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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5088
Experience:  Dr. Mark is a PhD in psychology in private practice
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Im experiencing a sensation Ive found people referring to

Resolved Question:

I'm experiencing a sensation I've found people referring to as "brain zaps" after tapering off of Sertraline about a week ago. They are very disorienting and quite frequent. How do I get them to stop?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 2 years ago.

Hi! I believe I can be of help with this issue.

I can imagine how distressing this situation must be for you. I'm sorry you're going through this difficult withdrawal from the sertraline (Zoloft). The symptoms you describe are THE classic symptoms for sertraline withdrawal.

Most people usually start feeling the worst of it begin to start easing up after the 10 days to 2 week mark. You're almost at that mark now and if in a few days you are not feeling yet the easing up, then that puts you into the secondary group that feels the symptoms strongly for about 14-20 days and then slowly it begins to ease at the month mark in a clearly visible way.

There is a small number of people that have an even longer withdrawal period and then the tapering has to be slowed down. Some people with SSRI withdrawal symptoms have to taper off in tiny, tiny increments.

If in the next few days to a week no improvement is seen, you may need to talk about redoing the tapering with your doctor. Meaning going back to a higher dose now and very, very slowly tapering down.

I know this sounds awful but it's only a little while longer. So try to stay strong as you go through the withdrawal. I know it's unfair that the doctors don't tell people when they START the SSRIs about the withdrawal symptoms.

You might also consider adding a behavioral component to your treatment for your depression and anxiety. While behavioral treatment requires more effort from the patient than medications and is not as quick acting, it doesn't have the side effects nor withdrawal symptoms of the medications. If you would like to introduce a behavioral treatment, feel free to ask me another question about it.

Okay, I wish you the very best!

Customer: replied 2 years ago.
They have become more frequent in the last 24 hours. Is this normal when under a lot of stress? I just feel like I can't function when they occur too often and I'm wondering if there is anything I can do to help reduce the frequency and/or intensity of them? I've read that fish oil and B-12 helps, is that true?
Expert:  Dr. Mark replied 2 years ago.

Stress will make the anxiety reaction, which is what the brain zaps that people call them are, more intense. I'll give you a simple behavioral technique to use to help you when anxiety gets high/brain zaps.

Fish oil is Omega 3 and is highly beneficial. The studies are conclusive on the benefit of this. A clinical dosage would be 2-3,000 mg. Go to a good health food store and get a good brand they recommend of fish oil or flax oil.

The research on B-12 and anxiety is not very encouraging.

Now for the technique: here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.


I want to stress the importance of breathing as well. Part of the physiology of what is happening to you when the anxiety of depression is present is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety and depression, which strengthens the emotion and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


INSTRUCTIONS:

  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.

Again:

Dr. Mark, Psychotherapist
Category: Mental Health
Satisfied Customers: 5088
Experience: Dr. Mark is a PhD in psychology in private practice
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