Brain zaps

[F0nzie]

Is there a medical term for this? I have had a few patients complain of "brain zaps" when tapering off of SSRIs. I have not been able to get a clear sense of what it is.

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[Shikima]

Discontinuation syndrome I believe.

 

[F0nzie]

I didn't even realize that was described in the syndrome

 

[F0nzie]

Brain zaps confirmed by Wikipedia. Wikipedia > Med school.

 

[Psychobabbling]

lol yeah - "brain zaps" - I have even gone over this when talking to patients about the importance of taking their meds regularly, so as to avoid, "brain zaps" lol

 

[notdeadyet]

It seems particularly prevalent with Paxil.


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[keifernny2]

I usually differentiate between "brain zaps" from effexor and "feeling like crap" from paxil /other ssris.


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[Ceke2002]

Is there a medical term for this? I have had a few patients complain of "brain zaps" when tapering off of SSRIs. I have not been able to get a clear sense of what it is.

I've only experienced it once myself. If you want to know what it feels like, it quite literally feels like your brain is vibrating around inside your skull - as in it's not just electrical type zaps that are felt on the scalp. Now obviously I doubt one can actually feel their brain move inside their skull, but that is what brain zaps feel like it - imagine sitting perfectly still but you can feel something sloshing around and shaking from inside your head, it's probably one of weirdest sensations I've ever felt.

 

[splik]

Discontinuation syndrome I believe.

let's stop using this euphemism. it is a withdrawal syndrome. the term discontinuation syndrome has been used to disguise the serious issue for many people of becoming dependent on these drugs because of often quite severe withdrawal symptoms. everyone should read this paper

 

[F0nzie]

I've only experienced it once myself. If you want to know what it feels like, it quite literally feels like your brain is vibrating around inside your skull - as in it's not just electrical type zaps that are felt on the scalp. Now obviously I doubt one can actually feel their brain move inside their skull, but that is what brain zaps feel like it - imagine sitting perfectly still but you can feel something sloshing around and shaking from inside your head, it's probably one of weirdest sensations I've ever felt.

Sounds quite unpleasant. :x Thanks for sharing.

 

[nitemagi]

http://www.ncbi.nlm.nih.gov/pubmed/25721705

"Electric-shock sensations"

 

[wolfvgang22]

It seems most common in Venlafaxine and Paxil. Venlafaxine more than Paxil.

 

[F0nzie]

I've seen it with Lexapro and Cymbalta.

 

[birchswing]

My father in high school took me cold turkey off Paxil (why he was making those decisions instead of a doctor is a whole other can of worms). Oh what fresh hell. Brain zaps every time I turned my head. Sometimes several in a row like gunfire. My vision would shift as well. I realized what it was (pretty obvious connection). I don't think the discontinuation syndrome had been identified yet. So after my dad had me go off cold-turkey, I met him halfway and went down step-wise (like every other day or so). As soon as I started taking it again, the zaps went away.

Many years later, I am on Paxil and have been on it for many years, and I still have occasional brain zaps, which I believe *could* be residual from the cold turkey withdrawal. Now I get them sometimes when I have a fever or after a long hot shower. I also have little jerks every once in a while that feel like shocks, but they're not the same as the Paxil brain shocks. I never had them in my life before Paxil. I can't say for sure that I get them now as a residual effect of having at one time gone off cold turkey, but it is one of several possibilities. I've heard anecdotally that once you go off Paxil it never works the same again, and for me at least it's not as helpful as it was when I first went on it (when I first went on it I could actually feel it blocking anxiety—I would have thoughts that I normally would when anxious, but I had this blocked feeling where I didn't physically feel the anxiety as much). I was taken off it a couple more times (but very gradually those times and did not suffer brain zaps), and then later had it reinstated but it's never had the same benefit. So I dunno. But, yes, brain zaps are real. Not pleasant, but definitely somewhat avoidable with a slow taper.

 

[Shikima]

let's stop using this euphemism. it is a withdrawal syndrome. the term discontinuation syndrome has been used to disguise the serious issue for many people of becoming dependent on these drugs because of often quite severe withdrawal symptoms. everyone should read this paper

It did happen with one of my Pt's where I had him abruptly stopping Seroquel XR at 600mg HS for another agent. Seroquel and other manufactures do call it discontinuation syndrome. This is a good paper to read. Thanks!

 

[nitemagi]

Many many drugs have withdrawal symptoms. Including beta blockers.

 

[PikminOC]

Many many drugs have withdrawal symptoms. Including beta blockers.

correct. But aren't DEA regulated

 

[shan564]

I think it's pretty well-known that this is part of SSRI discontinuation syndrome (call it withdrawal, call it whatever). It's more likely with drugs with short half-lives (i.e. Paxil, Effexor), and is rare with drugs with long half-lives (i.e. Prozac). Pretty sure I learned that in med school... or at least I wrote a question about it in a psych shelf Qbank that I'm working on.

 

[notdeadyet]

I think it's pretty well-known that this is part of SSRI discontinuation syndrome (call it withdrawal, call it whatever). It's more likely with drugs with short half-lives (i.e. Paxil, Effexor), and is rare with drugs with long half-lives (i.e. Prozac). Pretty sure I learned that in med school... or at least I wrote a question about it in a psych shelf Qbank that I'm working on.

Yep. True with any drug discontinuation/withdrawal, no?

 

[Shikima]

I guess it's technically possible with all medications,.

 

[birchswing]

I guess it's technically possible with all medications,.

What about simethicone?

Sorry, I have difficulty not finding an exception when the opportunity presents itself.

But maybe you can prove me wrong on simethicone.

 

[whopper]

IMHO this is an example of patients knowing more about this phenomenon than the doctors cause we don't take the medications ourselves. There's Internet communities where patients educate each other on meds such as SSRI and some of them know more about the stuff than a lot of psychiatrists I've met. Brain-zaps appear to be a term they came up with but I've seen several patients describe this phenomenon of "doc it's like there's sparks going off in my head."

When I saw the 5th patient that didn't know the other patients tell me this I knew there was something to this phenomenon.

IMHO we docs on occasion should go to some of these patient forums and see what they talk about.

 

[birchswing]

IMHO this is an example of patients knowing more about this phenomenon than the doctors cause we don't take the medications ourselves. There's Internet communities where patients educate each other on meds such as SSRI and some of them know more about the stuff than a lot of psychiatrists I've met. Brain-zaps appear to be a term they came up with but I've seen several patients describe this phenomenon of "doc it's like there's sparks going off in my head."

When I saw the 5th patient that didn't know the other patients tell me this I knew there was something to this phenomenon.

IMHO we docs on occasion should go to some of these patient forums and see what they talk about.

As a patient who has researched this, I can tell you that this discontinuation syndrome predates SSRIs, and that when SSRIs came out companies like GSK knew about these symptoms and even warned their sales reps about them and told them to downplay it. They withheld information about that and suicidality and emotional lability.

I hate GSK for very personal reasons. When it was on-brand, Paxil was manufactured in Puerto Rico in a site that was constantly being cited by the FDA for problems (GSK was also producing generics of Paxil in that same site after it went off patent). Eventually it was raided by federal marshals because it was such a mishandled plant and I think there were some black market operations there as well. It was bad--very bad. With benzo brain, I can't remember the details, but I'm sure it's online.

Anyhow, before the plant was eventually shut down, there was a Class II recall on Paxil. Class II means that the patient in most cases never finds about it—if it hasn't been dispensed it's pulled, but if it has been dispensed nobody contacts you. I had been getting really, really agitated. I couldn't figure out the cause. I was seeing a therapist and psychiatrist and nothing was different in my life. Couldn't figure it out. I started doing research on my prescriptions. Being a hypochondriac/obsessive person paid off. I found out that the Paxil I was taking had been subject to a Class II recall for being superpotent. I could not understand why my pharmacy hadn't told me. Their answer: We don't have to tell you (legally they don't). When I called GSK to get more information about how superpotent it was, they were some of the most uncaring, non-empathetic human beings I have ever encountered. They would only tell me that the amount in it was considered safe enough not to recall. They couldn't tell me an actual amount--just that it was not so superpotent that it was a danger to people it had been prescribed to. I mentioned at the end of the call that not one person I had spoken to at GSK had apologized, and even after saying that no one did. My memories are vague so I can't remember everything they said on the phone, but I can remember the tone, and it makes me never want to do business with that company again. It wasn't safe. In me it caused the same reaction that I had when I had previously and intentionally updosed Paxil--it was activating. In a person with bipolar disorder, the effects could have been far worse.

Anyhow, my original point was that the drug companies in addition to patients have information you might not know about--the difference is the patients will tell you. It was the consumer advocacy group ConsumerLab that tested generic versions of Wellbutrin XL that finally got the FDA to look into it. Don't get me started on the FDA. They seem actively resistant through some sort of bureaucratic inertia to doing what the title of their agency is. They just this year have finally for the first time put in place an initiative to test some foreign generic drugs rather than rely on the companies making them to tell the truth. But even that hasn't started yet. It's a massive new sub-agency within the FDA that is planning to do this (the head of the new sub-agency received $300,000 last year), and they're not going to even test the drugs themselves: They're giving out grants to universities to test a select few foreign generic drugs each year. It's 2015 and they're going to start doing their job in a small way that is incredibly inefficient, not comprehensive, and mired in bureaucracy. In 2015, we can't even track manufacturing site to consumer on prescription pills and you can do that on a banana which usually has a barcoded sticker on it! Back in 2006 I wrote a satirical article on this subject. It looks like my satirical prediction of 15% was generous, but my idea wasn't too far off: the FDA in only now starting to actually test generics itself basically admits the premise of this satirical article, and I also predicted they would outsource it (I satirically wrote that they would to the FAA--it ended up being to universities). And don't judge too harshly—this was an early creative writing attempt. In re-reading it, I can see it's not my best.

FDA Slated to Begin Monitoring Food and Drugs in 2010

The Food and Drug Administration announced that it will begin monitoring up to 15% of the nation's food and drugs beginning in 2010. FDA directors have in recent months had to face an increasingly disapproving Congress over safety concerns of food and drug products.
Testifying before Congress, FDA commissioner Andrew von Eschenbach noted, "The FDA has enjoyed a fantastic public-private partnership with companies like Procter and Gamble, Altria, Phillip Morris, and GlaxoSmithKline to monitor the food and drug industries. These organizations are able to perform food and drug monitoring for far less money than the government ever could."

When speaking with this reporter Eschenbacher said, "Because of concerns from crazed consumers the FDA will be hiring recently replaced airport security personnel to monitor the nation's pills and foodstuffs like pop and chips."

"We can't guarantee the types of efficiencies the private sector can give you. But apparently consumers want public officials doing inspections. All I can say is, be careful what you wish for," he added.

The Federal Aviation Administration is excited about sharing its workers with the FDA. FAA Administrator Marion Blakey clarified that airport security screeners will retain their luggage inspecting duties as they inspect food. She demonstrated several workers inspecting suit cases, boxes of cereal, and bottles of Vicodin coming down a conveyor belt. "It's synergy or something," said the Blakey, adding, "I can't get fired."

The workers seemed to be using the same X-ray machines traditionally used for luggage. When asked how they help to monitor food and drugs, Blakey responded that internal changes had been made to the X-ray machines making them suitable for monitoring food and drugs in addition to luggage. She would not cite what modifications were made, and added, "That's exactly the type of information Osama Bin Laden would like to get, so don't think for a second I'm revealing anything."

When questioning some of the food, drug, and luggage inspectors, this reporter was told that they were not aware of any changes made to the X-ray equipment.

Eschenbacher is excited about the test runs, saying that 100% of the food, drugs, and luggage have passed inspections so far.

President Bush condemned the FDA taking on food and drug monitoring responsibilities, saying it signals the return of big government. "If consumers want to know if their drugs and foodstuffs are safe, they should look no further than the FAQ pages on major corporations' web-sites," Mr. Bush said from his Crawford ranch.​

 

[shan564]

Yep. True with any drug discontinuation/withdrawal, no?

Yes, but it seemed like people were speculating about which antidepressants are more likely to cause it. That's a question that has a pretty clear answer.

 

[clausewitz2]

IMHO this is an example of patients knowing more about this phenomenon than the doctors cause we don't take the medications ourselves.

There was a paper a few years ago that I read that I am frustratingly unable to find written by a group of French psychiatrists who had taken a selection of antipsychotics in a systematic way and recorded their experiences/side effects, on the theory that this would give them greater insight into what their patients were experiencing when being given these medications. This struck me as a non-terrible idea.

 

[Ceke2002]

IMHO this is an example of patients knowing more about this phenomenon than the doctors cause we don't take the medications ourselves.

Not one I'm on myself but http://www.crazymeds.us/CrazyTalk/ is probably the best patient forum if you want to listen in on conversations regarding meds.

 

[digitlnoize]

IMHO this is an example of patients knowing more about this phenomenon than the doctors cause we don't take the medications ourselves. There's Internet communities where patients educate each other on meds such as SSRI and some of them know more about the stuff than a lot of psychiatrists I've met. Brain-zaps appear to be a term they came up with but I've seen several patients describe this phenomenon of "doc it's like there's sparks going off in my head."

When I saw the 5th patient that didn't know the other patients tell me this I knew there was something to this phenomenon.

IMHO we docs on occasion should go to some of these patient forums and see what they talk about.

I've never taken them, but there's gotta be psychiatrists who've taken SSRI's. I'm surprised there's not a few here. Depression and anxiety are pretty prevalent amongst the general population, and I'd be shocked if the rates weren't similar amongst psychiatrists.

I do scope out patient message boards. There's some great support groups on Reddit. Just a few (hope this isn't some violation...):

www.reddit.com/r/mentalhealth - good place to start, their sidebar has links to a bunch of other subreddits about various topics
www.reddit.com/r/suicidewatch - super popular. Someone needs to study this and see if it's effective
www.reddit.com/r/stopselfharm
www.reddit.com/r/stopdrinking
www.reddit.com/r/bipolarreddit
www.reddit.com/r/BipolarSOs - for significant others of patients with bipolar disorder
www.reddit.com/r/Psychiatry - the equivalent of us over there, but very few docs.

 

[shan564]

I've never taken them, but there's gotta be psychiatrists who've taken SSRI's. I'm surprised there's not a few here. Depression and anxiety are pretty prevalent amongst the general population, and I'd be shocked if the rates weren't similar amongst psychiatrists.

I'll bet psychiatrists probably have a higher rate of anxiety disorders than the general population. I know plenty of psychiatrists who are open about their (mild) psych history.

I'm sure you can find plenty of psychiatrists who have taken antipsychotics for a tic disorder or for migraines and wouldn't hesitate to talk about it. There are probably plenty who have taken them (or mood stabilizers) for bipolar disorder, but they may be less likely to talk about that.