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novopsych

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Hi, I was a member many here years ago and couldn't find my log-in or e-mail I used anywhere. So forgive me for starting over.

I have a head scratcher that none of my colleagues had any ideas on and remembered this place as a good place to get some feedback.

I have a patient who came to me from another doctor who I've seen for over a year now keeping him at his previous doses as he's stable on them and gets anxious about changing them. He takes 50 mg Seroquel at night (the original prescribing reason was for Tourette's), 4 mg Ativan daily, and 30 mg Paxil daily (broken up 10 mg t.i.w.)—those were all recommendations of a previous doctor, not me. Working on slowly lowering the Ativan dose. But anyhow, that is not the urgent issue.

The last two times he's gotten a flu or cold (he has the flu right now, tympanic temperature self-reported as 101.5 F), he reports what he calls brain shocks that he says are identical to the ones he had when he abruptly discontinued Paxil years before. Apparently when he was in high school his dad took him off Paxil over the summers when school ended for the year, and he says the shocks he had then are similar to the ones he has now. He gets them with any head movement and sometimes just randomly. He's also described them as "seizure"-like. He doesn't lose consciousness, but they're very uncomfortable. He said his vision doesn't shift like it did with the Paxil withdrawal shocks, and that these ones often come rapid fire: several small ones rapidly in a row. If he's not sick, he gets them once in a blue moon, particularly after long showers, he said.

Wondering if anyone has any ideas on the mechanism behind this and any treatment? Could it be be related to Paxil (either current usage or previous discontinuation, although that was over 10 years ago)? Less availability of the Ativan somehow? How does the flu fit in? He says that right now all he can do is remain perfectly still to try to avoid the shocks. He's pretty miserable having both the flu and this. He is drinking plenty of fluids.

Thanks.
 
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novopsych

novopsych

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Sounds a tad migraine-like.
Thanks, that's a good thought to pursue. He does take ibuprofen several times a month for headaches and said that he had a bad one yesterday before the flu came on, but no headache today when he called.
 

nitemagi

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Thinking a little outside the box, maybe his metabolism is a little revved up and he's burning through the paxil at a faster pace when having the flu.

Try switching to prozac and see what happens.
 

OldPsychDoc

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You know I've had enough patients report the "shocks" or the "zings" that I suspect it's something "real"--but what is it? Has anyone written about the neurologic substrate of this phenomenon?

Thoughts?
 
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I wonder if you could get more bites on a neuro forum. Perhaps he needs an increase in the paxil, switch to an agent w/ longer half-life.

Have the shocks improved along with his flu sx?
 

kugel

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I wish we knew what the incidence of this is in the general pop'n.
This is one of those rare but persistent complaints that medicine has largely ignored, in part because it comes most loudly from psychiatric patients, and partly because it doesn't seem to have any serious outcomes - but that's very hard to know without ever asking the questions.
 

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Thinking a little outside the box, maybe his metabolism is a little revved up and he's burning through the paxil at a faster pace when having the flu.

Try switching to prozac and see what happens.
Along the lines of this, could be taking a cold medication, remedy, diet change, etc. that induces paxil metabolism?
 
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He didn't want to make any medication changes because he knew from previous experience it would be self-limiting. The shocks were the worst in general the day the flu came on and after that got worse in between doses (taking Paxil would provide relief for 1-2 hours). It's complicated by the fact that he takes his Paxil doses with Ativan, though. The day after his fever broke the shocks went away and didn't come back. He was taking ibuprofen alternating with Tylenol to keep the temperature down, but the shocks started before starting those. No other OTC drugs. He had more difficulty with temperature regulation than most people his age would have with the flu, which I think may be due to the Paxil and Seroquel. His self-reported temperature at its worst was up to 104.8 tympanically, 103.6 by mouth. I would have had him go into the hospital had I known, but it was back to normal by the next time I saw heard from him.
 

birchswing

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I can’t believe I found this thread.

I have the EXACT same experience as the described patient, almost down to a T. I was on Paxil as a kid and was also taken off cold turkey and went through a horrible discontinuation syndrome, which at the time was not recognized as being a thing. I went back on Paxil several years later and have been on it for probably about 15 years. As of a few years ago, any time I get a virus (cold or flu), it is withdrawal hell all over again. My pulse goes up, my head feels shivery, and especially when moving my head I get huge Paxil shocks (as I call them).

There has to be a connection here. The other thing I find interesting is that people often describe going on Paxil or withdrawing as feeling like having a “flu.” And then in my experience and the other patent described a flu or other virus (I’e had it with both colds and flu, with and without a fever) causes the withdrawal brain shocks to come back.



I’ve told my pdoc about this but she sort of shook her head and just said to drink lots of fluids, which I do (water and coconut water).
 

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Sounds like "brain-zaps." Now are these really brain-zaps? Of course I haven't examined the patient myself and don't know all the details. I've never heard of a phenomenon where if one gets an infection it increases the odds of getting them. Interesting and worth further looking into. If anything, perhaps change the Paxil to Paxil CR, or a long acting SSRI like Prozac as mentioned above.
 

whopper

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Just thought about this. Interferons can reduce the brain of serotonin precursors. This could explain why someone would get brain-zaps when on an antidepressant. Just a theory.
 
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I just came across this forum, and thought I'd comment, as I have similar experiences. I am not a doctor, nor affiliated with medicine (I am an engineer).

I've experienced brain zaps for most of my adult life at the onset of moderate or severe viral infections. I don't get them with common colds, but I do with influenza, stomach flus, or other more severe infections. It's actually a key indicator for me that I'm about to get quite sick.

At one point, I was briefly on an SSRI, and upon ceasing it, I experienced very similar sensations. I was convinced I was getting sick, but realized later that it was a withdrawal symptom.
 

Ceke2002

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Wow I missed this post first time round. Brain zaps are freaky, like a really, really bizarre sensation. Thankfully I've only had them a few times, but it's not like it's a tingling or electricity feeling on your scalp (which I think some people might assume), it literally feels like your brain is vibrating inside your skull, like you can feel this sensation of your brain moving around inside your head. It's just weird, and disturbing, and very unique at the same time - I mean there's not really anything I could compare it to, it's not like a migraine aura, or a presyncope episode, or vertigo, or occipital neuralgia, or pins and needles of the scalp, etc, it's just almost in a class of its own.
 

MacDonaldTriad

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I have a cousin who describes this when he misses a Paxil dose.

Didn't we establish the fact that novopsych and birchswing are the same person, or do I have this wrong? :bag:
 
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Ceke2002

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I have a cousin who describes this when he misses a Paxil dose.

Didn't we establish the fact that novopsych and birchswing are the same person, or do I have this wrong? :bag:
Yeah, same person.
 
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I came across this forum when searching for brains zaps with fever, and thought I should post a reply. I, too, am suffering from brains zaps. I'm currently sick with a fever, and I'm also taking Lexapro. The brains zaps are very similar to when I stop taking Lexapro. I've never taking Paxil. I was just wondering if there has been any new information about this in the past couple of years since this thread was last commented on.
 

birchswing

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I came across this forum when searching for brains zaps with fever, and thought I should post a reply. I, too, am suffering from brains zaps. I'm currently sick with a fever, and I'm also taking Lexapro. The brains zaps are very similar to when I stop taking Lexapro. I've never taking Paxil. I was just wondering if there has been any new information about this in the past couple of years since this thread was last commented on.
I never found an answer from a doctor. I just know when I get sick I have to fairly aggressively keep the fever down or I get the SSRI withdrawal brain zaps, and fevers never did this to me before taking an SSRI. A pharmacist suggested the fever might make me metabolize the SSRI faster, but I have no idea.
 

hamstergang

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I never found an answer from a doctor. ...A pharmacist suggested the fever might make me metabolize the SSRI faster, but I have no idea.
Well, when you impersonated a doctor on here to trick us into giving you answer, a doctor gave you the same suggestion.
 

birchswing

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Well, when you impersonated a doctor on here to trick us into giving you answer, a doctor gave you the same suggestion.
I was a bit too mortified to scroll back up because I remembered how this thread started and the account I started it under but had an aversion to re-reading it, and I had forgotten the answers given. I should not have done it. In answering now I didn't want to pretend, though, that I wasn't the one with the issue who originated the thread.
 
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Hello,
I have been experiencing these "brain zaps" with fevers for the past few years or so. I have never been on an SSRI, and I cannot attribute the symptom to any drug as I only take a multivitamin daily. They will go away when I take an antipyretic or when the fever resolves. It was such an alarming occurrence that I did a google search to see if there have been reports of others with the same experience. So far I haven't found any other cases that are not drug related except my own.
 
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I'm currently on Lexapro, I noticed I was getting brain zaps when I was running a fever when I had the flu. And now I've been noticing when I exercise and I get pretty hot and sweaty I noticed some brain zaps too. So I think it has to do with body temperature or metabolism
 
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I made an account here just to post about this.

Ive been on paxil for 3-4 years now, also tried to cold turkey it once and became familiar with brain zaps or whatever we want to call them. Now i get them occassionally for no reason, but they dont bother me too much.

However I started coming down with cold or flu-like symptoms as of yesterday, and today started experiencing brain zaps nearly every time I move. I'm glad I'm not the only person who experienced this. I kept thinking i had forgotten to take my paxil, when i distinctly remembered I had.
 
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I was searching everywhere for this phenomemon!! So glad I am not the only one. I haven't taken these medications either, and the earliest I remember this happening to me is when I had measles as a kid - I was very very ill with it. I think it's the same thing, but I think of it more as the world switching on and off rapidly - flickering. Does anyone remember very old television sets? If you switched them off and on again very quickly, the picture would kind of leap up and flash across the whole screen before settling down to something you could watch - all in a fraction of a second. It's like that happening one time or several times very rapidly. But it's NOT a visual flash. Its much more a flickering of consciousness itself. Happens more if I walk around turn my head when I am unwell than if I am sitting still. I was actually wondering whether it would turn out to be a very brief episode of vertigo maybe with rapid nystagmus if it was ever investigated. It's fairly apparent that not everyone gets this, no wonder I have been having a hard job googling it.

I should add yes, there is definitely like a woosh too when it happens - again not necessarily auditory, more a surge. I do wish there was a standard medical term for this because "brain zaps" sounds so... well like some cult pseudo-science lol.
 
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