Papp and Onton 2018, Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation link

  • One of the more surprising findings from this data set, one that also has not been described in the literature, is the report of lateral eye movements acting as a trigger for the zaps—it was the most frequently described trigger on this website. Even in the case of the second most frequently reported trigger, running/walking, the movement of the head or eyes can be assumed to be involved, thus further reinforcing the involvement of eye movements.
  • The duration of taking antidepressants before the onset of brain zaps ranged from 2 days to 25 years, with 2 years or more reported in a little over half of the cases (Table 2).
  • (that’s from n = 149, and we can assume that this might be a disproportionately severe sample as more severely affected people are most likely to post about it online)

Zhang et al 2024, Incidence and risk factors of antidepressant withdrawal symptoms: a meta-analysis and systematic review

  • These symptoms were generally measured for <4 weeks, and in some studies patients were returned to their medication after a short observation period. So, the total duration of symptoms is difficult to establish, but some of the studies reported that after short-term use (8-12 weeks) withdrawal symptoms lasted <4 weeks. Other studies found symptoms lasted months or longer, generally in people who were using antidepressants for longer periods.

Framer 2021, What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications link

  • Across psychotropics, physiological dependence is developed in 1–8weeks; following discontinuation, immediate or acute withdrawal similarly lasts 1–8weeks.36 Physiological dependence on SSRIs has been found to occur in about 4weeks,65,66 risk of antidepressant withdrawal syndrome increasing after the same period.59,64 Antidepressant withdrawal symptoms have long been held to last a few weeks,3,64 which may represent only acute withdrawal while the drug’s target receptor at least partially re-adapts.54
  • However, across psychotropics, subsequent postacute withdrawal symptoms (PAWS, also known as protracted withdrawal syndrome or PWS,), differing qualitatively from acute withdrawal, may last much longer, even years,35,36,55,67–70 indicating that further neurobiological re-adaptation occurs at individual rates, sometimes very slowly.24,57,62,71–73 PWS can be as debilitating and disabling as acute withdrawal symptoms.27,28,32,35,55 Our longitudinal case histories reveal that the arc of recovery from PWS is frustratingly halting and very gradual, with many setbacks, on a scale of 6months to years,35 much as described in addiction medicine.33,74–77

Fava and Cosci 2019, Understanding and managing withdrawal syndromes after discontinuation of antidepressant drugs, link

  • Withdrawal symptomatology does not necessarily subside within a few weeks
  • Reintroducing the antidepressant that was initially used or switching from one antidepressant to another to suppress symptomatology, as suggested by current guidelines, may actually aggravate the state of behavioral toxicity and be detrimental in the long run.
  • If one subscribes to the oppositional model of tolerance, reintroducing the antidepressant that was initially used or switching from one antidepressant to another (such as fluoxetine) to suppress clinical manifestations of withdrawal are both highly questionable suggestions. It is one thing to reintroduce an antidepressant after a drug-free period if relapse has occurred. It is another thing to do so if withdrawal has ensued: we should be aware that, by doing this, we are simply postponing, and most likely aggravating, the problem.

Zwiebel and Viguera 2022, Discontinuing antidepressants: Pearls and pitfalls link

  • Symptoms can last for days to months, and different symptoms have different durations.
  • The sensations typically last a few weeks but can persist for years and may be associated with dizziness, the perception of crackling or sizzling noises, and various other symptoms such as depersonalization (feeling detached from and outside of one’s own body) and derealization (the sensation that the external world is unreal). Common triggers are eye and head movements, but patients note many other triggering activities. There are no known treatments that successfully and specifically target brain zaps other than resuming the medication at the previous dose.