SSRIs are a huge help to me. I'm one of the lucky (?) ones.

For those curious about what a brain zap is, it's like you're going about your normal business, then you feel a jolt like you're surprised, but only in your head. Then it's difficult to remember what you were thinking about prior to the zap. When it happened to me last, I stopped walking and couldn't resume my inner monologue/ train of thought. I just started walking and let another one conjure itself up.

It's been decades since I've had one, Wellbutrin is much better.

Thats exactly the problem I'm having!

Working with my GP to titrate off Sertraline (Zoloft) at the moment.

My GP, like many others, wasnt really aware of the issues with getting off the drugs!

I describe the brain zaps as like a wave of electricity.

Like a Sci-Fi pulsing wave. As if i've got some sort of giant capacitor discharging in my brain.

The sort of thing from a 50s Sci-Fi movie thats a tower of electricity, glowing and pulsing and radiating an electrical light show!

Exactly the sort of thing that might re-animate Frankenstein!

It's not painful as such, but it's debilitating and causes you to literally pause and make a sharp intake of breath.

I hate being on the bloody things. Wish I'd never started them. CBT is much more effective in the long term, for me. YMMV.

I find SSRIs kill my motivation and creativity.

I'd really suggest anyone think twice before assuming these pills, that GPs dish out like candy, are an easy and consequence free solution!

I think there’s more to it than just messing with serotonin.

There’s something about Sertraline (Zoloft) that seems to make it quite reliable at causing brain zaps. 3 people I’ve known who stopped Sertraline all experienced brain zaps. 1 of those people also talked about stopping Prozac (cold turkey) and Lexapro (4wk taper) and did not have the zaps, but a 4-month taper of Sertraline was not enough to avoid them.

In fact in the article they recommend switching to Prozac and then tapering that, as a way to avoid the zaps.

> Someone I know took about 4g of MDMA over a 4-day period

I am all for freedom of drugs and people experiencing one of the most beautiful states of mind one can achieve, but 4g MDMA over 4 days is literally in the attempted brain-damage territory.

> sleep paralysis with demons in the room (feeling like you are laying in bed with a demon coming towards you but you physically cannot move)

This gave me literal chills when I read it because this exact thing happened to me for the same reason as your acquaintance (but far, far lower doses). I was prone to getting sleep paralysis anyways, but abusing MDMA resulted in the most terrifying experience of my life two nights in a row. Your description was spot on.. I felt the covers on my bed being pulled off of me by some demonic presence the first night, and the second night the same thing happened but that time I was lifted out of my bed and slowly dragged away. Felt like I was awake and perfectly conscious the entire time and I literally frozen with fear to the point where I couldn't speak. I stayed up the entire night after that for fear of it happening again. I also got terrible brain zaps for weeks afterwards, too.

i used to get zaps when my body tried to feel good on normal occasions after 'fucking with my seratonin levels'. I remember i used to get them when I was reading something i found clever or funny, chugging cold water, biking etc.

I think some other posters already commented, but I wouldn't put too much stock in the MDMA being MDMA -- I use MDMA pretty frequently and never had brain zaps from it, but when I was on sertraline and quit without tapering off, I definitely had the brain zaps being described, and I still get them almost 15 years after discontinuing sertraline.

MDMA depending on where you are and what you got can be quite a few things, it's why test kits are important. It's not to say that MDMA cannot cause brain zaps, but given that we know that MDMA is usually cut with a lot of filler/other drugs without the user knowing, I would acknowledge it could do it, but would always have doubt it was actually the MDMA due to the knowledge that whatever the users who experienced brain zaps took likely had many other drugs/substances in it. In the current political climate surrounding drugs, I'm not even sure how a study could effectively be done correctly.

Which is unfortunate because brain zaps really suck and withdrawal from SSRIs is pretty rough. I easily get into addictive substances, and have successfully stopped use on quite a few pretty heavy things, and they didn't come close to the withdrawals from SSRIs for me. This is personal experience of course, and likely many other factors in my life helped with my stopping some recreational drugs without hugely adverse affects, but SSRIs just nothing helped and at the time (2010-2015), I really couldn't find any reliable information online or from doctors about the brain zaps.

I'm glad to read this article because it's great to see that there is attention to this and more focus on the side effects of SSRIs. SSRIs definitely can help many people, but it is pretty intense drug and the withdrawal is nasty for quite a few people.

I've gotten them from taking SNRIs, so I wonder if norepinephrine is involved somehow, or maybe SNRIs are not actually that selective.

> Someone I know took about 4g of MDMA over a 4-day period

For anyone reading who's unfamiliar, this is a ridiculous dose of MDMA. A normal recreational dose would be 0.1g-0.2g once every few months. (I have no idea whether this dose is safe or not, just saying it's a common one for people to take.)

A bad thing about MDMA is that you become tolerant to it very quickly, so people who do it too regularly need to take more and more over time to feel the effects. That's probably what happened to the parent comment's friend.

> sleep paralysis with demons in the room

I've heard of people experiencing similar things when practicing techniques for Lucid Dreaming or Astral Projection.

> Someone I know took about 4g of MDMA over a 4-day period

As an aside, there are several dozen drugs that street dealers sell as “MDMA” with wildly variable dose-response curves. 4 grams of MDMA sounds insane but it is absolutely feasible that a person could end up having to take that much of some other cathinone/MDxx drug for a comparable experience

Do these occur without the use of SSRI's? e.g. in ADHD patients? What if _someone I know_ has had these brain zaps extremely infrequently but definitely noticed them in the past?

Oh wow, I had a very similar experience with brain zaps after a slightly lower dose over 4 days. They were mostly non intrusive and around the nape of my head. I hope they’re not a signal of damage.

80% of everything is crap, including psychiatrists, plus if you take away SSRIs that's a huge chunk of their business. Upton Sinclair and all that.

If anyone has had their teeth whitened and felt the zaps in their teeth… it’s like that but in your brain.

Fucking sucked.

> Physicians were initially unaware or dismissive of brain zaps due to limited information and a focus on downplaying the addictive nature of antidepressants.

Seems like another example of: "Deadly Psychiatry and Organised Denial" https://www.deadlymedicines.dk/deadly-psychiatry-and-organis... "Deadly Psychiatry and Organised Denial explains in evidence-based detail why the way we currently use psychiatric drugs does far more harm than good. Professor, Doctor of Medical Science, Peter C. Gøtzsche documents that psychiatric drugs kill more than half a million people every year among those aged 65 and above in the United States and Europe. This makes psychiatric drugs the third leading cause of death, after heart disease and cancer. Gøtzsche explains that we could reduce our current usage of psychotropic drugs by 98% and at the same time improve patients’ mental and physical health and survival. It can be difficult, however, to come off the drugs, as many people become dependent on them. As the withdrawal symptoms can be severe, long-lasting and even dangerous, slow tapering is usually necessary. In his book, Gøtzsche debunks the many myths that leading psychiatrists – very often on drug industry payroll – have created and nurtured over decades in order to conceal the fact that biological psychiatry has generally been a failure. Biological psychiatry sees drugs as the “solution” for virtually all problems, in marked contrast to the patients’ views. Most patients don’t respond to the drugs they receive but, unfortunately, the psychiatrists’ frustrations over the lack of progress often lead to more diagnoses, more drugs and higher doses, harming the patients further."

Other alternatives for health and wellness I have collected: https://github.com/pdfernhout/High-Performance-Organizations...

One example from there: "The Depression Cure: The 6-Step Program to Beat Depression without Drugs" by Stephen S. Ilardi

From the Amazon book blurb: "In the past decade, depression rates have skyrocketed, and one in four Americans suffer from major depression at some point in their lives. Where have we gone wrong? Dr. Stephen Ilardi sheds light on our current predicament and reminds us that our bodies were never designed for the sleep-deprived, poorly nourished, frenzied pace of twenty-first century life. Inspired by the extraordinary resilience of aboriginal groups like the Kaluli of Papua New Guinea, Dr. Ilardi prescribes an easy-to-follow, clinically proven program that harks back to what our bodies were originally made for and what they continue to need with these six components:

  * Brain Food [supplement with Omega 3s; remember your brain is mostly fat]
  * Don't Think, Do [avoid excessive rumination by doing things]
  * Antidepressant Exercise [aerobic exercise is medicine]
  * Let There Be Light [get natural sunlight and supplement as needed with vitamin D3]
  * Get Connected [engage in face-to-face social activities regularly]
  * Habits of Healthy Sleep [get enough sleep by following basic guidelines]

TL;DR as Ilardi says: "We were never designed for the sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden, frenetic pace of modern life. (Stephen Ilardi, PhD)"

That said, if you are on prescription psychotropic meds already, do not stop taking them or change doses without some medically-approved plan for getting off them. Peter Gøtzsche wrote an entire book about that: "Mental Health Survival Kit and Withdrawal from Psychiatric Drugs: A User's Guide" https://www.amazon.com/Mental-Health-Survival-Withdrawal-Psy... "This book can help people with mental health issues to survive and return to a normal life. Citizens believe, and the science shows, that medications for depression and psychosis and admission to a psychiatric ward are more often harmful than beneficial. Yet most patients take psychiatric drugs for years. Doctors have made hundreds of millions of patients dependent on psychiatric drugs without knowing how to help them taper off the drugs safely, which can be very difficult. The book explains in detail how harmful psychiatric drugs are and gives detailed advice about how to come off them. You will learn: ... that psychiatric drugs should never be stopped abruptly because withdrawal reactions can be dangerous..."

I echo your experience. Effexor/Venlafaxine are absolute poison. I tapered off of it slowly over the last two months under doctor’s supervision. The day after I took my last dose — small thanks to the tapering — I’ve had constant brain zaps, wobbly vision, horrible perpetual nausea, cold sweats, and inability to sleep more than an hour at a time. It’s been two weeks so far of lying in a dark quiet room waiting for things to resolve so I can go back to my wife/kids/job/life. Still no noticeable improvement. On sick leave for the first time in my life.

I was on venlafaxine for about 5 years and had always heard horror stories about the withdrawals. About 7 or 8 months ago I decided to ask my doctor to start tapering me off. Took about two weeks in total and the only side effect I had was when I would turn my head I could "feel" my brain moving around. It was a very strange sensation. I was on 150mg and then 75mg to nothing. I feel extremely fortunate I didn't have any of the issues most seem to have getting off the stuff.

> I learned later that Cymbalta had a black box warning for suicidal ideation

Most of the drugs that alter neurotransmitters (ADHD and depression meds, some seizure meds) will have a warning for suicidal ideation that may occur at some point of the treatment (usually early on). It's a balancing act between the treatment and the "illness" and has to be taken with caution.

Almost every doctor or psychiatrist I've seen or my family members have seen usually start off too strong and in many cases will advise cutting cold turkey. I always ignore it and taper on slowly over for about a month and if I need to get off the meds, I taper off slowly over 1-2 months. I was on Zoloft for 10 years and I was able to successfully got off the drug with minimal side effects that way. Although there was definitely a short period of brain zaps near the end, it wasn't as bad as the usual kind I'd get if I forgot to take the meds for a couple of days.

EDIT: If you use the taper off method, make sure to understand the half-life/how long it stays in your system.

Alternatively, as someone with severe ADHD, bupropion at the lowest dose gave me a psychotic episode where I started hearing things. Felt like I’d been dosed with schizophrenia pills. The razor blades told me to give them a look see. I threw them behind my fridge to keep them away. I went to my mom’s house, crawled in bed and cried for 24 hours straight. I’ve never had anything remotely like that before or since. This was nearly twenty years ago. Absolute worst day of my life.

My daughter had a pharmacogenetic screening test a few years ago and I’m not sure what this means exactly, but they give you a number with 1 being baseline expected response (this was awhile ago) and bupropion was a 9.

I’m extremely cautious about any sort of medication for me and my children because of this episode.

Bupropion + SSRI is a fairly common combination for treating depression! Back in the day I think people used to start on an SSRI alone and then would add bupropion if they needed an extra kick, but it may be more common now to start with the bupropion (not sure).

And re. serotonin syndrome, I can anecdotally say that I accidentally gave myself mild SS by mixing imipramine, ondansetron, and NyQuil. I suspect that also being on bupropion at the time is what put me over the edge, but it's hard to say; even without the bupropion it may have been a nasty combo. Live and learn!

Bupropin has been wonderful for my ADHD and probably saved my life. I'm at the US max (450) and I still get those occasional intrusive thoughts -- I've learned to just ignore them and they don't really affect me, but it is weird that they pop up. Flying has been the one time it's been actually bad.

You mentioned that those went away after increasing dosage? I've been on the fence about going up since I'd need to take anti-seizure meds.

Do you have any issues sleeping? This has been the one (major) side effect, that I can't as easily get good reliable sleep. I wake up at 7am every day, cannot sleep in, and have trouble falling asleep (which was typical prior, but I'd be able to get around this by staying up til exhaustion and then sleeping in to get my full 8 -- now I have to get to sleep by 11 but find it very hard to fall asleep).

Are you me? I had the same experience but I'm at 450mg + adderrall.

It's basically a miracle. Not sure if the newer non-stimulant adhd meds work in combination with buproprion if you don't want a stimulant or can't take one or get one.

I will probably drop down the buproprion now.. I suspect that buproprion is basically just less effective Adderall.. however, the generic buproprions really have bad quality control. I think there's a big scandal there brewing like before.

Buproprion inhibits cypd2, which means drugs like DXM have much stronger serotonin effects. I combine these 2 drugs for treatment of major depressive disorder (the latter is easily available on Amazon, the former is prescribed to me)

I did Prozac for about two months earlier this year, a relatively light baby dose.

It was utterly terrible. I couldn’t think about anything, basically zero focus on anything that took more than a minute of attention span, I felt completely detached from anything resembling an emotion, and I also seemed to completely lose my ability to feel hungry or thirsty, so there would be entire days where I would forget to eat or drink anything, probably making all the other symptoms worse.

They transitioned me to Pristiq, which has been considerably less horrible, though not terribly effective either. I am actually undergoing TMS now.

2,000 mg is likely an unsafe dose of any SSRI. In the past I was prescribed one and the dosage was 20 mg and even that made me feel a little bit strange and uneasy for the first few days until my body adjusted to it. Sorry you went through that.

That sounds odd. Were you taking 20 tablets at a time?

Damn, 2 grams? I had no idea the dose could get that high.

Obligatory warning that SSRI withdrawals can be extremely dangerous.

I was on Lexapro for a minute. It worked for a bit, but then I started to not care about anything. A certain amount of anxiety/emotional swing is important for my humanity, as I found out. I really wanted to get off that stuff. But my doctor insisted that I ween off of it by reducing my dosage over a period of 2 months. I'm glad I listened. I could acutely feel each reduction.

>I think the lack of scientific, evidence-based examination and treatment pushed by MDs/DOs, therapists, and psychiatrists is a big part of the problem. There is not much in the way of nosology or real personalized medicine going on to understand specific root cause(s). It's just throw random medications and therapy approaches "spaghetti" against a wall and hope something sticks.

Totally agree. Think its a big problem and not enough study is being done on it (can't monetise it).

At least some of the medical professionals are willing to admit that the above is true. I'm pretty sure they've also put the words "treatment resistant depression" into my file.

I was pretty good with regularly taking my dose, but decided to go off after I felt entirely emotionally numb to everything. The closest I could get was feeling deeply sad watching a movie with an emotional scene and realizing I didn't feel any emotion. I decided to quit mainly because of that and other issues (mainly sex taking forever and feeling a bit hollow). I halved my dose every 3 weeks and stopped around 5mg (from 40mg). The zaps fucking sucked and lasted heavily for ~2 months. Even now 8+ years later every once in awhile I get that kind of rollercoaster drop feeling in my head every few days that had preceded my zaps previously. It would feel like an initial void in my head, followed by a shock travelling from my feet to my head and I'd legitimately jerk my whole body while it happened. It made me feel depersonalized and I found it most tolerable dissociating physically and just mentally observing the effect occur. Walking seemed to trigger it the most, but I definitely had some times trying to sleep where I just felt completely zapped with discomfort (less electrical fwiw). I would have to smoke a ton of weed to sleep and still feel a lingering disconnect from my physical self. Paxil initially helped a ton with my social anxiety and depression (likely triggered by feeling of inadequacy and being left behind my peers). Now I'm awaiting a diagnosis for ASD. I've been able to cope decently without SSRIs/SNRIs but have more or less accepted the feeling of incompleteness that follows me eternally. I still feel generally lost in life purpose, but have accepted that as best I can. I'm not sure if it's the ASD or the SSRI's but I do appreciate the mental pathways they opened, it just never lead to a conclusion I wanted to follow through with. Everything feels pretty arbitrary, I just try to enjoy life as it happens now.

I had a similar experience in 2015: a doctor was trying to prescribe a choice between Venlafaxine (Effexor) and Duloxetine (Cymbalta) as third line ADHD medications. I was astounded that they didn't know that brain zaps were a common side effect and brought up some papers to show them. They apologized and indicated that they would likely stop prescribing them.

I was skeptical when they mentioned that other doctors had been promoting these drugs at gatherings, but what irritated me most was that they didn't have access to the research discussing the known side effects because the journals were behind a paywall. A willingness to pirate / use Google scholar to bypass paywalls shouldn't have been necessary to know about safety issues for a drug.

Wow, now that's an interesting one! You described the feeling perfectly though, it's exactly like that. I wonder what would happen if you took an SSRI...

Site's back up. Good info, but I felt nauseous by the end of the article.

This was interesting:

> Perhaps the most disconcerting feature of the zaps is the jumpy lateral eye movements. “People actually hear their eyes move when they move their eyes from left to right. They almost feel a faint ‘whoosh’ sound in their heads,” Papp explained. “Sometimes, people feel as if the brain stops for a moment and reboots like a computer.”

I wouldn't say I could hear my eyes moving (!), but I definitely noticed that eye movements or a turn of the head could trigger a brain zap. That was one of the most disabling things, as it eventually led to a feeling of restricted freedom of movement and exploration.

BTW, I had some major heart palpitations on SAM-e. It may have been tied to Vitamin B-12 but that was a hypothesis. Just make sure to talk with your doc.

Other comment: https://news.ycombinator.com/item?id=41813058

How does lack of understanding of the mechanism by which something works imply that it is useless at best? I do not think that follows and can think of many counterexamples.

"Helpful" is relative. I had to get off of Adderall due to bad side effects like hair loss on my scalp/body, and increase in prostate/urinary infections (turns out stimulants have a link to this - Vyvanse also caused the same side effects for me, it's how we found out).

Perhaps on average, but LSD bad trips can screw you up in a way no SSRI possibly can

It's already back up.

> I cannot explain the number of times the arguments I've had with coworkers with acupuncture.

Tell them it helps with blood flow. The needles stimulate the body to bring more blood to a specific area, which can help with certain issues like pain. It's not mysterious.

It’s funny too, because research doctors have been finding systems in the body that we didn’t know about until very recently. I have no doubt that there are treatments like acupuncture that interact with these or other systems that we’re currently unaware of. Heck, even gut bacteria affects the brain!

Added above. Thanks!