Brain zaps and antidepressants,
why do they happen?
How long do they last?
What do you do about them?
That's what I'm gonna be talking about today.
I'm Dr. Tracey Marks, a psychiatrist.
And I publish weekly videos on mental health education
and self improvement.
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Brain zaps are a part of what we call
medication discontinuation syndrome.
Medication discontinuation syndrome
are symptoms that you can see when you suddenly stop
taking your medication
or if your dose suddenly drops from high to low
for example.
When there's drastic changes in the medication level
in your bloodstream.
In this case, I'm gonna be talking about
what you see when you stop the serotonin enhancing
antidepressants.
So first let me talk about the symptoms.
An easy way to remember these symptoms
is with the pneumonic FINISH.
F starts for flu like symptoms.
And this can be things like achiness, sweating,
headache, fatigue.
You can really feel like you're coming down with the flu.
I stands for insomnia.
If you suddenly stop your medication,
you can have trouble sleeping.
And even have vivid dreams.
I have a video I made several years ago
on why antidepressants cause vivid dreams.
And you'll see that in the corner.
And you can watch it after the video.
But in this case, the vivid dreams
would be occurring as a part
of the discontinuation syndrome.
N stands for nausea or maybe even vomiting.
I is for imbalance or dizziness
or even vertigo, which is when you feel like
your head is spinning.
S is for sensory disturbances.
This would be the electric shocks that seem
like they're coming from your brain.
Some people call them brain zaps.
And it's kinda like someone is suddenly
turning on an electrical source on and off in your head.
Or kind of like a glitch.
Some people even describe it as though
your brain is dropping in space.
All kind of weird sensations
having to do with your brain.
But you can also have burning or tingling sensations
in your body as well.
And then lastly H stands for hyperarousal.
And this would be anxiety, irritability,
aggression, or even jerkiness.
Any of these symptoms can occur when you stop
the medication suddenly.
And this isn't that hard to do.
You can go on vacation,
leave your pills at home,
or you can take your last pill in the morning
and then you forgot to call the pharmacy.
Then the pharmacy has to order it
or your insurance has to approve it.
And that can take a couple days.
So it's not always intentional
that someone just stops taking their medication.
Now, you may say,
I've missed a pill or two here and there
and this didn't happen to me.
It's more likely to happen with medications
that have a short half life.
Half life is the amount of time
that it takes for the drug
to break down to half the amount.
And drugs with short half lives
leave your body quicker than ones
with long half lives.
And some examples of shorter acting antidepressants
that you can see this with
are Paxil, Effexor, and Cymbalta.
Why does this happen?
Well, of course we don't know exactly why it happens
because we don't look in people's brains
to see what's going on at the time
that it's happening.
But a working theory is that it has to do
with the sudden depletion of serotonin
and norepinephrine in the nerve cells.
So, when you strip the drug away,
you get this rebound effect that
makes the nerve hyperactive.
This hyperactivity of the norepinephrine in your brain
is thought to be causing the shock like feeling.
Now this is just a theory.
But it is a real thing that happens to people.
So when does it happen?
The symptoms of discontinuation syndrome,
including all of the ones that I mentioned,
not just the brain shocks.
But the flu like symptoms and the other things,
can show up within a day to three or four days.
And they can last from a day
or even about two weeks on average.
Some people have reported the symptoms though
lasting a year.
And I've seen some patients where it lasted longer
than two weeks,
but it wasn't happening every single day.
It may have started out every single day,
but after a couple weeks,
it just kind of tapered off.
But then there may be a day here and there
where it popped up again.
And that kinda went on for a few months.
So what do we do about it?
Well, the first and obvious thing
is that you should always wean off your medicine
and not just stop it suddenly.
But hey, if you go on vacation
and leave your medication behind,
or if you're going on a long work trip or something,
you may just want to go through the trouble
of getting a temporary supply of it called in
to a pharmacy wherever you are.
But, let's say you can't do that.
Or you're only gone a few days.
Once you get back home,
if you restart the medication,
the symptoms usually go away within a day or so.
What if you were trying to get off the medicine anyway?
And you don't really want to get back on it?
Then, you would consult with your doctor
about restarting the medication,
but gradually tapering off of it.
And depending on how long you were taking it
and the dosage you were taking,
you may want to taper over a couple of months.
A slow taper would be reducing the dose every couple
of weeks to a month.
A faster taper would be reducing the dose
every few days.
Effexor and Cymbalta can be pretty wicked
when it comes to this kind of withdrawal.
So you wouldn't want to go too rapid with these medications.
And tapering your medication should be something
you do with your doctor's assistance
so that you know exactly how much to reduce your dose by
and how often you should reduce it.
How do you know when your taper's complete?
The general rule is that the dose that you started at
is usually the dose at which you can stop.
So, for example, we usually start Cymbalta at 30 milligrams.
So once you get down to 30 milligrams,
you can usually stop at that dose.
So what if you have trouble getting off
that last 30 milligrams?
There is a 20 milligram dose of Cymbalta,
but that's not really the point.
Because if you have trouble getting off at 30,
you're probably gonna have trouble getting off at 20.
A workaround to this is that we will sometimes
add another medication like Prozac.
Now, hold on, you might say,
well, why would I start a new medication
when I'm trying to get off this first one?
Adding Prozac would be a temporary thing
to help you get off the Cymbalta.
Because Prozac is a long acting antidepressant.
In fact, it takes about a month to completely
get out of your system.
Short acting medications tend to have a sharp drop off
when they wear off.
Whereas longer acting medications
- Wee! - tend to have
a smoother on and a smoother off.
Since the withdrawal has to do with your body
getting used to the medication being gone,
when you add Prozac,
you add back a little bit of the serotonin
and then let it gradually fall off
because of the long half life.
Now that said, discontinuation syndrome rarely happens
with Prozac, especially at lower doses.
One last point about this.
It's important to realize that the symptoms
that you can get when you suddenly or quickly stop
your antidepressant is the withdrawal effect.
This is different from a relapse.
I bring this up because sometimes people will feel
as though they can never get off their medication
because every time they try to get off,
they start to feel worse.
Now, it could be that you're stopping the medication
while you're in the throes of an episode
and now is not the time.
But, real relapse symptoms don't come on
as quickly as a day or two.
You usually see this with withdrawal or discontinuation.
If you're wanting to see whether or not
you'll be okay off of medication,
you really need to give it a month or two
to see how you feel.
And whether or not you'll be fine
without taking the medication.
I hope this was helpful.
I'm interested to know if you've had this experience
with stopping a medication.
And if you know someone who could benefit from this video,
then share it.
See you next week.
("My Harlem Days 1" by Jan Chmelar)
♪ I am what I am today ♪
♪ 'Cause I did it my way ♪
♪ Nuttin' y'all can say. ♪
♪ In this life or the next one ♪