Buzzing, vibrating and electric shocks in the head

[GreyGoose]

Greetings

Many people with various anxiety-related disorders either directly due to the disorders themselves or sometimes because of the side effects from the medication(s) they are on (often an SSRI or Selective Serotonin Reuptake Inhibitor) experience bizarre and frightening symptoms such as an occasional and brief "buzzing", "vibrating", "jolt" or "electric shock" sensation in their heads. Sometimes people also experience dizziness, vertigo or feel like they are about to pass out during these times or they may even think that they are having a stroke and rush to the emergency room.

I was just wondering if any of these symptoms sound familiar and if any of you would care to share your own stories here. I know that I sometimes experience these symptoms myself and I have heard quite a few others describe them.

- Regards, GreyGoose

[jerseygirl]

I've been getting the tingling and electric shocks sensation for a couple of weeks now. The start of it coincided with a doctor's visit allaying my fears about heart fluttering - the heart issues stopped almost immediately, and the head issues started. I've noticed that I feel much better when I'm doing something - for a couple of days after I went back to school, I felt almost completely normal. It's when I'm alone with my thoughts that I start feeling things. I'm not on any medication, so I'm guessing (hoping) it's the anxiety itself.

The one thing that is weird is that the tingling feeling is sometimes pretty enduring. I felt tingling on the side of my head and left cheek for close to a week almost non-stop. But again, I noticed that sometimes I would wake up feeling completely normal, then start in on "Do I feel it? No... am I sure? wait - there it comes. Just a little. Is that it? Yup..." as if I was making myself start feeling it again.

[GreyGoose]

Hi jerseygirl

Thank you for the reply. These appear to be very common symptoms related to anxiety. I forgot to mention that sometimes people will also have these symptoms (or at least a few of them) when they are weaning themselves off of certain SSRI's (Paxil comes to mind). Let me ask you something...when you get these, do you feel them in your head/brain or just in other parts of your body (or both)?.

Since symptoms can sometimes be so vague and difficult to describe, I have compiled a short list of various phrases I have heard other people use over the years to describe the symptoms I mentioned earlier...

* A current of electricity briefly flowing through my brain.
* An electric buzz sensation.
* An electric jolt.
* Brain zaps.
* Brain shocks.
* An electrical tingling sensation traveling through my head/brain.

I'll add to this list if I can think of any others.

- Regards, GreyGoose

[apple]

When my anxiety starts to build, it feels as if I have wool or some kind of fog in my head, my neck starts to tingle...sometimes my head buzzes too.  Then if this turns into an all out attack...I feel like my Brain is getting electric shock and can last for a while on and off.  Sometimes afterwards my brain feels like a lightbulb that makes noise and shorts little bits.(old, old lightbulb feeling)

I know it is my anxiety that does this and only when I get some sleep from exhaustion does my head feel better.

[jerseygirl]

GreyGoose - It's generally head/brain. Right now, however, my head feels (for the moment) normal and the tingling is only going on in my cheek. I really want to google that, but it's probably a bad idea.

You're so right about the vagueness of the symptoms. I'm really not sure how to describe it. I think the occasional sharp pains are kind of like mild electric shocks. What I'm calling tingling might actually be more what you're calling buzzing. Honestly, sometimes these things are so subtle that I feel that no one expcept for me (and other hypos and GAD people) would even notice anything, although sometimes they are more pronounced.

[GreyGoose]

Hi Apple. Yes, I get that foggy-headed feeling a LOT and it drives me nuts. It's sort of like your brain has been anesthetized with Novocaine or something and you just feel numb inside.

Hi Jerseygirl. You've described it perfectly and this is what has really been plaguing me lately (especially today).

Sorry this is such a short response but my head feels like someone drilled a hole in it and ran an egg beater through my brains right now so I have to find something to take for this. I've also been doing some fairly scatterbrained and senile things lately and that scares me. I almost feel like I've suffered years of brain damage from alcohol, drugs, etc but deep inside, I know it's probably just the anxiety. Wow, I hate this

- Regards, GreyGoose

[jerseygirl]

I hope you start feeling better, and thanks for posting this thread! To be honest, the only thing that made me able to get through the first few days of these sensations was finding this site and realizing that all of these things could be anxiety symptoms - while my dad kept telling me that earlier, I hadn't quite believed it until I found other people who felt the same way.

[sam]

Ohh yeah, and that sharp POP noise just inside your skull.. been there a lot!  I get the electric jolts in my hands and shoulders as well.  I'm not taking any medication so that's not the cause.  It only happens though when my anxiety levels are up. (very frequently lately)  I get dizzy and have to bend over like when you are hyperventaliating just to keep from passing out.

[aussiegirl29]

Yes, I get a tingling on the left side of my head. I've thought I was itchy or something but I couldn't scratch it as it felt like it was coming from inside my head.

[kelro]

Oh thank GOD for all of you. I just had a baby 7 days ago and for about a week leading up to the arrival I started having lots of dizziness then the panic attacks came. Now I have a history of panic attacks but I thought I'd had it under control and hadn't had an episode in years.  I was just seen in the ER about 2 wks ago. They ddi an MRI, EKG, loads of blood work, etc etc and found nothing. In fact, my midwives were convinced that I was getting dizzy (plus as an aside-I was getting almost daily ocular migraines) due to my pregnancy and all the fluids in the head, etc. So now that I had the baby, I natrually assumed I'd feel great. NOT so. I wasn't really sleeping for about 1 wk before the baby came, started having middle of the night panic attacks because I'd get a dizzy, or "whooshing" sensation and/or BUZZING, electrical kind of feeling in my head that scared the S*&T out of me!!!  Now I've got a 7 day old baby plus my 6 and 4 yr olds. My husband is doing sooooooo much for me while I've had to accept the fact that nothing medically is wrong at ALL and I've got some big time postpartum WITH anxiety going on.  I've already seen a psychiatrist who put me on Remerol-anti depression, Ambien for sleep and Klonopin for anxiety.  I feel like I'll stay in  this medicinal STUPPOR forever. But I know I've got to accept that this anxiety is obviously a very real thing. And this nonstop BUZZ in my head making me believe I'm having, I don't know--mini strokes or seizures all day and not is NOT because something's seriously wrong with me in terms of a life threatening disease. But in fact it's MY brain and body creating this. I even dragged poor hubby to a neurologist and an ENT this week-----all within 3 days of my giving birth because I just really was certain something else would be found.   I could use any and ALL support I can get right now. And I just haphazardly put in a search on the internet for "anxiety and head buzzing" and found all of you. Thank you Lord!! I feel a lot more confident in this psychiatrist's assessment of me now.  Another aside..........if anyone's still listening/reading is that the postpartum is hitting hard too because I can't breastfeed while on all these meds. I breastfed my other 2 children for over a yr. Now I'm dealing with these emotions of wanting to breastfeed and be there for my new little guy and NOT even wanting to hold/pick him up.........such a mixed bag of crazy emotions. AND perhaps an entirely different topic for a different forum!    Thanks for listening, Kelly

[o-ren]

I have only recieved these symptoms after I took celexa.  Before celexa I was only experiencing parethesia.  After 6 months and quit celexa the buzzing, vibrating feeling in my head has never left. I still feel like a ball of force is moving around from my left side of the brain to the right. Sometimes it goes from any direction and it last for 20 minutes then it relaxes.  However it never totally leaves, it just slows down.  With these feelings I am having a more difficult time to concentrate and envoking my parethesia.   If I stop this, I know my anxiety will be gone.  The question is how.

[CGPanic84]

I apologize, and I KNOW that this is an OLD topic, but I have had the EXACT same symptoms happen to me, and am in dire need of help/reassurance!! It started when I started on Zoloft to take for my anxiety/panic attacks, that were mostly chest-related at the time....

I at first thought I was going INSANE when I had my first vibrating/electrical sensation. I thought for sure I was going insane, and I didn't know WHAT to expect. I thought for sure it would lead to a seizure, I would black-out, or something!!

I was initially told that I was suffering from Panic Disorder/Panic Attacks. since I at first was getting the typical attacks of the heart palpitations, clenching chest wall pain, lightheadedness, and freaking out that I was going to die or have a heart attack.

So my doctor decided to try putting me on Zoloft, in the SSRI class of anti-depressants since she thought for sure it would do me wonders and eventually get rid of and eliminate my symptoms. My GP promptly wrote me a script for Zoloft at 25 MG, and told me, "take this, you will be fine and it will do you wonders!"

So I left, of course stupididly believing every word she said. I went and filled the prescription, and the next day popped my first pill...

About a few hours into taking it, I had the WORST feeling in my life (well, it only got WORSE from there). I felt severely woozy and lightheaded, and had to sit down to balance and keep myself together. It felt like the entire room was spinning, and my head just felt BLAH all together, like I was getting a head illness or something. I was in a store that day, since I assumed everything with the med. would be fine, and was getting ready to check out when it just HIT me like a ton of bricks. Now, I have had lightheaded spells TONS of times in the past as well as Panic Attacks and Chest Pains, and it was NOTHING like those I had experienced before!! 

After that ONE day of taking the pill, I deviated away from taking it again! My symptoms improved, and I no longer had any more of those light headed spells after that one day..

However, as I was STILL suffering from the severe heart palps, chest pains and anxiety/panic attacks, my mother convinced me to give the med. another try, since my "sis was on an SSRI for her GAD and it was working her WONDERS." Still skeptical about taking the med., but DESPERATE to get rid of my other symptoms, I again popped the med...

Now, the first day I was fine, and this was on a Friday. I was back in the apartment with my fiancee, and it was late one Saturday night, and I was just lying in bed waiting for my man to finish getting ready for bed so I could follow up as well. I then all of a sudden felt this ELECTRICAL SURGE seem to VIBRATE throughout my head/brain, along with a ten-fold pins-and-needles feeling that surged through my head. I then felt the electrical surge feeling continue to surge through me, even going up and down my spinal cord. I PANICKED, of course, not knowing WHAT was happening to me. I started seeing blotches, and I PANICKED that I was going to pass out, have a seizure or SOMETHING!! I ran around the apartment, the feeling still going on through my head. I then tried sitting on the bed to calm myself down and regain myself, and it seemed like it started to pass. Then, I felt ANOTHER attack, worse than the first, which truly caused me to have blotchy vision and just go into utter chaos. 

My fiancee drove me to the hospital in case by the time we got there my symptoms worsened or progressed. Eventually, the off-and-on symptoms DID pass, after about 45 min. to an hour of pure hell and off-and on VIBRATION FEELINGS and ELECTRICAL FEELINGS surging through my brain.

We just went back to the apartment, and I went to bed that night.

The next morning, I woke up, and probably a mix between me having the attack that night and due to the fact I didn't get much sleep, I felt completely SLOW and BLAH the entire day. I could barely bring myself to speak, I dragged myself slowly across the room, and I just overall felt like a complete pile of ****!! 

I called the doctor-on-call (since it was a weekend) and told him about my horrific experience. You know what he did?? He "Poo-Pooed" me away and told me "Oh, it's not the medicine, just you. It was probably just a bad Panic Attack." I was SO mad....he also told me to "continue on the med."

I continued taking the med., and that following week, on a Wednesday, I had ANOTHER milder, but more PROLONGED attack that lasted off-and-on for about 2 HOURS!! It kept me up until like 1:30 a.m., so needless to say I slept in late the next day...

The problems FINALLY seemed to dissipate, for about 2 weeks. However, after those 2 weeks were up (and I was still on the med.), I AGAIN began getting the weird head attacks!! Most were not as severe as the first, but they were still attacks nonetheless. Now, I have had Panic Attacks, and know what those were like, and sure these caused me to have Panic Attacks also, but moreso since I didn't know WHAT THE HELL was going on!!!

I was then getting head-related zings/buzzings/electrical sensation attacks EVERY DAY, sometimes mild and bearable and other times not.

I eventually STOPPED the med. after having it in my system for a month, but my stupid GP (she is a good doctor, but not for things like this) told me to QUIT IT COLD TURKEY. She said I should not experience too much side effects, if any.

Well, needless to say it made my head attacks TEN FOLD!! Sometimes they were mild and bearable, like before. And there were days I went without attacks. But when the bad ones struck, they left me PARALYZED in certain limbs, my head felt like it was going to go into CONVULSIONS or something, and it was just like PURE HELL!! I was completely conscious during these attacks, so you can imagine the FEAR I was under during this time.

I had an attack that was SO BAD once: I was just sitting on my computer, and then I all of a sudden felt this WEIRD sensation in my brain, particularly on my RIGHT side, and it felt like my brain/head was going to go HAYWIRE!! It physically felt like I was about to have a stroke, seizure or SOMETHING, even though I never did!! Well, of course I PANICKED, and I called the ambulance in fear it was in fact a TIA, stroke, or seizure about to happen!! I walked downstairs from my apartment, and as I stood on the stairwell by the doors to my apartment complex, I could feel my WHOLE RIGHT LEG BUCKLE UP, GO NUMB, and I COULD NOT EVEN MOVE IT!!! I was PETRIFIED!! What the HELL was going on with me?!?! The ambulance came, and before they came I could feel the feeling return in my right leg, it went "erect" again and I was able to regain control of it. I had to BALANCE myself by holding onto the railing of the stairs while it happened. Yet I remember every speck and detail of it perfectly...     

After about a month 1/2 or so, and after starting on a mult-vitamin since I thought maybe I had some vitamin deficiencies that were attributing to my problems, my problems not only began to dissipate, but the head zings almost vanished COMPLETELY!! I still get the dizziness/lightheadedness and my head will feel quooky/odd still at times during some of my Panic Attacks, yet NOTHING like I had to endure before!! And sure, I still get heart palps and anxiety, but NOTHING like the torment and torture I had to go through getting ON and then OFF the Zoloft!!! 

I am now seeing a Psychiatrist, who prescribed me with Lorazepam and also prescribed me with Lexapro, even though I TOLD him about my reaction to Zoloft. He was STILL convinced, however, that it was just Zoloft and that another SSRI should do the trick. Well guess what happened???

I took it on a Saturday, and for most of the day I was fine (aside from feeling a little tired). I thought maybe I was HOME-FREE and found a med. that would work GREAT!! I took it at NOON along with the Lorazepam, which I take 2-3 times daily. After 6 HOURS of the med. being in my system (Lexapro), I got ANOTHER head-related attack of the electrical vibrations, ten-fold pins and needles feeling, and getting sweaty and clammy, then cold. I immediately called my doctor, and STOPPED taking the med from there on out.

I am still taking another med., Lorazepam, for the panic attacks, but I still get the head zings and vibrations occassionally still (perhaps as a reaction to having the Lexapro in my sys. for that one day???).

I mean, my doctors assumed it was part of my Panic Attacks, but how could it make my LIMBS GO NUMB like that and UNABLE TO MOVE, let alone those painful electrical surge feelings I used to always get.

[King]

Hi Greygoose

Perhaps I can offer a biochemical focus on this....

As we know all medications for anxiety and depression work by balancing or selectively increasing neurotransmitters in our brains.

Our brains work via nervous transmission along infinite numbers of pathways linking one region to another. Nervous transmission in our brains is affected by the levels of 6 core neuro-chemicals, out of which 3 particularly affect mood - dopamine, serotonin and noradrenalin. GABA isnt a mood chemical but affects adrenalin production causing fight/flight responses. All these chemicals are targets for drug synthesis and effect.

However, its much more complex than that. As you affect one chemical the brain tends to correspondingly increase or decrease other chemicals via indirect mechanisms.

Anyway, because CNS (central nervous system) drugs affect neurotransmitter levels, they affect which pathways are used by the brain.

Or in other words, the change in neurotransmitter levels means that the brain is able to use different pathways than before - or pathways that it had stopped using. The same regions are linked as before, its just that they can be linked via an infinite number of different routes.

Its this switching or restoring of routes that causes a kind of 'rewiring' effect which is often felt as a "brain shock" or as an "electric shock" in the brain. These feelings will often come in the first few weeks or during tapering off for a CNS drug. Or they can occur without drugs.

I also believe that the jolts, buzzes and tingles are caused by similar bases. Although the tingles may be skin or muscle related which are typical anxiety symptoms.

These effects are nothing to be worried about although they have the potential to startle and unsettle us. The brain is designed to rewire itself as needed.

Over a period of time, as the brain gets used to using new pathways (and it does this all the time - its just that for some people taking drugs causes this happens more markedly) the effects felt will diminish. Remember, its the brain's ability to use new pathways or upregulate some and downregulate others at different times that makes it such a special and complex organ. And makes it quite self-defensive, like how a person who has had a stroke with loss of speech is able to speak again after a period of time as new pathways are used (and built).

Anyway, hope this is of interest
King

[itsmeesindee]

Hey Goose,

About 15 years ago when I first starting taking anxiety meds I felt as if all the nerves in my body were vibrating. I believe that med was Buspar.  This same side effect happened with a couple other meds I tried until I realized how sensitive I was to the medication.  When I started taking the meds at an extremely low dose and slowly increased it, this side effect was just about nonexistant.  For those people that have side effects when first starting an antidepressant, I would definately recommend starting off at a very low dose.  it does take longer to feel the full effects of the med, but it is well worth it.  Also just know that those feelings do go away after a short period of time and in my opinion a little discomfort for a week or so if definately better than anytime with anxiety/panic attacks.

Cin

[jenny649]

Hey there.

I generally don't feel any fo that, but when I miss a dosage of lexapro I do feel brain zaps, which feel basically like your brain is jolting around in your head. As long as I know the reason for it , it generally doesn't scare me too much, but I can definitely see how it would.

[CGPanic84]

As we know all medications for anxiety and depression work by balancing or selectively increasing neurotransmitters in our brains.

Our brains work via nervous transmission along infinite numbers of pathways linking one region to another. Nervous transmission in our brains is affected by the levels of 6 core neuro-chemicals, out of which 3 particularly affect mood - dopamine, serotonin and noradrenalin. GABA isnt a mood chemical but affects adrenalin production causing fight/flight responses. All these chemicals are targets for drug synthesis and effect.

However, its much more complex than that. As you affect one chemical the brain tends to correspondingly increase or decrease other chemicals via indirect mechanisms.

Anyway, because CNS (central nervous system) drugs affect neurotransmitter levels, they affect which pathways are used by the brain.

Or in other words, the change in neurotransmitter levels means that the brain is able to use different pathways than before - or pathways that it had stopped using. The same regions are linked as before, its just that they can be linked via an infinite number of different routes.

Its this switching or restoring of routes that causes a kind of 'rewiring' effect which is often felt as a "brain shock" or as an "electric shock" in the brain. These feelings will often come in the first few weeks or during tapering off for a CNS drug. Or they can occur without drugs.

I also believe that the jolts, buzzes and tingles are caused by similar bases. Although the tingles may be skin or muscle related which are typical anxiety symptoms.

These effects are nothing to be worried about although they have the potential to startle and unsettle us. The brain is designed to rewire itself as needed.

Over a period of time, as the brain gets used to using new pathways (and it does this all the time - its just that for some people taking drugs causes this happens more markedly) the effects felt will diminish. Remember, its the brain's ability to use new pathways or upregulate some and downregulate others at different times that makes it such a special and complex organ. And makes it quite self-defensive, like how a person who has had a stroke with loss of speech is able to speak again after a period of time as new pathways are used (and built).

Anyway, hope this is of interest
King

I thank you for your reply King. The least it has done has provided some sense of comfort. However, I wish you would read my post, and PLEASE respond to WHY you think I had all the reactions I did. Typically, with drugs like SSRI's, if you DO have any reactions to the serotonin increase, then it should dissipate within 1-2 weeks. Mine DIDN'T. They progressed, and got worse, to a point where it was EVERY DAY!!! So I understand your theory, yet according to your theory the brain SHOULD rework itself to adjust within that 2 week timeframe. However, for me it CONTINUED TO WORSEN/PROGRESS

And when I quit cold-turkey...well that just was NOT a pretty sight. PLEASE read my post above for more info., and for your insight on the whole ordeal!!

~Crystal (CGPanic84)~

[King]

Hi Crystal

Sorry I was responding to the OP to be honest.

However, having read your post(s) I'm not sure if what you were experiencing was actually an adverse reaction to the drug. Perhaps you are sensitive to SSRIs. Perhaps the rewiring/pathway effect for you is too strong or is more pronounced than normal.

I had a bad reaction to Celexa which gave me chemical chill/electricity feelings, headaches, insomnia, etc.

So again in summary, I think you may have had an adverse reaction to the drug. Maybe you need to try another class of drug outside SSRIs?

King

[nevergoback]

This is a fairly inelegant anology I have used in the past. Keep or sweep.


In anxiety, our basal arousal is way up. As a result, many of our sense organs are hypersensitive, and trigger stress responses much more quickly than they normally would.

I liken it to trying to go to sleep in a dead quiet room. Every little sound seems loud, and arouses you. If you turn on a fan (or other white noise) that is constant, you can longer hear those little intermittent noises. Problem is, AT first, the fan is just as annoying and loud as everything else.

I liken SSRIs (and antidepressants) to the noise maker. At first, their effects can just be annoying, but as you get used to it, it takes alot more to trigger your stress response.

Sometimes, people don't get used to the white noise. Or the noises in the room are too loud for it to matter.


There are actually are some correlates to this analogy in the chemistry, but it is not at all exact.

FWIW, electric shocks are much more common with SSRI withdrawal than introduction, but both can happen. I'll try to get some better answers for the original question.

[King]

I liken SSRIs (and antidepressants) to the noise maker. At first, their effects can just be annoying, but as you get used to it, it takes alot more to trigger your stress response.

Whats the specific science relating to the noise creation?

There are actually are some correlates to this analogy in the chemistry, but it is not at all exact.

Whats the correlation and the chemistry behind this, why isnt it exact?

[ocdengineer]

This is typical of anxiety disorders.  Once your brain sends the warning message to your adrenal glands and adrenaline starts coursing through your body, your senses are heightened.  This causes you to hear, feel, smell, sense things that you would not typically notice such as feelings within your body (stomach ache or even a gurgle), or thoughts within your head that you would typically dismiss.  This in turn creates more anxiety and more adrenaline release which increases the release of adrenaline.  This is your standard "Fight or Flight" reaction.  Over time, this nervous state of heightened awareness becomes constant and the smallest feeling or though can trigger an anxious response which could lead to a panic attack.  This is why many people who have simple anxiety disorders are always looking for a reason for their symptoms which are usually caused by their heightened state of "arousal", if you will.  Thus "Health Anxiety".  The "Brain Zaps" are absolutely harmless, however, with a heightened state of awareness they can spark fear in the people who are anxious to begin with.  This creates a trigger for more anxiety.  This is precisely why a benzo is prescribed in conjunction with most antidepressants, to slow down the CNS for the first month or so of treatment so that a person with anxiety disorder can get through some of the harmless yet uncomfortable side effects without going on melt down.

I also have had the brain zap feeling and it sucked.  It scared the crap out of me due to my heightened state of anxiety.  I decided that antidepressants were not for me and I didn't take any drugs for almost a decade.  I got the feelings in the beginning and end of treatment.  Later I found Xanax which doesn't have any initial side effect, but does have withdrawl effects and I am comfortable on the medication.

Later,
OE

[nevergoback]

I guess the one thing we know is that SSRIs inhibit serotonin reuptake, leaving the neurotransmitter in the synapse longer. My understanding is that there is some downregulation of postsynaptic receptors over time.

So the analogy is more serotonin at a basal level = noise, downregulation = getting used to it.

However, I'm pretty sure that no one knows completely why antidepressants work. I've seen studies where all antidepressants, regardless of which neurotransmitters they attentuate, cause increased neuronal differentiation in roughly the time people start to feel effects. I've also seen work where the changes are more organizational than down at the single synapse level.

The biology is very complex and clearly I don't know all of it, and my analogy is simplistic. But if it aids in someone getting a handle on their own condition, then it's useful.

[King]

I asked the question because the (bio)chemistry of anxiety and depression is very complex and I wanted to hear your reasoning behind the topline analogies you gave.

I'm still interested in your basal noise supposition - are you saying that low serotonin levels are associated with a desensitised or hypersensitised lateral amygdala (via a modified hypothalamus where stress triggers are first processed)? Bearing in mind that the hypothalamus is the 'noise control' centre and the amygdala the 'fear control' centre. And that following on from this I presume you mean that by changing serotonin levels this affects the amygdala's sensitivity to stress/fear triggers thereby giving it effectively a lower basal noise status than before? One problem with the noise theory is that serotonin (all in its 7 family groups - there's over 24 types of serotonin so far identified) works differently in different parts of the brain, not just in regard to the amygdala, suggesting a multicomponent approach to the alleviation anxiety and depression symptoms is present. But it gets more complex than that.

Looking at the chemistry behind SSRI effect further (well biochemistry really, this is not fundamental chemistry behind protein synthesis or reversible/irreversible enzymic inhibition we're talking about here), you may be interested to know that you can both increase synaptic cleft serotonin (with SSRIs) or even DECREASE it (with tianeptine - it works in the opposite way to SSRIs) and depression symptoms are alleviated on both counts(!). So increasing or decreasing background monoamine noise via serotonin modulation seems to have the same effect. An interesting biochemical riddle wouldnt you say? This exemplifies our current naivety towards treating depression and anxiety via the monoamine hypothesis. It also highlights our ignorance of how these drugs actually work given the clinical outcomes they afford.

You rightly mention that post-synaptic receptors are down-regulated by SSRIs - but only initially. Their action thereafter becomes finally balanced - going up and down - leading to better serotonergic (or dopaminergic or noradrenergic) stasis. This is one (but only one) of the reasons why is takes antidepressant 3-6 weeks to get working (as you mention) for all patients - the receptors take ages to become finally tuned to the point whereby they can maintain equilibrium. This suggests that depression/anxiety is not due to lack of serotonin (supported by that fabled monoamine hypo again) but actually due to malfunctioning of the post-synapse receptors themselves. Clearly we need a new theory.

However, maybe the most interesting supposition that is currently utilised to describe SSRI's therapeutic lag period is the link between serotonin and hypothalamic pituitary adrenal system/axis, which as I already described above is involved in stress processing. Stressful triggers or stimuli cause the neurons in hypothalamus to release corticotrophin releasing factor (CRF - a current target for drug companies) into the bloodstream. CRF impacts on the anterior pituitary, which responds by releasing adrenocorticotrophic hormone (ACTH), which is then transported to the adrenalin gland (as mentioned by OCD Engineer). The adrenal gland then produces glucocorticoids (cortisol). Cortisol interestingly then goes back to influence the anterior pituitary, the hypothalamus, and the hippocampus through glucocorticoid receptors – so this is a negative feedback process to maintain a normal level of cortisol in the nervous system. As we know, in response to stressful events, cortisol levels rise, giving the person more energy and heightened alertness. CRF-producing neurons are found not only in the hippocampus, but also throughout the CNS – in the cerebral cortex, the amygdala, and interestingly in the brain stem. So, in addition to regulating the release of ACTH, CRF appears to function like a neurotransmitter, modulting endocrinal, immunological, autonomic, emotional, and cognitive responses to stress triggers.

This is all well and good but getting to the point about SSRIs, trials show there is substantial augmentation of CRF, ACTH, and cortisol levels in depressed patients and an anatomical increase in the number of CRF-producing neurons. Constant high levels of these proteins cause the downregulation of glucocorticoid receptors and its thought this imbalance leads to the development of depressive (and probably anxious) symptoms - but the exact reasons for that are not clear. Anyway, the imbalanced glucocorticoid receptors are also thought to decrease cell resilience, increase cellular apoptosis (death), and decrease neurogenesis, ultimately leading to decreased hippocampal volume - yikes. Studies show that SSRI's normalize the imbalanced glucocorticoid receptors, indirectly influencing cell survival and cell plasticity. This SSRI effect takes about 2 weeks which adds to the explanation of therapeutic lag.

Coming to another point you made, SSRI's may not only alleviate/resolve symptoms of depression but they may also help reduce stress vulnerability - i.e. core regions dont respond to stress noise as they did.

Another reasoning behind SSRI lag is probably due to complex pathway modulation. We know that increasing serotonin has an impact on levels of dopamine and noradrenalin, and vice-versa, via complex indirect pathways.

Wrap up:
1. Despite successful drug outcomes, we are no clearer on the origin of depression or anxiety. Serendipity will probably lead us to new discoveries.
2. The lag-effect of SSRIs is complex and not due to just reuptake modulation.
3. Increasing or decreasing serotonin levels in depressed/anxious patients both lead to positive clinical outcomes. Increasing noise isnt the driver.
4. Prejudice is widespread vs. the older "dirty drugs" which affect several biological processes rather than the "clean drugs - SSRIs" which exert influence over a much smaller range of biological processes (or so is communicated). "Dirty" TCA's can be more effective in some cases than the "clean" SSRI's.
5. SSRI's inability to hold 50% of patients in remission suggests there cannot be a single medication for everyone.
6. Study of the highs and, more importantly, the lows of SSRI's potentially lead us to recognise that what we call "depression" or "anxiety" may be not one, but a spectrum of multiple functional disorders (outside current subsets). Each disorder having distinct paths of origin and each needing different treatments. So, in future treatments we may need not one magic bullet but combinations that affect multiple implicated pathways.
7. Most controversially, as mentioned above, studies into SSRI's actions suggest there is no single cause even for individual subtypes of depression or anxiety, but multiple processes (environmental, genetic, intracellular) in multiple parts of the brain. Combinations of these effects (different in different individuals) will produce depressive or anxiolytic symptoms. So, serotonin imbalances may only be one of many "final pathways" that the multiple causes of depression/anxiety take. Taking all of this taken into account there is a need to continue searching for new understandings of the causes of depression and to develop new medications that will include serotonin-regulating effects, but whose mechanisms of action will also include directly modifying other imbalances as described above.

Anyway my point is that the effect of SSRIs (and the underlying processes they treat) are more complex than just increasing background noise.
And as Jeanette Winterson said, SSRIs, like oranges, are not the only fruit.
King

[nevergoback]

King,

As long as that was I've read dozens and dozens of pages of articles that summarized less.

I am coming from a very different model. I started my training in biological model, but finished in counseling, and my "theories" are just attempts to make our current knowledge (as much as I can get my brain around it) available to the layman.

Here's another bad analogy that I use to help folks which will have more of a point to your discussion in a second.

I talk about the body's "normal" stress response a fair bit and talk about two chemicals: which I call adrenaline and cortisone. Of course I'm using adrenaline as a general catchall for catecholamines and cortisone for the ACTH axis, but those are words most people will have heard before they walked through my door.

Everything I've read seems to point to the fact that the real heart of the matter may be in the ACTH half of the equation. We just happen to be alot better at modifying the catecholamine half.


I'm am NOT convinced that any of my analogies hold true on the molecular level when you get down to the nitty gritty of things. But they're a heck of alot better than "I have a chemical imbalance."

Clearly what ever multiple cascades are happening chemically, you can do alot of good at multiple places along the chain(s).

[apple]

I found SSRI's that affect the seritonin to make me too drugged up sleepy.  My main source for anxiety is ADRENALIN.   

Wow, everyone wants to know how depression and anxiety work to help find a cure (med).  There are SSRI's for adrenalin, however the side effects are worse for me than the anxiety.  Not everyone has my problems with SSRI's. 

I find the anti-psychotics to work wonders for me.  What is the major difference between anti-depressants and anti-psychotics?
I am curious...so many different views, but I am interested if you could tell me what you know.   

[apple]

please dont respond to this...I dont want to start a debate.  Unable to erase this at the moment