Nobody told me when I went on antidepressants that my brain might asplode.

July 12, 2008 11:51 AM

I am getting Brain Zaps from my SNRI (effexor at 150mg) meds and am headachey and I want to get off the meds. Help me figure out how best to proceed...

I am taking this stuff for OCD and anxiety. The anxiety was kind of an isolated episode but the OCD with emphasis on obsessive and not so much compulsive is shall we say more permanent.
I am working on CBT and mindfulness as an alternative to medication but I haven't gotten very far. Meanwhile these brain zaps are making a medication which I questioned whether it was even doing anything for me not worth being on.
I think weaning myself will be tricky and as these brain zaps aren't even well understood by the medical community any personal experiences would be helpful.
My doctor is great, but of course I want to compile my own information to supplement her guidance.

posted by GleepGlop to health & fitness (21 answers total)

How long have you been taking the Effexor for?
posted by different at 12:10 PM on July 12, 2008

Effexor is notorious for being hard to get off....and one of the primary symptoms of going off it is brain zaps.

Talk to your doc and go sloooooowwwww....

OTOH if you haven't been on it long do know that those symptoms will more than likely disappear with further use. I used to get them on Zoloft at the very beginning but that didn't last long at all.
posted by konolia at 12:24 PM on July 12, 2008

I went off cold turkey from a way higher dose and had no problems at all. Of course I don't recommend it but it's a counterpoint to the many people with a cudgel against Effexor. Taper down by 37.5 every few days or so and you should be fine. Don't do this without asking your doctor, but you'll probably need the doctor to prescribe that dose anyway. (I can't imagine breaking caps up into four pieces so easily.)
posted by loiseau at 12:26 PM on July 12, 2008

Been taking it for about 4 months. They didnt start right away. My doctor said that it means I am at the max dose that I can gain any benefit from... Don't know if there's anything to that. She also said that 150mg is the minimum dose for the norepinephrine to kick in.
posted by GleepGlop at 12:28 PM on July 12, 2008

Do you take the Effexor at the same time each day? I get the brain zaps (from an SSRI) if I'm even a few hours late.
posted by granted at 12:40 PM on July 12, 2008

granted: hmm, I don't take it at the exact same time everyday, but I do take it with my first major meal of the day, whenever that is. Interesting though...
posted by GleepGlop at 12:43 PM on July 12, 2008

Check out crazymeds.us. It is a good site that explains in detail everything about anti-depressants and the like. It also has recommendations on how to quit taking your meds.
Of course, you do need to talk to your doctor first.
Taper down over several weeks, be prepared for misery - Effexor is hard to ween off of. Fish oil and vitamin B pills will sooth your brain and keep you from spiraling too far into sad town. Good luck.
posted by idiotfactory at 12:49 PM on July 12, 2008

Ohhh, do I feel for you. The brain zaps, for me, are worth it for me for the benefit I get. However, a few thoughts:

Try taking at a different time of day
Take consistently at the same time of day
Check your blood pressure -- Effexor can raise BP and you should make sure those aren't high BP-induced headaches.
Are you on regular Effexor or Effexor XR (Extended Release)? If just regular Effexor, you may talk to your doctor about the XR.
Have a serious talk with your doctor
Get a new doctor

...I think talking with your doctor is most important though, but these are some things to think about. Hang in there!
posted by mattholomew at 12:52 PM on July 12, 2008

I know a person who is trying to wean off it right now. She's in a great deal of misery. What we're (I'm trying to be supportive/a help to her) doing right now, is opening a capsule and removing 3 THREE grains a day. That's a very slow reduction, but she's desperate.

Her physician ignored her request to try fluoxetine as a withdrawal aid.

I've sent him this article: http://pb.rcpsych.org/cgi/content/full/29/6/219
posted by reflecked at 12:57 PM on July 12, 2008

Wow, that's what they're called!

Nthing tapering down, but I also noticed that even a few hours' delay in taking my dose brought them back.
posted by avocet at 1:31 PM on July 12, 2008

Crazymeds (as linked above) is a great site. I recommend it wholeheartedly for anyone with medication issues.
posted by sondrialiac at 1:31 PM on July 12, 2008

Head wobbles! At least you know what they're from. When I was getting off Effexor nobody warned me about them and I had no idea what was happening. (I've had a long history of crazymeds trial and error, and for me at least Effexor was the worst.)

FWIW, I have a friend like granted, who will feel withdrawal after just a few hours. Try being religious about when you take it and see if that helps.

It's a touchy issue as to whether you need the meds or not, but 4 months is really just barely enough time to tell if it's working. I'd say if Effexor isn't doing what you think it should be doing, if you're getting side effects and withdrawal symptoms without any benefits, it's at least worth trying something else before you decide to forgo pharmaceuticals entirely, assuming your diagnosis is correct and you're still symptomatic. It's not unusual to try 2 or 3 meds before you find the one your brain likes. CBT plus meds (at least initially) is generally accepted as the most effective treatment for anxiety disorders, more effective than either one alone [citation needed!]. If you do decide to stop taking meds altogether, definitely talk to your doctor about tapering, and show her that fluoxetine article refleckted linked to.

Nthing crazymeds.

Incidentally, the only thing that ever helped ease my head wobbles/Brain Zaps™ was marijuana.
posted by ultraultraboomerang at 3:03 PM on July 12, 2008 [1 favorite]

Effexor is notorious for causing this, the way my friend weaned himself off of it was to open the capsules and pour a little of the powder out every day and then a little more after a few days. IANAD! However, it makes sense to me!
posted by Raichle at 3:27 PM on July 12, 2008

Absolute regularity in medication helped me, as an anecdotal point. I went off Paxil cold turkey (it was a minimal dose) and don't recommend it though I got by. Is your doctor a psychiatrist? I found benefit it working with an MD whose special focus was mental issues. I have to say that random input from people off the internet who know zero about your history (and mostly know zero about the issue period besides their meaningless (to your situation) anecdotal experiences is a poor way to compile your supplemental information. Ask your doctor for a referral to an expert if you want more guidance.
posted by nanojath at 3:41 PM on July 12, 2008

Nano, the problem with this subject is that many doctors -- even psychiatrists--are completely ignorant of how to deal with it and rely on the same anecdotal mess as the random people on the internet do. There's no data on this-- who would fund the research? So people who have done it are important sources and the best thing to do is what seems to work for you. If you do have a knowledgeable doctor with lots of clinical experience (AKA mostly based on many anecdotes from her patients) that's great, but many people don't. A psychopharmacologist is the doc most likely to know something beyond anecdote, but from what I can see (and I follow these issues as a health reporter), there's not much data.

NIMH should fund studies.
posted by Maias at 4:04 PM on July 12, 2008 [1 favorite]

Venlafaxine has a very short half-life, so yeah, be careful when you take it; being late even for a few hours can have this effect, in my experience (thought it was very mild at that point). If you're not on the extended release capsules, well.. yeah, I wouldn't do that, not with a half life of under 12 hours.

I went all the way up to 300mg iirc; unfortunately, while it was helping with the depression at that point (maybe; sadly I left the control me in the other universe), it was doing bad things for my anxiety, so I ended up coming off them soon afterwards. Beta blockers helped quite a bit though.

Coming off them wasn't a serious issue, I just tapered off gently at my own pace using more, smaller capsules. The zaps and such were certainly noticeable, but not exactly debilitating.
posted by Freaky at 5:42 PM on July 12, 2008

hmmm...I am currently tapering off 150mg dose of the evil effexor. It is a big drag: fatigue, nausea, headaches. I'm doing the take-out-3-additional granules a day thing.

I got the brain zaps and spinning nausea (which were at times quite debilitating) whenever I was more than a couple of hours late on taking the med, but only then (short half-life as mentioned upthread). Be sure you take them at same time everyday...

That being said, if I knew then what I know now, I would've stuck with meditation, yoga and CBT. Yes, the depression and anxiety were pretty terrible at times, and probably the drug(s) did help, but being addicted/life-time prescribed to a pharmaceutical (that cannot safely be taken while pregnant) is its own nasty capsule of hellishness.

Hang in there. Good luck.
posted by tingting at 6:51 PM on July 12, 2008 [1 favorite]

I tapered slowly off Celexa (same class, different drug) but I had the assistance of my little friend known as Ativan. Without it, I'm pretty sure I would have gone insane. Without the Ativan, I was getting a lot of vertigo and zaps, but with it, I did fine. It didn't really get rid of the zaps, but it helped a bit. It still took me a full two weeks to get over my withdrawal symptoms. I was just happy to be free and have my sex drive back.
posted by nursegracer at 7:17 PM on July 12, 2008

A lot of stuff to work with here, much appreciated!
posted by GleepGlop at 10:52 AM on July 13, 2008

I just got off of Effexor (225 mg/ day, extended release) life *really* sucked for a good two weeks. Nausea, brain zaps, leg spasms that kept me awake, crazy mood swings, and sadness...and I pretty much felt like that the whole time. I got nothing done - I slept a lot, went to work, watched netflix, that was about it.

As others have said:
Be sure that you take your meds at the same time each day, as others have mentioned. Even a few hours delay made me a bit dizzy and nauseated.
Time of day matters, too - for me, I had to take it in the mid-afternoon; later than that and I couldn't sleep.
As far as I know, and IANAD, it is common for people to start taking Prozac when they are cutting down on Effexor. Effexor has a very short half-life (a few hours), while Prozac has a very long one (four days, IIRC). From what I can tell, no one really knows what the brain zaps are, or what causes them, but my doctor thinks that they are due to (at least partially) the drop-off in seratonin. The Prozac helps to maintain a more regular, even seratonin level and thus can help with the brain zaps.
I took a week to get off of Effexor - it had been really messing with my sleep (insomnia, deeply bizarre, vivid dreams that left me wasted and unable to distinguish between dream and reality), so I was willing to suffer to get off of it. The side effects lasted another week, and slowly faded. By the end of the second week, I'm pretty much back to normal (my stomach is still rather upset, but that's minor).
I didn't take the Prozac as the side effects thankfully subsided fairly quickly. From what I've read, it varies wildly from person to person, and the list of possible side effects from Effexor withdrawal is about as long as the Chicago phone book.

What helped me:
A prescription for Ambien - the leg spasms kept me awake, along with that "whoosh- whoosh" feeling from the brain zaps - I rather likened it to the feeling one has with a bad sinus infection, or serious head congestion. With the Ambien, at least I could get 8 hours of sleep.
Vitamins - Omega 3-6-9 and B vitamins. Well, I guess I really don't know if it helped - I take those vitamins anyway, but I've read that they can be helpful. But I tried to eat lots of fruit and veggies - they didn't bother my stomach and generally made me feel (somewhat) better.
Give yourself some time off - even if you can't get off work, accept that you will probably not be feeling right for a time, and don't be too hard on yourself when all you can tolerate doing is watching tv.
Talk to your doctor. A lot. You should be in frequent contact to monitor your side effects. Again, IANAD, but I really get the sense that the brain zaps and the side effects in general are really not understood, and thus, cannot be easily or predictably treated.

Good luck!
posted by queseyo at 11:01 PM on July 13, 2008

Oh, man, do I feel for you... the stuff is horrible to get off of, even if you follow your physician's instructions to the letter. Try to get your doctor to titrate you to the smallest dose possible before you stop taking it completely (this might involve taking the smallest dose commercially available and further dividing it yourself), and be ready to lose a week or two of your life to the step down from $tiny_dose to zero... it really sucks out loud, and there's something especially bad about Effexor in particular. I don't think there are any serious long-term effects from the brain zaps and the vertigo, but speaking from my own experiences many years ago, I would avoid doing anything extremely performance sensitive for the duration (up to and including driving a car), because your reactions are going to be shot to hell and you won't be responsive during the zaps themselves. I would also warn the people you spend the most time around that you're going to be coming off of the Effexor, because the unpleasantness of the experience, coupled with the sleep loss that will probably accompany it, will most likely not make you the most pleasant person to be around.

Good luck... it'll suck to push through, but if you can get onto a regimen that's better suited for what you need, or off of them entirely, it'll definitely be worth the hassle.
posted by Mayor West at 5:01 AM on July 14, 2008 [1 favorite]