Health
Maddy felt ‘brain zaps’ after stopping antidepressants. No-one told her they were a common symptom of withdrawal
When Maddy Britton stopped taking her prescribed antidepressants, she knew she might go into what is described as withdrawal.
Key points:
- Patients withdrawing from antidepressants say they experience a symptom called brain zaps
- Psychiatrists say there is little research about the cause, and there is currently no effective treatment
- A new survey is looking to find out more about the effect of brain zaps on Australian patients
But the days and symptoms that followed were “scary and unexpected”.
“Going off my anti-depressants was such an uncomfortable experience, something I have never felt before,” she said.
“I was pretty scared. I had no idea what was happening to me.”
Her experience is all too common, according to Jon Jureidini, a psychiatrist and academic at the University of Adelaide.
“There’s already research in place to show that withdrawal problems in antidepressants had been under-represented and under-reported,” he said.
Maddy, a 26-year-old retail worker from Brisbane, was taking a low dose of escitalopram, or Lexapro, an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class.
The drug is mainly prescribed by GPs to treat depression and anxiety.
Maddy had been on 10 milligrams for two years when she ran out of her script and couldn’t secure an appointment to get a refill for a few days.
She said she was not adequately warned of how quickly side effects of withdrawal could happen.
“I was at work when I started noticing the withdrawals come into effect,” she said.
“My arms and legs felt numb, or full of pins and needles.”
She was so worried that she felt she could not drive and she felt extremely exhausted and emotional in the days leading up to her GP appointment.
Users can experience ‘brain zaps’ coming off SSRIs
While Maddy knew about the side effects of taking the drug, she was unaware of the effects of going off it.
Although her GP had told her not to stop taking it abruptly, she did not know about the potential side effects of withdrawal.
“I felt like my vision was lagging,” she said.
“It felt like my brain was one to three seconds behind my eyes.”
This symptom is called “brain zaps”, a colloquialism that emerged on internet discussion boards.
“I didn’t piece together really how I was feeling until I saw a TikTok about ‘Lexapro brain zaps’,” she said.
“I did some googling and realised exactly what I had felt, and [that] it was a common occurrence.
“I was really frustrated this wasn’t explained to me when I had started the medication.”
“Brain zaps” are widely talked about in online communities, but there isn’t much research into what they actually are and why they happen.
While Maddy did not go off the drug by gradually lowering the dose, as recommended by GPs, brain zaps are still widely described by patients who are reducing intake gradually, a process known as “tapering”.
Researcher says doctors have been slow to see the problem
Professor Jureidini said until relatively recently, websites such as that of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) suggested there was no problem.
He is currently conducting a survey to find out more about the adverse effects of brain zaps and other withdrawal effects.
“The medical community has been very slow to recognise this problem,” he said.
His University of Adelaide survey has had several hundred respondents with varying experiences of going off the medication.
“We haven’t analysed the information yet, but just looking at some of the responses it’s clear there is a significant proportion of the population who use antidepressants who have very real and significant problems getting off them,” Professor Jureidini said.
He worries GPs may be overprescribing antidepressants and not stressing the difficulty of stopping them.
“It’s an absolutely necessary part of informed consent,” he said.
“Many people stop antidepressants without any problem.
“But it is common enough that informed consent is required,[so that] when somebody takes an antidepressant they’re warned about the possible difficulties of stopping them.
“The reality is that’s how the system responds with medication.”
Nicole Higgins is the president of the Royal Australian College of General Practitioners.
She says GPs are spending more time than ever with patients who are experiencing mental health issues, and working with them to go on and off medication is often done very well.
“This time of year is a time often when people decide to stop medication, and stopping antidepressants is something that is not done lightly,” she said.
One in seven Australians take antidepressants, according to the Australian Institute of Health and Welfare.
Dr Higgins said doctors always aimed to prescribe as little medication as possible and give patients a slow tapering plan, “so people know what to expect and we can manage their expectations”.
But with 22 million Australians visiting their GP in 2022, Professor Jureidini acknowledges the system is under strain.
The RACGP says its members have concerns about workload, burnout and fragmentation of care.
The body’s most recent General Practice Health of the Nation Report recorded an 11 per cent increase in patients presenting with psychological issues between 2017 and 2022.
Over that six-year period, GPs consistently reported that the most common health issues they managed were psychological.
“GPs are expected to deal with everything without ideal time or training, so it’s not surprising they reach for a prescription pad,” Professor Jureidini said.
“That’s a systemic problem, not a blind spot for individual GPs”.
‘Too vague to be taken seriously’
In the US, Alexander Papp from the University of California San Diego is behind some of the world’s first research into brain zaps.
He began to look into the condition when a patient came to him desperate for a solution to the issue while he was tapering off the drug sertraline, also known as Zoloft.
“After delving into the scant literature on the topic and attempting a few unsuccessful strategies, I had to admit to him that I wouldn’t be able to help either,” he told ABC News.
“He expressed his disappointment vehemently, chastising me and, through me, the entire psychiatric profession for lacking solutions to this problem, which stem from the medications that psychiatrists themselves prescribe.”
This prompted Dr Papp to explore medical literature about the symptom.
He came across a website where patients share their encounters with mental health issues, the treatments they undergo and the side effects.
There, he discovered a lengthy thread about brain zaps.
He examined 595 unsolicited posts and found that 378 contained references to antidepressant withdrawal symptoms.
He and computational neuroscientist Julie Onton found an inverse relationship between the half-life of the antidepressant and the likelihood of it causing brain zaps..
“This aligns with the broader pattern seen in antidepressants inducing discontinuation symptoms, (eg vertigo, tinnitus, etc) suggesting that ‘brain zaps’ are indeed a form of discontinuation symptom,” Dr Papp said.
“We consider this finding significant because the psychiatric literature often treats brain zaps as a mere curiosity or a symptom too vaguely defined to be taken seriously.”
The research also found a very significant majority of people reported symptoms occurring when they moved their eyes in a back-and-forth, sideways motion.
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“We believe that a scientific study exploring this phenomenon could potentially unveil important insights about AD [antidepressant] discontinuation, and perhaps even about ADs in general,” Dr Papp added.
“A disappointing finding was the very meagre help available in alleviating brain zaps.”
Dr Papp said there was a “notable sense of bitterness” within a certain segment of the public about the lack of information and help available for brain zaps.
“Of the various neurological drugs, sedatives, vitamins, and herbs, none proved consistently beneficial” in alleviating brain zaps, he said.
“Only restarting the medication showed a reliably positive effect.”
Maddy agrees that it needs to be stressed how difficult getting off antidepressants can be.
“I’ve been meaning to trial how I can go without them [tapering dosage] for a while again, but I’ve just been putting it off because of the withdrawals,” she said.
The University of Adelaide survey’s findings will be released later this year.
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