alt Hacker NewsI think there’s more to it than just messing with serotonin.
There’s something about Sertraline (Zoloft) that seems to make it quite reliable at causing brain zaps. 3 people I’ve known who stopped Sertraline all experienced brain zaps. 1 of those people also talked about stopping Prozac (cold turkey) and Lexapro (4wk taper) and did not have the zaps, but a 4-month taper of Sertraline was not enough to avoid them.
In fact in the article they recommend switching to Prozac and then tapering that, as a way to avoid the zaps.
Replies
Prozac has a notoriously long half-life, which is one of the reasons it's indicated for adolescents who are likely to skip/forget doses.
The long half-life is also the reason it's prescribed for SSRI withdrawal symptoms.
Sertraline is a potent SSRI in terms of inhibiting the serotonin transporter protein itself. It also has a relatively short half-life. Makes sense that cessation would induce withdrawal symptoms.
It's the same principle behind prescribing Suboxone for opioid withdrawal. The drug has a ridiculously long half-life, so it has the potential to smooth out what would otherwise be acute withdrawal.
I've heard similar about Zoloft, and Effexor (which is notorious for causing withdrawal symptoms when coming off it).
I believe Lexapro is a highly selective SSRI, which might explain its lack of withdrawal symptoms (and also its "does absolutely nothing" effect for some people). Prozac has a very long half-life compared to other SSRIs so it's basically got an in-built taper, and is why it's often 'cross-tapered' to when coming off another SSRI.
I don't know enough specifics, but there's multiple subtypes of serotonin receptors. It's possible that perhaps Sertraline affects different subtypes or a combination. Perhaps the binding affinity is different, but yeah, each of these are different (hence why they're different drugs, and not just generics of the same thing).
I've had a brainzap when I was used MDMA somewhat regularly for a short period in the 90s. It was only once, so it was more a weird "What is this? I feel... something... in my brain?" But I don't think I would want to deal with it happening spontaneously and constantly like withdrawal symptoms present. Sounds awful.
I take Effexor which is an SNRI... From what I've read, is one of the worst in terms of withdrawal (brainzaps and other side-effects). I'm really not liking the idea of me having to someday go off of it, so far for now it keeps me stable, but... if something happened where I would need to go off of it, I'm not looking forward to it.