SSRI discontinuation syndrome (brain zaps)

This is not the time for science. Or editorializing. My wife has SSRI discontinuation syndrome, and I want it stopped.

Consequently, Wikipedia will be commonly cited in this post.

Okay, just a little editorializing. And, I’m sorry, you may see a hint of science.

Minor and subtle editorializing

First, SSRI (selective serotonin reuptake inhibitor) discontinuation syndrome has been accused of being a pharmaceutical manufacturer manufactured term (PMMT)—not unlike ED (erectile dysfunction), GERD (gastroesophageal reflux disease), and the RAMP (renal anemia management period). Some cynics believe these terms were invented by pharmaceutical manufacturers who happened to have emerging drug brands that treat the new conditions. I have no citation here; Google it yourself.

Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic GERD and can be a cause of dysphagia or difficulty swallowing.

Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic GERD and can be a cause of dysphagia or difficulty swallowing.

I’m not going to provide any visuals on ED. And you may not have heard of the RAMP, which was a creation of my marketing team at Torre Lazur McCann Healthcare Worldwide. I will, however, provide a link to a monograph I wrote on it.

Furthermore, I promise not to use the acronym PMMT again, as I just made it up as part of my minor and subtle editorializing.

For our purposes today, in fact, I don’t give a shit who made up the term SSRI discontinuation syndrome. I do know this: from the patient’s perspective, there can be an agonizing withdrawal from SSRIs, which strongly implies that these common antidepressants are also addictive.

(Note in case I’m being too minor and subtle—That’s the whole reason drug companies get involved in the creation of disease/condition terminology. In the case of SSRI discontinuation syndrome, the cynics say, the drug companies would prefer that term over the use of words such as addiction and withdrawal. Get it?)

A hint of science

I’ve reviewed the Wikipedia definition of SSRI discontinuation syndrome and find it accurate and adequate, as far as it goes. By writing that sentence, I’ve now become what Wikipedia would call a secondary source. In formal scientific and medical writing, the use of Wikipedia as a reference would almost automatically disqualify you from consideration. And members of the journal article review committee would look at you strangely at future professional meetings, tittering at you behind their hands. (Tittering is like tweeting, except cattier, and less documentable.)

That’s because, not only is Wikipedia considered a secondary source, but it prefers secondary sources over primary sources to support all claims made in its extensive library of knowledge. I know this because I’ve written some Wikipedia entries. And it’s infuriating when I cite the seminal paper for some important medical advance, and am chastised for citing the primary source (which I’m convinced is the best evidence of its own existence). Apparently, they (the Wiki establishment, as it were) want a New York Times article describing the seminal (primary) paper as an important medical advance.

I guess I get it. After all, they rely on random idiots like me to provide content.

In fact, Wikipedia offers a helpful definition of the difference between primary and secondary sources here, for those who wish more information. (Just remember the source.)

So here’s the bottom-line hint of science: The SSRI discontinuation syndrome appears to exist. It is often mild, commences within 1 week of stopping treatment, and resolves spontaneously within 3 weeks. It comprises diverse physical and psychological symptoms.

And here’s the bottom-line subjective experience of my wife (combined with my own subjective research of some relevant discussion groups): The syndrome includes “brain zaps” and other neurological symptoms that can last up to 18 months and have pervasive negative impact on the quality of life. What the fuck is that about?

Prevention and treatment per Wikipedia, which reflects current medical opinion downplaying the condition

I don’t have time for this. Here’s the Wikipedia text:

Patients should be advised of the elimination half-life times of their specific medication, and patients should be aware if changing from a long half-life medication such as fluoxetine (Prozac), to a shorter one, that taking their dose regularly becomes much more important. Patients taking fluoxetine can often miss several doses without noticing any discomfort, but the shorter half-life of other SSRIs such as venlafaxine, paroxetine, duloxetine, citalopram, escitalopram, and sertraline (ranging approximately 10 hours) means that a single missed dose may cause withdrawal symptoms. When discontinuing an SSRI with a short half-life, switching to a drug with a longer half-life (e.g., fluoxetine or citalopram) and then discontinuing from that can decrease the likelihood and severity of withdrawal syndrome.

Many doctors advise patients who are suffering from SSRI discontinuation syndrome to use fluoxetine as a substitute for their current drug. Substituting fluoxetine in the final stages of SSRI discontinuation, or post discontinuation, provides a rate of reduction of antidepressant which can minimize or eradicate withdrawal symptoms in the patient. Fluoxetine migrates slowly from the brain to the blood. The active metabolite of fluoxetine remains a long time in the brain because it is lipophilic, with a biological half-life of 4 to 8 days (the longest of any SSRI). Therefore the level of the drug in the body falls slowly at a rate to which the brain can adjust when the dosage is reduced. Fluoxetine is also available in a liquid formula, allowing the physician to titrate the drug with greater ease (e.g., with an oral syringe).

What my wife found (and I confirmed)

For all the reasons you’d think (well, one reason, actually: there’s no money in it), there is not a whole lot of solid published scientific research on the health advantages of natural ingredients and related cheap supplements that can be found over the counter everywhere. But that’s where my wife and I ended up.

Here’s the physiology:

Once serotonin is made, the pineal gland is able to convert it at night into melatonin, the sleep-inducing hormone: L-tryptophan > 5-hydroxytryptophan (5-HTP) > serotonin > N-acetyl-serotonin > melatonin.

Either tryptophan or 5-HTP are good natural options since they convert into serotonin after going into the brain.

After 2 months off of escitalopram (Lexapro), a few days ago my wife began getting the brain zaps (BZs). The BZs are a symptom she’s experienced in the past, and inevitably resulted in her returning to escitalopram, as a junkie might have trouble giving up, well, junkie stuff.

She’s a smart cookie. She understood the physiology. She saw the potential of 5-HTP, and she bought some. And for at least the past few days, 5-HTP has helped.

She bought her 5-HTP from the Vitamin Shoppe. This is not an endorsement, just a fact. You want a primary reference?

A drug may one day be launched that treats the neurologic symptoms associated with SSRI discontinuation syndrome. So the drug company not only can come up with a name for the condition, but a PMMT for the side effect, BZ, which has a terrific new treatment that will challenge our deductibles and Flex account, etc., until it’s generic in 20 years. And then it will be OTC, like aspirin, for BZ.

I lied about not using PMMT again. I couldn’t resist.

About Keith Croes

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Posted on June 30, 2013, in Marketing, Medicine, Science and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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