[HN Gopher] In SSRI withdrawal, brain zaps go from overlooked sy...
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       In SSRI withdrawal, brain zaps go from overlooked symptom to center
       stage (2023)
        
       Author : RicoElectrico
       Score  : 61 points
       Date   : 2024-10-11 19:42 UTC (3 hours ago)
        
 (HTM) web link (www.psychiatrist.com)
 (TXT) w3m dump (www.psychiatrist.com)
        
       | wil421 wrote:
       | 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 wrote:
         | Damn, 2 grams? I had no idea the dose could get that high.
        
         | kristianp wrote:
         | That sounds odd. Were you taking 20 tablets at a time?
        
         | notjulianjaynes wrote:
         | 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.
        
         | tombert wrote:
         | 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-b wrote:
           | 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.
        
       | mmsc wrote:
       | (2013)
        
         | dang wrote:
         | Added above. Thanks!
        
           | alaithea wrote:
           | But the article says it was published in 2023.
        
             | mmsc wrote:
             | Sorry that was a brain zap. Indeed 2023:(
        
             | dang wrote:
             | Fixed. Thanks!
        
       | StefanBatory wrote:
       | 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 wrote:
       | 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-b wrote:
         | 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...
        
       | mmsc wrote:
       | >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.
        
         | camgunz wrote:
         | 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.
        
         | thescriptkiddie wrote:
         | I've gotten them from taking SNRIs, so I wonder if
         | norepinephrine is involved somehow, or maybe SNRIs are not
         | actually that selective.
        
           | larve wrote:
           | 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.
        
           | jrflowers wrote:
           | The S in SNRI stands for Serotonin, not Selective.
        
             | fzzzy wrote:
             | Wow, I did not know that. Good to know.
        
         | asimovfan wrote:
         | 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 wrote:
           | 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.
        
             | selimthegrim wrote:
             | So far only a certain episodes of Curb Your Enthusiasm have
             | given me this
        
         | ChadNauseam wrote:
         | > 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 wrote:
           | 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?
        
         | marknutter wrote:
         | > 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 wrote:
         | > 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 wrote:
         | 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.
        
       | karim79 wrote:
       | 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 wrote:
         | 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 wrote:
       | 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.
        
       | alaithea wrote:
       | 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 wrote:
         | 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.
        
           | alaithea wrote:
           | Thanks, my doc knows about it, but I get the feeling they
           | don't know anything about it. I'll keep that in mind.
        
         | alaithea wrote:
         | 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 wrote:
       | 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 wrote:
       | 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 wrote:
         | 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.
        
           | zahllos wrote:
           | 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.
        
             | nixonpjoshua wrote:
             | I would guess it has more to do with the serotonin,
             | Atomoxetine has small S activity and large N activity and
             | relatively it can be discontinued much easier than any of
             | these other drugs.
        
         | ifj382jfueo wrote:
         | 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.
        
       | temporallobe wrote:
       | 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-b wrote:
         | > 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.
        
       | dekhn wrote:
       | 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.
        
       | dang wrote:
       | 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!
        
         | alaithea wrote:
         | It's already back up.
        
           | dang wrote:
           | Fixed. Thanks!
        
       | neonate wrote:
       | https://archive.ph/iH2oy
        
       | mxmilkiib wrote:
       | 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 wrote:
         | 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 wrote:
         | 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.
        
       | symlinkk wrote:
       | 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 wrote:
         | 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-b wrote:
         | "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).
        
       | kristianp wrote:
       | 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 wrote:
       | 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.
        
       | pajeets wrote:
       | 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 wrote:
         | 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!
        
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