSRI, I was just starting and somehow my prescription was for 2 grams instead of 200mg, due to a mistake. Worst experience ever, brain zaps and something else I’ve never felt before. Once I figured out the mistake I stopped taking it.

Luckily I was just a teen going through teen things and didn’t really need anything, just a little time.

willcipriano• 2 years ago

Damn, 2 grams? I had no idea the dose could get that high.

kristianp2• 2 years ago

That sounds odd. Were you taking 20 tablets at a time?

notjulianjaynes• 2 years ago

2,000 mg is likely an unsafe dose of any SSRI. In the past I was prescribed one and the dosage was 20 mg and even that made me feel a little bit strange and uneasy for the first few days until my body adjusted to it. Sorry you went through that.

tombert2• 2 years ago

I did Prozac for about two months earlier this year, a relatively light baby dose.

It was utterly terrible. I couldn’t think about anything, basically zero focus on anything that took more than a minute of attention span, I felt completely detached from anything resembling an emotion, and I also seemed to completely lose my ability to feel hungry or thirsty, so there would be entire days where I would forget to eat or drink anything, probably making all the other symptoms worse.

They transitioned me to Pristiq, which has been considerably less horrible, though not terribly effective either. I am actually undergoing TMS now.

y-c-o-m-b4• 2 years ago

If you're not responding well to SSRI/SNRI drugs, you could give bupropion (Welbutrin) a try. Just ask for a small dose at first. You may even be able to take them together with Pristiq. It's worth a discussion with your care provider.

mmsc3• 2 years ago

(2013)

dang4• 2 years ago

Added above. Thanks!

alaithea5• 2 years ago

But the article says it was published in 2023.

StefanBatory• 2 years ago

I was lucky when I was taking Sertraline. Because I was only sleepy for the first two-three days and besides that I had no side effect. Only thing I noticed from that period is that it was genuinely harder for be to be in a very negative mood - like my mental state went from a range of 5 to -8 to 5 to -5.

duncancarroll• 2 years ago

I started getting these post-Covid, but I'm not on any SSRIs. It feels like your brain does a "degauss" thing like the old CRT monitors; it's not fun.

There's some evidence to show that long Covid is connected with low serum serotonin, and the zaps make me wonder if it's connected to cerebral serotonin as well, since I imagine it's the sudden reduction that causes the zaps: https://www.cell.com/cell/fulltext/S0092-8674(23)01034-6

y-c-o-m-b4• 2 years ago

Wow, now that's an interesting one! You described the feeling perfectly though, it's exactly like that. I wonder what would happen if you took an SSRI...

mmsc3• 2 years ago

Physicians were initially unaware or dismissive of brain zaps due to limited information and a focus on downplaying the addictive nature of antidepressants.

I don't know why. It's a pretty well-known effect of fucking with your serotonin levels. Someone I know took about 4g of MDMA over a 4-day period and what followed was about 2 weeks of these "brain zaps", sleep paralysis with demons in the room (feeling like you are laying in bed with a demon coming towards you but you physically cannot move). This stuff has been known about for decades but unable to be researched due to the US' drug laws. Those brain zaps are apparently like just doing whatever you're doing, when BAM, it feels like an electric shock has gone through your head into the back of your eyes.

camgunz2• 2 years ago

80% of everything is crap, including psychiatrists, plus if you take away SSRIs that's a huge chunk of their business. Upton Sinclair and all that.

malfist• 2 years ago

SSRIs kept me from killing myself. You should moderate your opinion. I'm sure you wouldn't advocate for taking away a diabetic's insulin of an organ recipients immunosuppressant

thescriptkiddie• 2 years ago

I've gotten them from taking SNRIs, so I wonder if norepinephrine is involved somehow, or maybe SNRIs are not actually that selective.

larve• 2 years ago

got them after weaning of SNRIs, for about 1-2 years I had random brain zaps. Not that big of a deal per se, but definitely annoying.

jrflowers2• 2 years ago

The S in SNRI stands for Serotonin, not Selective.

_moof• 2 years ago

If you're talking about Effexor - famous for wicked brain zaps after only one missed dose - this could have more to do with its very short half life.

p1anecrazy• 2 years ago

The only time I got them was getting off a high dose of Strattera (atomoxetine), the rare non-stimulant ADHD medication, cold turkey.

asimovfan2• 2 years ago

i used to get zaps when my body tried to feel good on normal occasions after 'fucking with my seratonin levels'. I remember i used to get them when I was reading something i found clever or funny, chugging cold water, biking etc.

jamiek88• 2 years ago

Finally! Someone else with this. Reading Crime and Punishment gives me this feeling, I get zaps and it kinda hurts my brain to read. Only happened with that novel and some Shakespeare.

carlmr• 2 years ago

I remember i used to get them when I was reading something i found clever or funny

I have to ask do these zaps feel good, bad, do they hurt, do they tickle. I can't quite imagine what zap is supposed to mean.

Without any history of SSRI use, when I read something funny or clever, I've often experienced a weird feeling which could be described as electric, but also tickly and kind of good feeling. Mostly in my brain and upper spine.

I also get this listening to ASMR audio. Not sure if that's the same thing we're referring to though.

ChadNauseam• 2 years ago

Someone I know took about 4g of MDMA over a 4-day period

For anyone reading who's unfamiliar, this is a ridiculous dose of MDMA. A normal recreational dose would be 0.1g-0.2g once every few months. (I have no idea whether this dose is safe or not, just saying it's a common one for people to take.)

A bad thing about MDMA is that you become tolerant to it very quickly, so people who do it too regularly need to take more and more over time to feel the effects. That's probably what happened to the parent comment's friend.

morkalork• 2 years ago

I've seen someone do 1g over the course of a long evening but they were a seasoned user. That's the kind of dose that would send a average sized teenage girl to a hospital in convulsions. 4g over 4 days? It's not even about the tolerance at that point, by days 3/4 do you even have any serotonin left for it to be any fun?

TheSpiceIsLife• 2 years ago

I'd argue 100 to 200mg every few months is a normal therapeutic dose.

What's normal and recreational is much less well defined.

Jerrrrrrry• 2 years ago

Having experienced this exact dosage, I can attest it is more of just raw dragon-chasing juxtaposed with an insane tolerance curve.

The euphoria caused by MDMA combined with literally any other drug (MDMA is like ketchup, can be combined with anything) synergizes and can quickly escalate to rampant re-dosing that _exponentially_ increases tolerance, all while preventing the receptor to re-regulate.

The "sads" following MDMA binges are so ironically over-bearing to a point of near artificial-ness and it is nearly obviously attributable to the chemical.

MDPM/6-APB are interesting as they are euphoric and serotonic but with less manic depressive the next circadian cycle.

marknutter• 2 years ago

sleep paralysis with demons in the room (feeling like you are laying in bed with a demon coming towards you but you physically cannot move)

This gave me literal chills when I read it because this exact thing happened to me for the same reason as your acquaintance (but far, far lower doses). I was prone to getting sleep paralysis anyways, but abusing MDMA resulted in the most terrifying experience of my life two nights in a row. Your description was spot on.. I felt the covers on my bed being pulled off of me by some demonic presence the first night, and the second night the same thing happened but that time I was lifted out of my bed and slowly dragged away. Felt like I was awake and perfectly conscious the entire time and I literally frozen with fear to the point where I couldn't speak. I stayed up the entire night after that for fear of it happening again. I also got terrible brain zaps for weeks afterwards, too.

Traubenfuchs• 2 years ago

Someone I know took about 4g of MDMA over a 4-day period

I am all for freedom of drugs and people experiencing one of the most beautiful states of mind one can achieve, but 4g MDMA over 4 days is literally in the attempted brain-damage territory.

survivedurcode• 2 years ago

I think there’s more to it than just messing with serotonin.

There’s something about Sertraline (Zoloft) that seems to make it quite reliable at causing brain zaps. 3 people I’ve known who stopped Sertraline all experienced brain zaps. 1 of those people also talked about stopping Prozac (cold turkey) and Lexapro (4wk taper) and did not have the zaps, but a 4-month taper of Sertraline was not enough to avoid them.

In fact in the article they recommend switching to Prozac and then tapering that, as a way to avoid the zaps.

spangry• 2 years ago

I've heard similar about Zoloft, and Effexor (which is notorious for causing withdrawal symptoms when coming off it).

I believe Lexapro is a highly selective SSRI, which might explain its lack of withdrawal symptoms (and also its "does absolutely nothing" effect for some people). Prozac has a very long half-life compared to other SSRIs so it's basically got an in-built taper, and is why it's often 'cross-tapered' to when coming off another SSRI.

wormius• 2 years ago

I don't know enough specifics, but there's multiple subtypes of serotonin receptors. It's possible that perhaps Sertraline affects different subtypes or a combination. Perhaps the binding affinity is different, but yeah, each of these are different (hence why they're different drugs, and not just generics of the same thing).

I've had a brainzap when I was used MDMA somewhat regularly for a short period in the 90s. It was only once, so it was more a weird "What is this? I feel... something... in my brain?" But I don't think I would want to deal with it happening spontaneously and constantly like withdrawal symptoms present. Sounds awful.

I take Effexor which is an SNRI... From what I've read, is one of the worst in terms of withdrawal (brainzaps and other side-effects). I'm really not liking the idea of me having to someday go off of it, so far for now it keeps me stable, but... if something happened where I would need to go off of it, I'm not looking forward to it.

heavyset_go• 2 years ago

Prozac has a notoriously long half-life, which is one of the reasons it's indicated for adolescents who are likely to skip/forget doses.

The long half-life is also the reason it's prescribed for SSRI withdrawal symptoms.

Sertraline is a potent SSRI in terms of inhibiting the serotonin transporter protein itself. It also has a relatively short half-life. Makes sense that cessation would induce withdrawal symptoms.

It's the same principle behind prescribing Suboxone for opioid withdrawal. The drug has a ridiculously long half-life, so it has the potential to smooth out what would otherwise be acute withdrawal.

jvanderbot• 2 years ago

SSRIs are a huge help to me. I'm one of the lucky (?) ones.

For those curious about what a brain zap is, it's like you're going about your normal business, then you feel a jolt like you're surprised, but only in your head. Then it's difficult to remember what you were thinking about prior to the zap. When it happened to me last, I stopped walking and couldn't resume my inner monologue/ train of thought. I just started walking and let another one conjure itself up.

It's been decades since I've had one, Wellbutrin is much better.

hirvi744• 2 years ago

For me, it felt like my brain would buffer like a YouTube video for a split second.

wruza3• 2 years ago

When I went off SSRIs, these zaps were regular for two weeks, especially outside when something like a car crawls into your peripheral view. Ranged from a full zap to light “buffering reset”, as if you just skipped a second of your life.

Idk how a doctor can just dismiss it. Ofc there is a variety in “brightness” out there but being that thick is something else.

gr4ntmr• 2 years ago

it's like striking your funny bone, but in your head

salawat• 2 years ago

Wellbutrin is not an SSRI. Wellbutrin works via the dopaminergic pathway. Same receptors that are generally targets for ADHD.

pdfernhout• 2 years ago

Physicians were initially unaware or dismissive of brain zaps due to limited information and a focus on downplaying the addictive nature of antidepressants.

Seems like another example of: "Deadly Psychiatry and Organised Denial" https://www.deadlymedicines.dk/deadly-psychiatry-and-organis... "Deadly Psychiatry and Organised Denial explains in evidence-based detail why the way we currently use psychiatric drugs does far more harm than good. Professor, Doctor of Medical Science, Peter C. Gøtzsche documents that psychiatric drugs kill more than half a million people every year among those aged 65 and above in the United States and Europe. This makes psychiatric drugs the third leading cause of death, after heart disease and cancer. Gøtzsche explains that we could reduce our current usage of psychotropic drugs by 98% and at the same time improve patients’ mental and physical health and survival. It can be difficult, however, to come off the drugs, as many people become dependent on them. As the withdrawal symptoms can be severe, long-lasting and even dangerous, slow tapering is usually necessary. In his book, Gøtzsche debunks the many myths that leading psychiatrists – very often on drug industry payroll – have created and nurtured over decades in order to conceal the fact that biological psychiatry has generally been a failure. Biological psychiatry sees drugs as the “solution” for virtually all problems, in marked contrast to the patients’ views. Most patients don’t respond to the drugs they receive but, unfortunately, the psychiatrists’ frustrations over the lack of progress often lead to more diagnoses, more drugs and higher doses, harming the patients further."

Other alternatives for health and wellness I have collected: https://github.com/pdfernhout/High-Performance-Organizations...

One example from there: "The Depression Cure: The 6-Step Program to Beat Depression without Drugs" by Stephen S. Ilardi

From the Amazon book blurb: "In the past decade, depression rates have skyrocketed, and one in four Americans suffer from major depression at some point in their lives. Where have we gone wrong? Dr. Stephen Ilardi sheds light on our current predicament and reminds us that our bodies were never designed for the sleep-deprived, poorly nourished, frenzied pace of twenty-first century life. Inspired by the extraordinary resilience of aboriginal groups like the Kaluli of Papua New Guinea, Dr. Ilardi prescribes an easy-to-follow, clinically proven program that harks back to what our bodies were originally made for and what they continue to need with these six components:

  * Brain Food [supplement with Omega 3s; remember your brain is mostly fat]
  * Don't Think, Do [avoid excessive rumination by doing things]
  * Antidepressant Exercise [aerobic exercise is medicine]
  * Let There Be Light [get natural sunlight and supplement as needed with vitamin D3]
  * Get Connected [engage in face-to-face social activities regularly]
  * Habits of Healthy Sleep [get enough sleep by following basic guidelines]

The Depression Cure's holistic approach has been met with great success rates, helping even those who have failed to respond to traditional medications. For anyone looking to supplement their treatment, The Depression Cure offers hope and a practical path to wellness for anyone."

TL;DR as Ilardi says: "We were never designed for the sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden, frenetic pace of modern life. (Stephen Ilardi, PhD)"

That said, if you are on prescription psychotropic meds already, do not stop taking them or change doses without some medically-approved plan for getting off them. Peter Gøtzsche wrote an entire book about that: "Mental Health Survival Kit and Withdrawal from Psychiatric Drugs: A User's Guide" https://www.amazon.com/Mental-Health-Survival-Withdrawal-Psy... "This book can help people with mental health issues to survive and return to a normal life. Citizens believe, and the science shows, that medications for depression and psychosis and admission to a psychiatric ward are more often harmful than beneficial. Yet most patients take psychiatric drugs for years. Doctors have made hundreds of millions of patients dependent on psychiatric drugs without knowing how to help them taper off the drugs safely, which can be very difficult. The book explains in detail how harmful psychiatric drugs are and gives detailed advice about how to come off them. You will learn: ... that psychiatric drugs should never be stopped abruptly because withdrawal reactions can be dangerous..."

hirvi744• 2 years ago

So, basically be rich enough to not work?

There is probably some true to this advice, but the issue is not that it's some hidden secret, it's that fact that is basically infeasible for a majority of people.

Trust me, while I benefit from psychiatry, I am by no means a fan of psychiatry as a whole. However, your comment only focuses on depression. There are plenty other disorders that psychiatry deals with, like Schizophrenia, that the list of advice above would hardly make a dent in for many.

MrDrMcCoy• 2 years ago

I'll add this to my reading list. Send like it's a good compliment to "This Is Your Brain on Food" by Uma Naidoo and "Brain Energy" by Christopher Palmer. Both very insightful and well researched.

firecall• 2 years ago

Thats exactly the problem I'm having!

Working with my GP to titrate off Sertraline (Zoloft) at the moment.

My GP, like many others, wasnt really aware of the issues with getting off the drugs!

I describe the brain zaps as like a wave of electricity.

Like a Sci-Fi pulsing wave. As if i've got some sort of giant capacitor discharging in my brain.

The sort of thing from a 50s Sci-Fi movie thats a tower of electricity, glowing and pulsing and radiating an electrical light show!

Exactly the sort of thing that might re-animate Frankenstein!

It's not painful as such, but it's debilitating and causes you to literally pause and make a sharp intake of breath.

I hate being on the bloody things. Wish I'd never started them. CBT is much more effective in the long term, for me. YMMV.

I find SSRIs kill my motivation and creativity.

I'd really suggest anyone think twice before assuming these pills, that GPs dish out like candy, are an easy and consequence free solution!

TexanFeller4• 2 years ago

Someone close to me is doing the same. Sertraline isn't easily available in tiny dose increments useful for weaning off gradually, and its half life isn't very long, so missing or reducing a dose is almost immediately noticeable for some people. A strategy that's helped is cross-titrating and switching to Prozac. Because Prozac has a massively longer half life it's a much smoother ride while you're gradually reducing it.

wruza3• 2 years ago

I hate being on the bloody things. Wish I'd never started them. CBT is much more effective in the long term, for me. YMMV. I find SSRIs kill my motivation and creativity.

That’s forbidden knowledge. For some reason they tend to just write you a recipe and see ya in a year, good luck with collateral damage to your life.

SSRIs get advertised as making you indifferent to bad things, well, you become indifferent to all things. Like a vegetable. It’s an amplitude modulator, not a negative cut off. I wonder how much that correlates with “psychotypes” and general development, because it almost feels like you become an average normal person, and not in a good sense. Blind, dumbed (not dumb but unmotivated), indifferent, uninterested. Just living through a life with a sort of a brainfog. Maybe SSRIs show success in large enough groups for which this is a natural state??

Also you can’t come. Ever watched The Fist of Rage?

Oh and if you hate bloody things, you’ll hate to cancel these much more :). Brain zaps are not the worst, it feels like all your psyche gets barely hinged together for quite a while. Like a wood house with every joint shaken a little for slack.

I'd really suggest anyone think twice before assuming these pills, that GPs dish out like candy, are an easy and consequence free solution!

Full agree.

CTDOCodebases• 2 years ago

sleep paralysis with demons in the room

I've heard of people experiencing similar things when practicing techniques for Lucid Dreaming or Astral Projection.

FractalHQ• 2 years ago

I’ve had lifelong intermittent sleep paralysis and it’s one of the worst feelings. Happened to me yesterday during a nap actually! I went to get up, and only my right foot moved an inch (or so it felt). I had to count to 3 and muster all of my strength to try to move again, and it didn’t work until the 4th time, when my body finally giggled a little.. enough to wake up the rest of it and free me once and for all.

pyinstallwoes• 2 years ago

If anyone has had their teeth whitened and felt the zaps in their teeth… it’s like that but in your brain.

Fucking sucked.

jrflowers2• 2 years ago

Someone I know took about 4g of MDMA over a 4-day period

As an aside, there are several dozen drugs that street dealers sell as “MDMA” with wildly variable dose-response curves. 4 grams of MDMA sounds insane but it is absolutely feasible that a person could end up having to take that much of some other cathinone/MDxx drug for a comparable experience

csydas• 2 years ago

I think some other posters already commented, but I wouldn't put too much stock in the MDMA being MDMA -- I use MDMA pretty frequently and never had brain zaps from it, but when I was on sertraline and quit without tapering off, I definitely had the brain zaps being described, and I still get them almost 15 years after discontinuing sertraline.

MDMA depending on where you are and what you got can be quite a few things, it's why test kits are important. It's not to say that MDMA cannot cause brain zaps, but given that we know that MDMA is usually cut with a lot of filler/other drugs without the user knowing, I would acknowledge it could do it, but would always have doubt it was actually the MDMA due to the knowledge that whatever the users who experienced brain zaps took likely had many other drugs/substances in it. In the current political climate surrounding drugs, I'm not even sure how a study could effectively be done correctly.

Which is unfortunate because brain zaps really suck and withdrawal from SSRIs is pretty rough. I easily get into addictive substances, and have successfully stopped use on quite a few pretty heavy things, and they didn't come close to the withdrawals from SSRIs for me. This is personal experience of course, and likely many other factors in my life helped with my stopping some recreational drugs without hugely adverse affects, but SSRIs just nothing helped and at the time (2010-2015), I really couldn't find any reliable information online or from doctors about the brain zaps.

I'm glad to read this article because it's great to see that there is attention to this and more focus on the side effects of SSRIs. SSRIs definitely can help many people, but it is pretty intense drug and the withdrawal is nasty for quite a few people.

zktruth• 2 years ago

I don't know why you're so skeptical that a drug possessing the primary effect of flooding one's brain with serotonin can cause SSRI withdrawal symptoms upon cessation.

As for whether or not it's 'really MDMA', not everybody is popping pressed ecstasy tablets. It's trivial to send a few crushed crystals to a spectroscopy lab and I very rarely see samples cut with anything other than carbohydrates.

mateus12• 2 years ago

What volume did you do? I took about the same amount as the OP and had it too.

alan-hn• 2 years ago

MDMA generally wouldn't cause the brain zaps after normal use (one 120-180mg dose), its usually high doses or abuse over multiple days that causes the changes necessary to feel these symptoms

mateus12• 2 years ago

Oh wow, I had a very similar experience with brain zaps after a slightly lower dose over 4 days. They were mostly non intrusive and around the nape of my head. I hope they’re not a signal of damage.

sporkland• 2 years ago

Do these occur without the use of SSRI's? e.g. in ADHD patients? What if _someone I know_ has had these brain zaps extremely infrequently but definitely noticed them in the past?

karim79• 2 years ago

Waaaay back in 2011, I withdrew from SSRIs (particularly, Seroxat). I had moved countries, had run out of it, and bravely decided to stop altogether. Brain shocks kicked in a couple of days later. They were not painful but they were definitely unsettling. They lasted for most of a week.

I then decided to stop altogether, which led to an overall improvement to my quality of life.

I'm sure not everyone is like me, but boy oh boy I'm glad I stopped taking those.

ryanianian• 2 years ago

Obligatory warning that SSRI withdrawals can be extremely dangerous.

I was on Lexapro for a minute. It worked for a bit, but then I started to not care about anything. A certain amount of anxiety/emotional swing is important for my humanity, as I found out. I really wanted to get off that stuff. But my doctor insisted that I ween off of it by reducing my dosage over a period of 2 months. I'm glad I listened. I could acutely feel each reduction.

metadaemon• 2 years ago

Same with SSNIs, I get brain zaps if I don't take my medication early enough in the day. It can come with nausea too, so missing a dose can potentially ruin my evening.

alaithea5• 2 years ago

Would love to read this, but the site is down.

I weaned myself off of Sertraline and pursued OTC options just because the brain zaps and the yawns/drowsiness were so bad. Didn't matter what time of day I took it, didn't matter that the dosage was low. The brain zaps made me lose trust in my own faculties. These momentary, split-second losses of consciousness, where after each one, I'd have to spend another split-second reorienting myself to the environment, got way too disorienting. It also got worse the longer I was on it.

Finally weaned myself off and use SAM-e instead. No perceivable side-effects there. For anyone who doesn't know, SAM-e is an OTC supplement in the U.S. but the same chemical compound as one of the front-line antidepressants in Europe.

ebiester• 2 years ago

BTW, I had some major heart palpitations on SAM-e. It may have been tied to Vitamin B-12 but that was a hypothesis. Just make sure to talk with your doc.

alaithea5• 2 years ago

Thanks, my doc knows about it, but I get the feeling they don't know anything about it. I'll keep that in mind.

alaithea5• 2 years ago

Site's back up. Good info, but I felt nauseous by the end of the article.

This was interesting:

Perhaps the most disconcerting feature of the zaps is the jumpy lateral eye movements. “People actually hear their eyes move when they move their eyes from left to right. They almost feel a faint ‘whoosh’ sound in their heads,” Papp explained. “Sometimes, people feel as if the brain stops for a moment and reboots like a computer.”

I wouldn't say I could hear my eyes moving (!), but I definitely noticed that eye movements or a turn of the head could trigger a brain zap. That was one of the most disabling things, as it eventually led to a feeling of restricted freedom of movement and exploration.

ianpenney• 2 years ago

Had a friend with this problem. Wanted to say this story hits home for me after many many years. I tried my best to help, don’t want to say exactly how because I’m not qualified.

But frankly the doctor who prescribed larger and larger doses of Venlafaxine shouldn’t have been qualified either.

It’s a much more potent norepinephrine reuptake inhibitor than it is for serotonin. My understanding is by the time you get an effective dose you’ve got some collateral negative effects.

1attice• 2 years ago

I have recurrent severe depression and I credit serotonin-modulating antidepressants with saving my life several times.

I generally found withdrawal from high dose SSRIs to be painful without tapering, but tapering made the withdrawal symptoms negligible.

SNRIs (Venlafaxine specifically), by contrast, were a horror; I spent eight months with a microgram scale 'tailoring' capsules by tiny increments every week, and I still got well-nigh intolerable withdrawal symptoms.

math_dandy• 2 years ago

I echo your experience. Effexor/Venlafaxine are absolute poison. I tapered off of it slowly over the last two months under doctor’s supervision. The day after I took my last dose — small thanks to the tapering — I’ve had constant brain zaps, wobbly vision, horrible perpetual nausea, cold sweats, and inability to sleep more than an hour at a time. It’s been two weeks so far of lying in a dark quiet room waiting for things to resolve so I can go back to my wife/kids/job/life. Still no noticeable improvement. On sick leave for the first time in my life.

zahllos2• 2 years ago

I can also confirm brain zaps both when I tapered down and if I missed a dose. It was unpleasant but I put up with it when reducing my dose. I changed from it because it caused insomnia as a side effect badly enough that it was worse than the problem.

My understanding (which may be incorrect, not a doctor) is that you need a higher dose to achieve the N part of the SNRI. I wonder if this somehow linked to the experience. On lower doses of SSRIs I never had any such experiences.

ifj382jfueo• 2 years ago

I was on venlafaxine for about 5 years and had always heard horror stories about the withdrawals. About 7 or 8 months ago I decided to ask my doctor to start tapering me off. Took about two weeks in total and the only side effect I had was when I would turn my head I could "feel" my brain moving around. It was a very strange sensation. I was on 150mg and then 75mg to nothing. I feel extremely fortunate I didn't have any of the issues most seem to have getting off the stuff.

seventytwo• 2 years ago

This gives me hope

temporallobe• 2 years ago

Not an SSRI, but similar - I was on an SNRI (Cymbalta) for 6 months coming out of a nearly fatal bout of asthma. Basically I was depressed because I was constantly scared of dying and still felt unable to breathe despite all objective tests indicating otherwise after successful treatment. Anyway, the Cymbalta worked and I felt great for the first 3 months, but then I slumped into the worst pit of depression and suicidal ideation hell I had ever experienced. Even my personality and sexual preferences changed. One day I decided to just quit it cold turkey, and for the next 2-3 weeks I had non-stop brain zaps. Eventually they stopped and I was back to normal. My doctor wanted me to continue and increase the dose, which would have been absolute insanity. I learned later that Cymbalta had a black box warning for suicidal ideation. Fun times.

y-c-o-m-b4• 2 years ago

I learned later that Cymbalta had a black box warning for suicidal ideation

Most of the drugs that alter neurotransmitters (ADHD and depression meds, some seizure meds) will have a warning for suicidal ideation that may occur at some point of the treatment (usually early on). It's a balancing act between the treatment and the "illness" and has to be taken with caution.

Almost every doctor or psychiatrist I've seen or my family members have seen usually start off too strong and in many cases will advise cutting cold turkey. I always ignore it and taper on slowly over for about a month and if I need to get off the meds, I taper off slowly over 1-2 months. I was on Zoloft for 10 years and I was able to successfully got off the drug with minimal side effects that way. Although there was definitely a short period of brain zaps near the end, it wasn't as bad as the usual kind I'd get if I forgot to take the meds for a couple of days.

EDIT: If you use the taper off method, make sure to understand the half-life/how long it stays in your system.

fibonachos• 2 years ago

I have tried a few times to taper off Venlafaxine with no success. Looking back I think the problem was twofold: I tried to do it too quickly (1-2 months), and expected things to somehow be different despite having made no other changes (lifestyle, job, etc).

This time is different. I'm now in a job that I find rewarding, started resistance training 4 days a week 2.5 years ago, changed my diet (mostly to support my fitness goals). I'm also taking it slow, halving the dose and taking several months to adjust to the new normal, whatever that looks and feels like.

It's a marathon, not a sprint. (True for both the fitness and mental health goals).

dekhn• 2 years ago

I described this to numerous doctors and none of them had any idea what I was talking about (around a decade ago, caused by Paxil). I'd accidentally go a day or two forgetting my pill, and not only would I get brain zaps, but a fair amount of depression-like symptoms.

Then some papers came out and a few of the doctors knew what I was referring to but didn't consider them particularly important. Eventually, I was able to find a therapist who helped me adjust my meds to somethign that works better and is more tolerant of forgetting for a couple days.

jamedjo2• 2 years ago

I had a similar experience in 2015: a doctor was trying to prescribe a choice between Venlafaxine (Effexor) and Duloxetine (Cymbalta) as third line ADHD medications. I was astounded that they didn't know that brain zaps were a common side effect and brought up some papers to show them. They apologized and indicated that they would likely stop prescribing them.

I was skeptical when they mentioned that other doctors had been promoting these drugs at gatherings, but what irritated me most was that they didn't have access to the research discussing the known side effects because the journals were behind a paywall. A willingness to pirate / use Google scholar to bypass paywalls shouldn't have been necessary to know about safety issues for a drug.

krsw• 2 years ago

I was pretty good with regularly taking my dose, but decided to go off after I felt entirely emotionally numb to everything. The closest I could get was feeling deeply sad watching a movie with an emotional scene and realizing I didn't feel any emotion. I decided to quit mainly because of that and other issues (mainly sex taking forever and feeling a bit hollow). I halved my dose every 3 weeks and stopped around 5mg (from 40mg). The zaps fucking sucked and lasted heavily for ~2 months. Even now 8+ years later every once in awhile I get that kind of rollercoaster drop feeling in my head every few days that had preceded my zaps previously. It would feel like an initial void in my head, followed by a shock travelling from my feet to my head and I'd legitimately jerk my whole body while it happened. It made me feel depersonalized and I found it most tolerable dissociating physically and just mentally observing the effect occur. Walking seemed to trigger it the most, but I definitely had some times trying to sleep where I just felt completely zapped with discomfort (less electrical fwiw). I would have to smoke a ton of weed to sleep and still feel a lingering disconnect from my physical self. Paxil initially helped a ton with my social anxiety and depression (likely triggered by feeling of inadequacy and being left behind my peers). Now I'm awaiting a diagnosis for ASD. I've been able to cope decently without SSRIs/SNRIs but have more or less accepted the feeling of incompleteness that follows me eternally. I still feel generally lost in life purpose, but have accepted that as best I can. I'm not sure if it's the ASD or the SSRI's but I do appreciate the mental pathways they opened, it just never lead to a conclusion I wanted to follow through with. Everything feels pretty arbitrary, I just try to enjoy life as it happens now.

dang4• 2 years ago

With psychiatrist.com and archive.org both being down right now, it looks like there's no way to read the article. I'm going to temporarily downweight this thread, with the intention of re-upping it when the domain comes back.

If anyone wants to let us know at hn@ycombinator.com when this happens, that would be great!

alaithea5• 2 years ago

It's already back up.

dang4• 2 years ago

Fixed. Thanks!

neonate• 2 years ago

https://archive.ph/iH2oy

mxmilkiib• 2 years ago

I'm really very ADHD and ASD, n I got finally got mental health relief on bupropion, after going through a fair gamut of serotonin affecting medications. It affects dopamine and noradrenaline (norepinephrine).

It only helps me truly at 600mg, which I started taking accidentally, and that's double the UK max, which used to be 600mg but was reduced as there's a mildly higher statistical likelihood of seizures as side-effect with that dose. Afair USA max is 450mg.

If I take any less, the depression causing emotional dysregulation and intrusive/automatic thoughts (hypermentalisations) come back (n I'm an utter mess at baseline), though it's said/known that ND folk can more often have hypo or hyper reaction to certain chemicals.

I read it can have an amplifying affect on other drugs in one's system, so could be a causal part of serotonin syndrome if another medication is being taken, but I can't find that paper again, which in part regarded someone who started it for smoking cessation and found, apparently, that it worked in combination with some serotonin based med to lift them out of depression, though pinch of salt on the causality and reality of all that.

It's also for ADHD, but it doesn't (really) help my attention or memory, though my psychiatrist noted that having space in the mind from not having bad thoughts certainly helps better attention..

spondylosaurus• 2 years ago

Bupropion + SSRI is a fairly common combination for treating depression! Back in the day I think people used to start on an SSRI alone and then would add bupropion if they needed an extra kick, but it may be more common now to start with the bupropion (not sure).

And re. serotonin syndrome, I can anecdotally say that I accidentally gave myself mild SS by mixing imipramine, ondansetron, and NyQuil. I suspect that also being on bupropion at the time is what put me over the edge, but it's hard to say; even without the bupropion it may have been a nasty combo. Live and learn!

wincy• 2 years ago

Alternatively, as someone with severe ADHD, bupropion at the lowest dose gave me a psychotic episode where I started hearing things. Felt like I’d been dosed with schizophrenia pills. The razor blades told me to give them a look see. I threw them behind my fridge to keep them away. I went to my mom’s house, crawled in bed and cried for 24 hours straight. I’ve never had anything remotely like that before or since. This was nearly twenty years ago. Absolute worst day of my life.

My daughter had a pharmacogenetic screening test a few years ago and I’m not sure what this means exactly, but they give you a number with 1 being baseline expected response (this was awhile ago) and bupropion was a 9.

I’m extremely cautious about any sort of medication for me and my children because of this episode.

steve_adams_86• 2 years ago

This is all very unsettling to read. Not only because of what happened to you, but because I had a terrifying experience with bupropion almost a year ago.

I’ve told myself I must have been at fault. I’m forgetful, I must have taken too much. I must have already been in a bad state. Whatever.

I quite literally almost died. I didn’t put anyone else at risk; nothing like it. But I went into a horrifying dark mental state and couldn’t imagine ever exiting it.

I tapered off and it took months to feel some semblance of normality again. I look back on it with a sense of fear. I genuinely lost my mind. I’ve taken psychedelics and even quite a lot of them at times and know the feeling of losing my ego and having a loss of control, but never have I felt so utterly disconnected and void.

I’ve wondered ever since how much this affects other people. Or how often it’s reported. I never told a soul until very recently.

drzaiusx113• 2 years ago

For the short time I was on Wellbutrin/bupropion I would have micro blackouts multiple time periods per day and couldn't recall what I did or where I was. Not for me. Sertraline on the other hand (SSRI) is a godsend.

theGnuMe• 2 years ago

Are you me? I had the same experience but I'm at 450mg + adderrall.

It's basically a miracle. Not sure if the newer non-stimulant adhd meds work in combination with buproprion if you don't want a stimulant or can't take one or get one.

I will probably drop down the buproprion now.. I suspect that buproprion is basically just less effective Adderall.. however, the generic buproprions really have bad quality control. I think there's a big scandal there brewing like before.

mmanfrin• 2 years ago

Bupropin has been wonderful for my ADHD and probably saved my life. I'm at the US max (450) and I still get those occasional intrusive thoughts -- I've learned to just ignore them and they don't really affect me, but it is weird that they pop up. Flying has been the one time it's been actually bad.

You mentioned that those went away after increasing dosage? I've been on the fence about going up since I'd need to take anti-seizure meds.

Do you have any issues sleeping? This has been the one (major) side effect, that I can't as easily get good reliable sleep. I wake up at 7am every day, cannot sleep in, and have trouble falling asleep (which was typical prior, but I'd be able to get around this by staying up til exhaustion and then sleeping in to get my full 8 -- now I have to get to sleep by 11 but find it very hard to fall asleep).

thatfunkymunki• 2 years ago

Buproprion inhibits cypd2, which means drugs like DXM have much stronger serotonin effects. I combine these 2 drugs for treatment of major depressive disorder (the latter is easily available on Amazon, the former is prescribed to me)

symlinkk• 2 years ago

Doctors have no clue how the brain works, so any medicine they offer that effects the brain is useless at best and dangerous at worst. The only helpful psych drugs are the ones they won’t give you - Xanax, Adderall. If something is addictive, that means it actually works.

dathery• 2 years ago

How does lack of understanding of the mechanism by which something works imply that it is useless at best? I do not think that follows and can think of many counterexamples.

y-c-o-m-b4• 2 years ago

"Helpful" is relative. I had to get off of Adderall due to bad side effects like hair loss on my scalp/body, and increase in prostate/urinary infections (turns out stimulants have a link to this - Vyvanse also caused the same side effects for me, it's how we found out).

kristianp2• 2 years ago

This is distinct from zaps felt in the body, which is quite common, at least for Sertraline withdrawal. I wasn't sleeping well on Sertraline, so am trying Mirtazapine instead. Sleeping better which may translate to having better alertness during the day.

throwaway918299• 2 years ago

I’m lucky. I was forced to go cold turkey after 6 years on SSRIs.

Disclaimer: NEVER DO THIS WITHOUT PROFESSIONAL SUPERVISION

I had about 2 weeks of extreme euphoria and insomnia. Then I was suicidal for about a month. Then about 8 months of rebound depressive symptoms on and off. Never had a single “brain zap” though I was told to expect them.

I will never take that garbage ever again.

Learning to cope with depression and having a good support system beats numbing my brain to zombie mode any day.

Not medical advice. Just my personal anecdote.

pajeets2• 2 years ago

I recently had this discussion with a cousin who is depressed and seeking SSRI

I brought up Psilocybin mushrooms and microdosing but ultimately it was written off as "voodoo" and "not enough data" aka "placebo"

I'm convinced that modern science in the West is largely ideological driven. I cannot explain the number of times the arguments I've had with coworkers with acupuncture. When you tell them it temporarily relieves pain and even helps in the long term in some cases, they are very hostile as if I have criticized a religious figure.

ok_dad• 2 years ago

It’s funny too, because research doctors have been finding systems in the body that we didn’t know about until very recently. I have no doubt that there are treatments like acupuncture that interact with these or other systems that we’re currently unaware of. Heck, even gut bacteria affects the brain!

pajeets2• 2 years ago

and traditional chinese medicine have known for years the connection between gut and mental health. ex) fecal transfer is recently being studied again

and its funny that people also throw in their subtle racially driven Western exceptionalism as if its civilization is totally healthy and isn't addicted to substances and magic pills.

mewpmewp2• 2 years ago

With acupuncture if there's effects beyond placebo, could it be endorphins or similar mainly or do you think there's merit to the meridian system etc?

Because endorphins can clearly relieve pain, and acupuncture definitely seems something that could make endorphins release.

rendall2• 2 years ago

I cannot explain the number of times the arguments I've had with coworkers with acupuncture.

Tell them it helps with blood flow. The needles stimulate the body to bring more blood to a specific area, which can help with certain issues like pain. It's not mysterious.

matrix872• 2 years ago

SSRIs + side effects are probably more dangerous (and less effective) than lsd

cherryteastain• 2 years ago

Perhaps on average, but LSD bad trips can screw you up in a way no SSRI possibly can

matrix872• 2 years ago

I used to think this way because I did them and had some bad trips... it made me more antisocial than where I was already. In hindsight, it forced me to recognize that problem

I don't think every bad trip is some kind of tough love, but you can't have tough love without some risk

tootie• 2 years ago

Lol at then citing a reddit post.

I was on venlafaxine (SNRI) for cataplexy a while ago. I told my doc it wasn't having any positive effects and several side effects. She said "ok" and just let me prescription lapse so I stopped cold turkey. Man oh man the brain zaps were wild. I had them almost non-stop for 2 days. Like my brain was bouncing around my skull like a marble

iwaztomack• 2 years ago

"Until recently, physicians have widely been unaware or dismissive of the symptom. "

Yeah no shit.

I went off Paxil and had brain zaps for over a YEAR. Gone now but I will never go on Paxil again, although it was 15 years ago and I think I've got this licked. :)

(And I tapered the paxil over two months, my doc just kept saying, "That's odd, they'll go away...")

blackhaj7• 2 years ago

Brain zaps are a common side effect after high/long doses of MDMA

Sounds like coming off SSRIs and post-MDMA usage have something in common

greenthrow• 2 years ago

I had minor brain zaps when coming off an SSRI but terrible ongoing brain zaps for two months earlier this year coming off an SNRI. It was truly debilitating and horrible. I was concerned I was going to be one of those rare cases who has them permanently. Thankfully they did subside. But now I don't want to try any more psychiatric medication.

oldgradstudent• 2 years ago

This is gross.

“There was an emphasis both within the [psychiatric] profession and pharmacological companies to make these medications sound not addictive,” he told Psychiatrist.com. Therefore, when SSRIs first became popular, very few systematic studies were conducted on antidepressant discontinuation effects.

Reminds me of the Feynman quote:

For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.

cubefox• 2 years ago

Interesting. When I had depression several years ago, I tried quite a few different SSRIs and similar medications. I personally had never any withdrawal symptoms and never read about them in the package insert (patient medication information). Without any "tapering off". Though the article does call brain zaps "relatively uncommon".

debo_• 2 years ago

I first experienced persistent stress/panic disorder symptoms after a panic attack in 2014. (At the time, I had no idea it was a panic attack.)

I had brain zaps for weeks after that, mostly at night in bed. Someone in this topic described them as feeling like "degaussing your brain" which I very much relate to.

They didn't bother me much compared to everything else that was going on, and they eventually went away. It was a rather spooky feeling at first, though.

itsboring• 2 years ago

I wonder if anyone else has experienced this. The brain zaps I got when stopping Lexapro (Escitalopram) were identical to brain zaps I get when I’m sick from something like the flu and I’m very tired. I have no idea as to an explanation. Anyone else?

yorick• 2 years ago

Other comment: https://news.ycombinator.com/item?id=41813058

tguvot• 2 years ago

when my wife was getting off cymbalta she was getting brain zaps. so i got scales with 0.001 resolution and were tapering off by a few percent at a time. it took like 2 or 3 months to get to 0.

0xDEAFBEAD• 2 years ago

I think I get these zaps sometimes if I rest the back of my head on an acupressure cushion.

TexanFeller4• 2 years ago

SSRIs have all kinds of horrible effects that are seldom acknowledged, that's why it's exciting that ketamine is getting popular for treating things like depression, anxiety, and OCD. Besides how you feel a few hours after treatment most people notice close to zero side effects. For some people its anti-depressive effects can be quite long lasting. It's considered a second line treatment for depression, but from what I've seen it needs to be moved to the front of the line.

hi-v-rocknroll• 2 years ago

Tapered on and off 16 medications over the past 20 years, including just about every SSRI, SNRI, and TCA. One dose of Paxil (paroxetine) was enough to give me "mild" serotonin syndrome hyperactivity, plus disassociation like it was ketamine or a hypnotic. Mirtazapine worked well for me for about 8 years, far better than any other medication. Then it gradually stopped working so well. Tried Viibryd (vilazodone), which lead to eye and leg twitching. Also tried tapering off mirtazapine a few times in extended time periods, but I was right back in severe, crushing, depression.

I think the lack of scientific, evidence-based examination and treatment pushed by MDs/DOs, therapists, and psychiatrists is a big part of the problem. There is not much in the way of nosology or real personalized medicine going on to understand specific root cause(s). It's just throw random medications and therapy approaches "spaghetti" against a wall and hope something sticks.

partomniscient2• 2 years ago

I think the lack of scientific, evidence-based examination and treatment pushed by MDs/DOs, therapists, and psychiatrists is a big part of the problem. There is not much in the way of nosology or real personalized medicine going on to understand specific root cause(s). It's just throw random medications and therapy approaches "spaghetti" against a wall and hope something sticks.

Totally agree. Think its a big problem and not enough study is being done on it (can't monetise it).

At least some of the medical professionals are willing to admit that the above is true. I'm pretty sure they've also put the words "treatment resistant depression" into my file.

rendall2• 2 years ago

Huh. I have never been on antidepressants, much less discontinued one, but this brain zap seems to describe a sensation I have experienced occasionally all of my life. I never really mentioned it because it was hard to articulate and never seemed to be a problem, and no one knew what I was talking about.

Very unpleasant, lasts less than a second, felt quite like described in the article. Hearing and vision would get intense for a split second then it'd be gone. I always assumed it was a kind of very minor seizure.

I haven't experienced one in years. It seemed like I could feel one coming and short-circuit it by changing the thought I was having.

vgb2k18• 2 years ago

SNRI's (Cymbalta etc) induce brainzaps even worse than SSRI's. Counting out individual beads from inside the capsule is actually a thing people do to wean off gradually (and the zaps are strong even then).

Eumenes• 2 years ago

My hope is in a few years, or a few decades, we'll have Nuremberg-like trials for doctors/pharma execs/advertising firms who misled the public and their patients on the dangers of SSRIs, stimulants, and other mental "health" drugs. Usually when this is discussed on the internet, weird comments on how these things 'saved my life' come out of the woodwork, when there is no doubt they've destroyed 100x more lives than saved, whilst making alot of people very rich.

PeterStuer• 2 years ago

Currently still tapering of Sertraline. The zaps when moving your head/eyes or blinking were an issue each time I tried before. Now doing an extremely long and slow reduction process over 12 months. Did not feel much difference until the 40mg to 20mg step (these are below the doses commercially available here but the pharmacy grinds the pills down and repackages them).

anacrolix• 2 years ago

I've experience the brain zaps a few times. I didn't mind it, after the first few days it felt like a little burst of energy with the brain zap. Probably was actually something nefarious like nerves dying or something.

tennisflyi• 2 years ago

I’ll take 400mg of Sertraline off label when needed and the only undesirable side effect for me is some diarrhea but an anti-diarrheal is more than enough to manage that

In SSRI withdrawal, brain zaps go from overlooked symptom to center stage (2023)

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