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Exploding head syndrome or SSRI withdrawal?

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Altostrata

I've experienced this myself -- it's a withdrawal symptom, another manifestation of neurological hyperreactivity. It happened a few times, randomly, and I hope it never happens again. http://www.clinicaladvisor.com/exploding-head-syndrome-or-ssri-withdrawal/article/236503/

 

Exploding head syndrome or SSRI withdrawal?

Sharon M. O'Brien, MPAS, PA-C April 13 2012

 

When a recent patient described hearing an intense noise that woke him from sleep, it wasn't clear to me at first what he was experiencing. He described the experience as terrifying, but not painful.

 

The patient underwent MRI, but nothing unusual had been found. He did have a history of selective serotonin reuptake inhibitor (SSRI) use and had recently been weaned from the medication.

 

Patients sometimes report feeling “brain zaps” or electrical sensations when being weaned from SSRIs. At first I thought he may be experiencing this side effect, but as he continued to describe his situation, I was not convinced SSRI use was to blame. He had no other withdrawal symptoms and said the episode occurred as he was trying to fall asleep.

 

Exploding head syndrome (EHS) is very rare. I can't say for sure that my patient actually has it, as he has only experienced symptoms on one occasion. However, his description seems to fit the syndrome. EHS is named after the sound patients with the disorder perceive hearing. Patients with EHS will complain of a severe noise that usually occurs when transitioning from wakefulness to sleep, although it has been recorded by polysomnogram in all sleep stages.

 

Patients may describe EHS symptoms as hearing a gunshot, an explosion, a bomb going off, a clash of cymbals, or thunder that awakens them from sleep. It is often accompanied by shortness of breath and increased heart rate. The cause is unknown, but etiology appears benign.

 

EHS episodes last for seconds and have a random pattern. Some patients may experience the symptoms several times and then never experience the problem again. For others, episodes can be quite frequent.

 

EHS does not cause pain, but it does cause anxiety and fear, as patients often believe something so intense must be serious. Some patients have described seeing flashes of light when the sound occurs. One theory is that EHS could be a manifestation of seizure activity.

 

Because EHS is benign, treatment is mostly reassurance.... EHS symptoms often decline after patients understand that the illness is benign.

 

In medicine we are often taught to think of horses not zebras. This case was a reminder that sometimes it is appropriate to look in the zoo....

 

Sharon M. O'Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

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Altostrata

My comment:

 

Sharon, your intuition about this phenomenon being related to SSRI withdrawal and "brain zaps" was correct. "Brain zaps" are thought to be a variety of Lhermitte's sign, abnormal electrical discharges in the brain.

 

I am a peer counselor for those tapering and recovering from antidepressant withdrawal syndrome. Often, withdrawal leaves the patient with nervous system hypersensitivity that does not show up on any tests but can be very significant.

 

In those who experience severe withdrawal syndrome from too-fast tapering, the nervous system hypersensitivity precludes treatment with any other neurologically active medications or even supplements. Such patients may also be hypersensitive to formerly tolerable foods. This can last for months or years.

 

Disordered sleep is very, very common among those suffering from withdrawal syndrome. Sleep panic, startling when drowsing off, and other alerting reactions are often reported. Patients will report having frightening dreams or hearing frightening noises, which cause them to startle and awaken with anxiety.

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Jemima

Another long, low whistle. I have occasionally heard some loud sounds while settling down for the night, usually in the form of loud car horns or backfires. (I live near the Pennsylvania Turnpike so this didn't particularly alarm me.)

 

I had one really strange experience pre-AD. I was stressed to an extreme and while lying in bed about to go to sleep, started seeing stained glass-like colors and shapes that obliterated my vision. I was terrified and thought I might be having retinal detachment. My vision was fine the next morning and the next and the next and eventually I discovered a phenomenon known as "headache-less migraine", the symptoms of which were exactly what I had had that night, all of it due to stress.

 

Methinks this goes to show what stress can do to a person, and those elevated Cortisol levels in withdrawal can certainly produce some mighty strange and scary stress effects.

 

May our psychiatrists get everything they so richly deserve.

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Gem

I have experienced the flashes of light in withdrawal, but without the sound.

 

At the time, I was either waking up or going to sleep, I can't remember which.

 

I had been reading a magazine article, and when the flashes of light occurred, images from the article suddenly popped into my head.

 

It was pretty bizarre.

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squirrel

i am sure I posted about this sometime ago. I have had this several times a loud explosion and a flash of white light when i was waiting to drift off to sleep.Its very alarming.

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ajnjj

I have had this. Only in wd. Never before.

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Nickie

Interesting....

 

I get this alot, especially lately. And I wake up in a horrible horrible emotional place.

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Nikki

Whatever it is....it feels like we took LSD and it is scary. I guess the way thru it is to just remind ourselves that it is the drug, over and over again.

 

Nickie if you wake from this, go take a quick shower. Water hitting my face helps alot and tones down cortisol/adrenaline.

 

Hugs

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Shanti

I was getting this too. I researched it and found out it's something some people deal with. I kind of put it in the catagory as my audio hallucinations, that can range from bells, phone rings, etc. But now I don't have this anymore, thank God.

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Goose

Hello all

I just had this exploding head thing last night, it scared the hell out of me! I hope it dosent happen very often, i feel as though im going crazy when it does! I couldntbsleep the rest of the night! Happy dreams People, happy dreams.

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Phil

I've had this once too. It was a horrible experience.

 

I've also had the hypnogic jerks occasionally, and sometimes I just get a load of loud internal chatter in my head. Some would call it auditory hallucinations, I guess. It only happens when I relax and try to drift into sleep.

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Shanti

Niacin is very helpful for the auditory hallucinations that are a part of hynogogic hallucinations. I get the same things, lots of background voices. I also get the loud bangs, bells, whistles... all of it. I tested the Niacin again. I stopped taking it for a few days to see if these things came back and sure enough, they did. It's interesting how something so simple like Niacin can be so effective. I have no idea why it works. But I read a book about Orthomolecular doses of it is effective for Schizophrenia. I'm sure if I had more of a scientific mind I'd remember the specifics of it all. But I'm not like that.

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Romido

I have had this. It's very upsetting. I think it has something to do with being exhausted for me because while the quantity of my sleep is better most of the time now, I think my sleep patterns are still disrupted. Last time, I was just falling asleep and within five minutes or so of me drifting to sleep, I heard someone say my name very loudly. That was what startled me awake and scared me. There was no one there of course, and it made me heart pound. I read up on it and it's a bit different than a panic attack like I was having early on, but still quite upsetting. I try not to fear it, but just endure these tortures. I have had it probably five or six nights, over the past year. Scary but harmless.

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Altostrata

I've had this a few times -- a loud clap as I was falling asleep. Hasn't happened in a long while, though.

 

Like Romido, I chalked it up to yet another obnoxious phenomenon brought on by withdrawal syndrome and autonomic dysregulation.

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Phil

Niacin is very helpful for the auditory hallucinations that are a part of hynogogic hallucinations. I get the same things, lots of background voices. I also get the loud bangs, bells, whistles... all of it. I tested the Niacin again. I stopped taking it for a few days to see if these things came back and sure enough, they did. It's interesting how something so simple like Niacin can be so effective. I have no idea why it works. But I read a book about Orthomolecular doses of it is effective for Schizophrenia. I'm sure if I had more of a scientific mind I'd remember the specifics of it all. But I'm not like that.

 

Apparently Niacin releases histamine in the body, so there might be a clue there. High histamine levels also have a connection with schizophrenia, I believe.

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mammaP

I've just seen this after following a link Alto posted. I've experienced this phenomenon too

many times since jumping on the drugs bandwagon! Loud noises that can be anything , 

the doorbell, (my doorbell is extremely loud and was fitted for someone who was hard of hearing).

gunshot (never happens here) . thunderclaps.......

I never knew what it was but it was terrifying for a long time because I thought someone or

something was  trying to scare me to death and succeeding.  Eventually I stopped being scared

and thought it was just me dreaming. It makes sense now I've read this! It's worse when insomnia

is bad but maybe that is because it's withdrawal that makes the insomnia worse. 

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Rhiannon

Cool. This has happened to me a few times in withdrawal. Interesting. I just thought I was dreaming and had dreamed a loud explosive sound.

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trouper

sometimes i wake up to odd sounds, too (doorbells, or just odd sounds.) i also get the mental chatter phil and shanti were talking about. this goes in waves and they both seem to coincide with each other. i was thinking it was glutamate activity related as it happens a few days after i get pretty anxious. i take l-theanine but I'm not sure if it helps or not. interesting to see that niacin may help. i was advised to stay away from niacin though. 

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Altostrata

More on exploding head syndrome

 

http://www.theatlantic.com/health/archive/2015/01/how-to-defuse-exploding-head-syndrome/384553/

 

....Researchers think that the cause of EHS lies in the brainstem reticular formation, an area of the brain that regulates sensory-motor reflexes, eye movements, motor control, and transitions between sleep and wakefulness. The theory is that as we approach sleep, the brainstem acts as a night watchman, switching off those functions. In EHS, this routine is somehow disrupted, resulting in wild brain-cell firings that cause the perception of loud noises and flashing lights, as well as muscle spasms.

 

As of now, there are no diagnostic tests for EHS. Researchers considered the possibility that it may be a form of seizure, but EEG testing, which is used to detect epileptic activity in the brain, has not shown epilepsy as a cause. The symptoms of EHS can be so distressing, however, that patients become convinced that they have something very serious, and end up getting tested for other conditions such as strokes or tumors. There is also no specific treatment, although a variety of medications, including anti-seizure drugs and calcium-channel blockers, have been used to alleviate the symptoms. A study by Gautam Ganguly, a neurologist at the University of Southern California’s Keck School of Medicine, suggested that the best treatment for EHS may be simple reassurance that the condition is benign rather than an indication of something more serious. He reported the case of a 57-year-old man whose symptoms had not recurred six months after doctors convinced him that his EHS was nothing more than an inconvenience.....

 

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DLB

Only had this while starting paxil a few times, and once when I hit tolerance.

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Colonial

I have had this twice in my SSRI Withdrawal period.  Both times under 16mgs of Paxil, when I had started at 25mgs of CR.

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InvisibleUnless

ive had both the aural and visual components of this while taking meds and also in withdrawing.  while taking the meds, it seemed especially likely to occur if i was more tired than usual (often from skipping a night of sleep, as the meds generally made me do about 4-14 times per month over the long term).  taking my bedtime meds (including the antipsychotic of the period) may have also been an agitating factor, though its hard to tell since i rarely tried to sleep without them due to dependence.

 

an interesting difference is that such EHS symptoms tended to be right while falling asleep initially while i was on the meds, and in withdrawal they are more often occurring during waking up from a period of sleeping or dreaming instead---a more prolonged experience of deafening noise (like hurricane winds) and/or explosions of light rather than the usual, more confined single or double explosion with a flash of pure whiteness.

 

it is barely meaningful to draw lines around ambiguously quasi-seizure activity because all psychotropics can cause abnormal firing patterns and functionality and a wide variety of side effects are seizure-like in manifestation.  if we dont understand seizures, comparing or connecting other neurological experiences to them is nearly useless except to differentiate them from patterned and replicable firing patterns which still cause disorder.

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JanCarol

Alto writes:

 

 

When a recent patient described hearing an intense noise that woke him from sleep, it wasn't clear to me at first what he was experiencing. He described the experience as terrifying, but not painful.

YES!  That's how it is for me.  My brain lights up, and my entire nervous system fires.  With some deep breathing, I can sometimes settle down, but I can imagine for someone not knowing what to expect (I've had phenomenon like this since the late 80's, just not very frequently) that it could be frightening.  If hubby had it, he would be terrified he was having a stroke.  Luckily we've kept him off the SSRI's. 

This is the first place I've seen it coupled with a noise.  As I listen to relaxing MP3's to drown out hubby's CPAP, it's on random play, and sometimes a change in the music is enough to set it off.  As far as an inner sound, like fireworks or doorbell, I think I've experienced that, too.  That is harder to pin down, because I'm always waking from a dream - was the sound in the dream, or was it from the external environment?

 

I've also had it from misinterpreting external sounds, internally.  The best example of it is a freight train roaring by the house (I live on a train line) becomes the screaming of thousands of people in distress.  NOT a good thing to wake up to - and even after I realize "oh.  That was a train," my chest keeps pounding for quite a while.  Breathing exercises distract me from the cortisol explosion - but let me emphasize that the Breathing exercises do not calm me.  They only distract me while I wait for the system to settle.  Sometimes that is 45 minutes.

 

Again, I associate it with the serotonin drugs - (including LSD, of which I was a user in the long ago and far away) and the withdrawal from them.  That I have them so many decades after being of SSRI's (though SNRI's and tricyclics were in there), I treat them like "flashbacks."

 

But they are scary, it's just that I'm experienced enough with misperceptions and hallucinations to get through them.  I have not told anyone about them, ever.  Till now.

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Purplestars22

I have had EHS a couple of times this year and this week. I experience noises while falling asleep and/ or waking up. The noises would be ringing bells, door slamming and various noises. I have noticed this happens when i have increase in stress or in a bad wave. It is so terryfying, anxiety and cortisol surges provoking. It is surreal leaving me traumatized and having shame of experiencing this horrendous symptom. There are times when I am afraid to fall asleep and manage to sleep only when I listen to YouTube videos playing on my phone.

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Nextra

I'm relieved to see this, I have had this happen several times over the past few months whilst in protracted withdrawal and never before. I find it very distressing. As I wake I hear a very loud gunshot in my head.... or does the noise wake me up? It is so tangible yet I know it is internal as I seem to feel it in my head at the same time.

For me it is very different to the phenomena of incorporating an external sound into the script of a dream.

It is however one of the less common sleep disturbances that are a constant feature for me now at 12 months off meds. I often feel like I have not slept at all, even when I do.

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antidepressantsNoMore

I've had this a lot during withdrawal. It wasn't something I wanted to talk about. I had one psychotic depression about five years ago- same thing after stopping anti-depressants. Maybe it was a relapse and caused another psychotic depressive episode. It sucked because it happened a lot in a period of 6 or so months. It is very distressful. Thankfully, it no longer happens anymore.

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Toulouse

I have had this too, maybe after the 1st month or two after Paxil withdrawal.  I'd occasionally hear a bang, or like a door slam.  About a month ago I woke up to what I thought was someone pounding on my door (at 3am) it scared the crap out of me, and I jumped out of bed. was so relieved it was what I chalked up to a very realistic dream.  I hope it doesn't happen again.

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btdt

My comment: Sharon, your intuition about this phenomenon being related to SSRI withdrawal and "brain zaps" was correct. "Brain zaps" are thought to be a variety of Lhermitte's sign, abnormal electrical discharges in the brain. I am a peer counselor for those tapering and recovering from antidepressant withdrawal syndrome. Often, withdrawal leaves the patient with nervous system hypersensitivity that does not show up on any tests but can be very significant. In those who experience severe withdrawal syndrome from too-fast tapering, the nervous system hypersensitivity precludes treatment with any other neurologically active medications or even supplements. Such patients may also be hypersensitive to formerly tolerable foods. This can last for months or years. Disordered sleep is very, very common among those suffering from withdrawal syndrome. Sleep panic, startling when drowsing off, and other alerting reactions are often reported. Patients will report having frightening dreams or hearing frightening noises, which cause them to startle and awaken with anxiety.

 

This was in part what got me the dx of PTSD... 

 

I would hear loud crashing ... since I had a MVA docs said it was ptsd.. I wonder how many military people are given the ptsd cause of this and the simple connection between explosives ect army noise in their experience and this side effect... 

 

interesting

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LexAnger

I'm so relieved finding posts in their thread !

After so many weird symptoms in to years tapering lexapro, I had the most weird and frightening head explosion today on the way drinking to work. I thought immediately there was a real bombing on the highway, although it truly felt the bomb started from inside my head and movement of the 'bomb' inside my head was super uncomfortable and disturbing. Very very scary even it lasted probably just a few seconds. A second one happened a few hours later when I was walking in the hall way of the office building, this time I actually fell (on to the wall right by me). A lot like a seizure fall without the shaking part.

 

I felt very sick, nausea afterwards, no pain was involved, but felt inner fearfulness.

 

This worries me a lot about driving. Anyone ever had this day time instead of round sleeping? Any other experience related to this symptom? What dose it indicate and what to expect from it?

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Altostrata

This is another one of those electrical events in the brain and nervous system.

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LexAnger

Hi Alto,

 

This thread saved me from being panicking from the incidence. I found it is the most informative link available online as its very rare in general. I'm sorry you had it too but at the same time I'm glad you know it as the first hand.

 

Do you know what I can expect from it? I'm thinking to hold longer just because this new symptom but don't know what to look for when deciding reduce further as its not a constant/ continuous symptom.

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LexAnger

Yes, it's something similar to seizure

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kesh

Just signing into this thread. Sleep starts (shocked awake by various symptoms while falling asleep) were what got me into my present mess.

 

Currently manageable most nights. Maybe two or three occurrences before I sleep. Some nights they keep me up for half the night.

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Survivor1

Keeping this thread alive ...

 

For a while have been having noises in the head (along with night myoclonus).  Sounds like a loud crunch (walking on gravel), or a loud click.  Terrifying ...

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