Papp, 2018 Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation.

[Altostrata]

ADMIN NOTE Also see Skaehill, 1997. Clinical Reviews: SSRI Withdrawal Syndrome. 

 

Our discussions:

Brain zaps

 

Paresthesia: Pins & Needles, Numbness, Tingling, Burn...

 

Constant low-level jolts in entire body

 

tremors, shaking, body vibration

 

Exploding head syndrome or SSRI withdrawal?

 

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Prim Care Companion CNS Disord. 2018 Dec 20;20(6). pii: 18m02311. doi: 10.4088/PCC.18m02311.

Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation.

Papp A1,2, Onton JA3.

 

Abstract at https://www.ncbi.nlm.nih.gov/pubmed/30605268 Full text at https://www.psychiatrist.com/PCC/article/Pages/2018/v20n06/18m02311.aspx

 

Objective:

To describe the characteristics of the electrical phenomena of antidepressant discontinuation syndrome known as brain zaps and their effect on quality of life.

 

Methods:

We examined 595 unsolicited posts made by individuals frequenting a popular lay mental health website. The site was accessed between December 13, 2014, and December 12, 2016, and its content was saved in a text document. The posts had been accumulating on the site since December 2014. These posts were analyzed and separated into 648 separate statements regarding antidepressant intake. Of the statements, 378 contained reference to symptoms experienced in the context of antidepressant discontinuation. These posts were further analyzed for specifics of the medications involved, temporal characteristics of the medication intake, associated symptoms, specifics of the "zap" experience itself, and effect of the zaps on quality of life. As this was a convenience sample, only qualitative analysis was performed.

 

Results:

Venlafaxine and paroxetine were reported more frequently, and fluoxetine less frequently, in the sample compared to their frequency of prescription in clinical practice. This finding mirrors the frequency distribution of all withdrawal effects versus antidepressant prescriptions written as reported in the literature. The most likely cause of brain zaps was abrupt discontinuation of the medication, but gradual tapering had only a partial mitigating effect. An unexpected finding was the frequent association of brain zaps with lateral eye movements. The presence of brain zaps was typically transitory, but in a small number of cases it caused significant disability lasting for months or years with no treatment available. Patients' inability to obtain effective help from prescribers and the perceived lack of interest in this symptom on the part of the medical profession risks fueling antipsychiatry attitudes among patients.

 

Conclusions:

Brain zaps are a poorly understood symptom of antidepressant discontinuation, which require further study for both better prevention and treatment. The apparent association of brain zaps with lateral eye movements may open avenues for investigation of this process.

 

 

From the paper:

Quote

 

....

The aim of this study was to gather information as reported spontaneously by internet users about the specific symptoms experienced while having brain zaps. For this purpose, we tallied the posts made by visitors to a website, Mental Health Daily,23 which was discovered while doing an internet search with the term brain zaps.

....

We examined 595 posts, which were analyzed into 648 statements (a single post sometimes described 2 or 3 experiences, and these were treated separately). They were entered into a large spreadsheet wherein the rows represented the individual posts and the columns the various pieces of information extracted, such as the name of the medication and the symptom described.

....

Most patients experienced brain zaps for less than a year (122, 77% of the 159 reports), about half of whom (37% of 159 reports) experienced them for a month or less. There were 24 reports of patients experiencing brain zaps between 5 and 30 years (37, 23% of 159 reports). The most frequently reported time lags between the last dose of the medication and the first instance of a brain zap were “immediate” and “while taking,” followed by “1–2 weeks” and “20–36 hours.”

....

Posters did not always mention a specific trigger for the zaps, but among the posts that did mention a trigger, movements of the eyes or head were surprisingly common (Table 5). About one-sixth of the posts described the valence of their experience and its impact on their lives (Table 6) unambiguously. In what appears to be a minority of the cases, experiencing brain zaps resulted in significant disability.

....

Several patients described their experience with their physicians. The descriptions of these experiences are summarized in Table 7.

 

Close to 50 different methods were described in the posts as attempts to alleviate the symptoms. These were activities such as exercising or relaxation and various ingestible agents ranging from chocolate to medications prescribed for other reasons. Most of the agents were mentioned only once. About half of the reports were positive, and the other half were negative in seemingly random distribution. The most frequent agents, based on recommendations of lay sites including Mental Health Daily, were various combinations of omega-3 fatty acids, B-complex preparations, and magnesium. Eight reports were negative, and 8 were partially or fully positive. Three reports of using 5-hydroxytryptophan and 2 reports of using nonsteroidal anti-inflammatory drugs were positive.

....

The most frequently used substance to alleviate zap symptoms was omega-3 fatty acid, but, overall, the efficacy was inconsistent and thus could not be recommended as an effective treatment. Since the pathophysiologic mechanisms offered to date in the literature are all hypothetical,15 it is not currently known how best to treat brain zaps.

Besides the SSRI discontinuation syndrome typically described in the literature, such as vertigo or nausea, we found some heretofore unreported symptoms as well, such as hearing a sound concurrently with the zaps or a sense of momentary disorientation or unreality. The sounds were invariably described as having a static or sizzling quality, with quite a few posters stating that they heard their eyes move. One of the more surprising findings from this data set, one that also has not been described in the literature, is the report of lateral eye movements acting as a trigger for the zaps—it was the most frequently described trigger on this website. Even in the case of the second most frequently reported trigger, running/walking, the movement of the head or eyes can be assumed to be involved, thus further reinforcing the involvement of eye movements. In the few instances when behaviors reducing the severity of brain zaps were reported, the actions specifically involved not moving, or fixating, the eyes. The only vaguely similar report in the literature came from Zajecka et al.3 Of the 15 case reports reviewed in the article,3 4 contained “electric sensations” and 2 contained experiences involving some unspecified abnormalities in eye movements. All 6 reports came from different patients. No connections were postulated to exist between the 2 phenomena.3

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The ad hoc expressions of negative attitude that we found on the site echo the more formalized positions of the antipsychiatry movement, which some of our patients who feel wronged by us may feel compelled to turn to. As Nasrallah28 warns, it is important not to dismiss the ideas put forth by antipsychiatry as irrelevant, even if they seem exasperating. Instead, we should strive to understand their origination and draw motivation from them to continue the progress toward better diagnostic models and treatment approaches.

SUMMARY

Brain zaps are an infrequent, but a fairly unique and poorly understood, symptom of antidepressant discontinuation. The speed by which the biological activity of the antidepressant diminishes in the brain after discontinuation appears to mediate some but not all of the effect.

The mechanism by which individuals can experience a momentary electrical shock inside their brain is unknown. People who suffer from brain zaps can experience varying levels of functional impairment, typically very little but at times disabling. Most of the time the symptoms last for weeks to months, but some decades-long durations have also been reported. Lateral eye movements seem to be involved in triggering brain zaps. This finding may open avenues for future objective studies.

The limitation of this study is the nature of the database, which is a convenience sample of spontaneous self-reports. While the numbers obtained are not suitable for statistical analysis, they still express trends and can be used to plan more systematic analyses of the problem.

To date, little specific attention has been devoted to brain zaps from the psychiatric community, which has caused serious grievances among patients experiencing them. Further study seeking systematic and statistically analyzable data about this phenomenon is needed to advance our understanding and provide help to those who experience brain zaps.

 

 

 

Edited January 14, 2019 by Altostrata
added admin note

[Cynthia]

OMG.  I just read this summary about brain zaps.  I didn't know how I was going to describe that it felt like I was hearing my eyes move inside my head.  And here it is!!  I see my psychiatrist tomorrow - have lots to discuss and don't know whether or not I'll get through.

But reading this is so validating.  I'm not crazy - -  I thought I was having a stroke and how was I going to tell a doctor that I hear my eyes move inside my head?! Um, let's get this lady on something STRONGER and send her away!

 

Thank you!

Whooshing eyes

[Altostrata]

Please see Admin Note I just added to post #1.

[Linus]

Yeah brain zaps, when I first discontinued my ad cold turkey many years ago (little did I know at the time), I told my psychiatrist about them, he just laughed, instead of telling me it was normal, my God I just can't get over the fact how clueless most of them are.