Friday, July 31, 2020
Alex Papp MD
Introduction to Brain Zaps
Known as ‘brain zaps,’ these perplexing phenomena are a fairly common yet poorly understood side effect of antidepressant discontinuation. Brain zaps are sensations perceived as electrical flashes occurring inside the brain, typically experienced when the levels of antidepressants in the brain are dropping. The aptly descriptive term “brain zaps” emerged on Internet discussion boards, but it has received so little attention in clinical psychiatry that it did not even have an official medical name.
The Emergence of Brain Zaps
Brain zaps first appeared in association with the third generation of antidepressants, the so-called “selective serotonin reuptake inhibitors (SSRIs)”. Prozac was the first of these SSRI medications to appear in medical practice in the US in 1988. For about 10 years, there was a flurry of interest in the symptoms related to the discontinuation of these new antidepressants, but that interest fizzled out.
Clinical Observations and Studies
No systematic studies on the nature of these symptoms has been conducted; there have been only a few case series and a few articles analyzing lay websites for reported symptoms ( Papp and Onton, 2018; Papp and Onton 2022)
Understanding the Frequency and Causes
The SSRIs Effexor (venlafaxine) and Paxil (paroxetine) appears to be associated with more frequent discontinuation effects than would be expected based on the frequency of their use, while Prozac (fluoxetine) seems to be the least likely SSRI to cause such symptoms. This suggests that the shorter the half-life of a medication, the more likely it will cause brain zaps, and vice versa.
Managing Discontinuation Symptoms
The most frequent cause of brain zaps is abrupt discontinuation of an antidepressant medication, but gradual tapering only reduces the risk to a moderate degree. There have been no clinical studies about the treatment of brain zaps. A large variety of agents have been tried by individuals to mitigate these symptoms, from vitamins to prescription drugs, but with little apparent usefulness. Sometimes changing from a short to a long half-life medication (for example from Paxil to Prozac) may help, but even that does not have a very reliable effect.
The Role of Healthcare Providers
Unfortunately, often patients are not prepared by their physicians for the possibility of having such reactions when getting off the medication, and they find help only on support sites such as mentalhealthdaily.com.
Conclusion
Make sure you always ask your doctor not only about what adverse effects you may have when you take a psychiatric medication, but also about what to expect when the medication is stopped. Consult your healthcare professionals before making any changes to your medication regimen and to discuss potential discontinuation symptoms.
References
- Papp A, Onton JA. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. Prim Care Companion CNS Disord. 2018 Dec 20;20(6):18m02311. doi: 10.4088/PCC.18m02311. PMID: 30605268.
- Papp A, Onton JA. Triggers and Characteristics of Brain Zaps According to the Findings of an Internet Questionnaire. Prim Care Companion CNS Disord. 2022 Feb 10;24(1):21m02972. doi: 10.4088/PCC.21m02972. PMID: 35144325.
