Fish Oil Attenuates "Brain Zaps" From Antidepressant Withdrawal

[DaveFoster]

Dr. Peat has written about the contributory role of omega-3 fatty acids in dementia, such as with "fisherman's disease," a high occurrence of dementia in fishermen who consume cold-water fish.

"Brain zaps," an uncomfortable side effect of withdrawal from certain antidepressants, such as the selective serotonin reuptake inhibitor (SSRI) and selective serotonin-norepinephrine reuptake inhibitor (SSNRI) classes, have been reported to diminish in intensity with the administration of fish oil. The following article by "Psychology Today" describes the phenomenon.

Fish oil and antidepressants have powerful anti-inflammatory effects in the brain, which suggests some potential benefit with other anti-inflammatories as well.

"Selective serotonin reuptake inhibitors (SSRIs) as well as selective serotonin and norepinephrine reuptake inhibitors (SSNRIs)—the most commonly prescribed antidepressants—are popular choices of treatment for depression and anxiety, in part because they are not supposed to be addictive.

Discontinuing an SSRI or an SSNRI, however, can cause extremely severe withdrawal symptoms, which often are so bad that people prefer to continue taking the drug to avoid suffering through them.

One of the most unbearable withdrawal symptoms reported are brain zaps (also sometimes called brain shivers, brain shocks, head shocks, and electrical shocks). They tend to be apparently uncaused sensations of electricity briefly passing through the brain. Some sufferers describe them as "a sudden jolt or buzz in the brain." Others report that they feel like "short bursts of white light mixed with dizziness." Sometimes brain zaps are accompanied by vertigo, tinnitus, throat tension, and nausea. They are sometimes triggered by sudden movement of the eyes or the head.

This side-effect of SSRIs and SSNRIs is only rarely discussed in the medical literature. But it appears to make people who are trying to wean themselves off of the drug feel that they have no choice but to continue taking the drug.

There is no consensus as to what causes brain zaps after withdrawal from SSRIs or SSNRIs. SSRIs and SSNRIs increase the active levels of serotonin in the brain by blocking the serotonin transporter. But there is some reason to think that low levels of serotonin in the bain is not the primary condition responsible for brain zaps.

One reason against this hypothesis is that people who have low levels of serotonin in the brain usually do not suffer from brain zaps prior to taking SSRIs or SSNRIs (though there are reported exceptions.)

Another reason against the serotonin hypothesis is that brain zaps have been reported when people discontinue the use of other drugs, such as benzodiazepines—used for anxiety relief and muscle relaxation—as well as the ADHD medication Adderall (amphetamine salts) and the illegal party drug MDMA (ecstasy).

SSRIs increase serotonin by blocking a serotonin transporter. The main serotonin receptor involved in the prevention of depression and anxiety is the 5-HT1 receptor. Activity at this receptor site is correlated with an increase in the activity of gamma-aminobutyric acid (GABA)—the brain's main inhibitory chemical, calming neuronal activity.

Although the brain chemical GABA is an inhibitory (or "calming") chemical, low levels of this chemical have been implicated in a number of conditions, including anxiety, depression, movement disorders, and seizures.

Benzodiazepines—a group of drugs that provide immediate relief of anxiety—work directly on GABA, increasing its availability in the brain. Adderall, and MDMA too, can increase the activity of GABA in some parts of the brain, primarily owing to their increase of available serotonin in the brain.

Because SSRIs, benzodiazepines, ecstacy and Adderall are all associated with an increase in the brain's level of GABA, discontinuing these drugs are likely associated with low brain levels of GABA.

As low levels of GABA can trigger seizures, this hypothesis leaves open the possibility that the reported brain zaps are instances of brief, localized seizures.

Seizures are the result of over-excitement in a small isolated group of neurons. A seizure occurs when the hyper-excitement of a small group of nerve cells spreads to larger brain regions. In a grand-mal seizure, the excitement of one or more neurons has spread to the whole brain. When most or all of the brain is over-excited, the brain's neurons send signals to the body in an uncontrolled way. This can result in severe convulsions and a loss of consciousness.

In a minor seizure the brain is capable of preventing the spreading of the hyper-activity to larger areas of the brain. Although it has still not been empirically confirmed, the theoretical considerations considered above suggest that brain zaps following the discontinuation of SSRIs, SSNRIs, and benzodiazepines as well as the withdrawal from Adderall and MDMA may be minor localized seizures."

Link: https://www.psychologytoday.com/us/blog/the-superhuman-mind/201710/what-causes-brain-zaps​

 

[Sobieski]

In reply to this, I suffered with brain zaps in the morning for years, all down to just one foolish high dose of MDMA. Fish oil did nothing, since Peating I haven't had one that I can remember.

 

[RobertJM]

Why is omega 3 most concentrated in the brain? Surely the brain, and all of its intricate workings and vulnerabilities, is going to be most at risk to a toxic substance like polyunsaturates?

Has anyone ever asked Dr Peat this? It seems odd to me.

As for fish oil being the anecdote for brain zaps, I’m sure Dr Peat would advise differently!

 

[Lecarpetron]

Thanks for posting this Dave. I've had issues with brain zaps, but not until years after I quit benzos. Cypro seemed to help. I wonder what other brain anti-inflammatories would target this aside from undesirables like fish oil.

 

[alywest]

The interview below I highlighted some really important points when Peat is discussing the relationship of serotonin to the whole inflammation process, ut it seems like the important thing is the pituitary being overactive at the end of the day. I'm not sure how or why fish oils tend to have an anti-inflammatory effect in the short run because that is what most people use it for, so obviously it doesn't always just cause immediate inflammation as it seems from the interview and the way PEat explains it in general. There must be some sort of short term reduction in inflammation or no one would be stupid enough to use it at all. However, it's obvious if you look at the big picture what a mistake it would be to inundate oneself with more PUFA in an attempt to overcome the withdrawal effects of SSRI.
So now onto my own theory. I have to wonder if completely withdrawing from SSRI has such negative consequences because one of the root things that the SSRI's do is to increase the enzyme 3a-HSD, which in effect increases allopregnanolone, which is a major GABAa mediator. The doses required for this process are below the SSRI loading doses recommended for the "anti-depressant" effect. My thinking is that if people were to reduce their SSRI dosage to the amount that much research has shown is below SSR Inhibition, yet still has steroidogenic effects would help eliminate much of the absolute withdrawal symptoms, without harm to the individual. If one has a decreased ability to produce 3a-HSD and then stops SSRIs, whether cold turkey or through a slow tapering process, one is also going to almost completely stop producing allopregnanolone which is what is going to have all the calming effects.
I personally take ~5mg zoloft (way below the prescribed dose which is pretty much the lowest dose a doctor will prescribe), along with a small amount of DHEA and about 100mg of pregnenolone. I also take thyroid (t3 and t4). I find this combo to be very calming and yet not sedating. I think when I took SSRIs in the past at reuptake inhibiting doses, I was actually benefiting from the allopregnanolone, but eventually the rise in serotonin would catch up with me and actually cause bad results, so I would stop altogether and then be in a completely crap place for a long time. I'm curious to know what my TSH level is now that I have been taking this combo for a few weeks, compared to a couple of months ago when I was just taking thyroid and progesterone and my TSH was technically in the normal range but still above 2.

From East West/Inflammation interview:

It's the accumulation progressively of the polyunsaturated fats that starts what we know as inflammation that it – it when cells are inflamed, the shift from an oxygen-based metabolism to a simple sugar consuming metabolism and are in an excited state that promotes cell division and in this oxygen free or oxygen wasting environment, cells begin to produce

00:11:22 > collagen as part of a repair process but the ability to remove the collagen is impaired by the presence of polyunsaturated fats and the breakdown of the polyunsaturated fats involves the production of prostaglandins which aren’t really part of the essential development of the embryo and fetus, but they become very important as we begin eating the polyunsaturated fats. So the presence of these excitatory mediators, prostaglandins, and the free fatty acids blocks the cleanup process and keeps the inflammation going and leads to the production of a scar depending on

00:12:24 > how unopposed the polyunsaturated fats are you tend to get a bad healing and a big scar and that's part of why vitamin E by opposing those processes can practically eliminate scarring if you got a very high concentration in the presence of the healing process. Jeanne Rubin: Ray, can I interrupt you real quick? You’re talking about the fetus and the placenta working as a filter in protecting the immune system against like you say in the polyunsaturated fatty acids,
I mean if a mother has a diet high in polyunsaturated fatty acids, would the placenta still act as a filtering agent to… Dr. Ray Peat: Yes, normally even people who have been on high n-3 and n-6 diet, the babies come out according to

00:13:26 > current definitions as being essential fatty acid deficient. And so that's the argument for putting fish oil in baby formula and such. But when you look at calves, they are extremely deficient at birth but even the small amount of polyunsaturated fat in milk, maybe 2% of the fat is unsaturated, they will gradually also start to load up as they grow and their fats will become more and more unsaturated. But when people have tried the supplement, pregnant women to correct that universal deficiency of the newborn, they find that the babies are born smaller, more susceptible to

00:14:28 > allergies and inflammatory diseases and the worst part of it is that their brains are smaller, not just their bodies but their brains are – development is retarded. And people who are trying to show that the brain requires the n-3 fats were feeding these to pregnant women and they expected to show that the fetus would be able to learn more easily in the uteral with a higher concentration of n-3 fats but in fact they found that they didn't Jeanne Rubin: It’s the opposite. Dr. Ray Peat: Yes. And one of the events caused by the excess of n-3 in particular is that the metabolism of tryptophan which should go largely to niacin and melatonin,

00:15:30 > this type of unsaturated fat in particular followed by linoleic acid and n-6 fat, these caused tryptophan to be metabolized in a toxic direction producing less niacin and more of the excitotoxic quinolinic acid and even more of the carcinogenic forms of the tryptophan indole derivatives. Josh Rubin: So [indiscernible] [0:16:10]. The stuff is fascinating. It definitely takes a little bit for a lot of us to wrap our head around but what do you think causes inflammation? I mean are you saying that all inflammation starts from polyunsaturated fatty acids from the food that people are

00:16:32 > eating or maybe you can elaborate that a little bit more for the listeners so they understand maybe where this inflammation is coming from? Is it just the food? Is it actually happening Dr. Ray Peat: The challenge is what starts it, and it instead of being a quick corrective process, it's the presence of the fatty unsaturated fats that cause instead of correction the inflammation, calcium uptake, accelerated growth and collagen production and eventually calcification of the fibrotic scar material. The end stage is calcification of fibrous tissue that then tends to lead to atrophy and creates the conditions for

00:17:34 > degeneration into cancer. But the challenge, the worst challenge that we are constantly exposed to is the bacterial toxin production in the intestine. Everyone has it unless they have been specially prepared in a laboratory like germfree rats, but everyone develops a balance of colonic bacteria. And the composition of the bacteria depend on what we eat but there are always some that are producing endotoxins, lipopolysaccharide molecule that creates a stress poisoning physical disruption of cells lining the intestine and this part of the reaction is

00:18:36 > to produce serotonin that the intestine is where about 95% of our body’s serotonin is produced and it has various functions to stimulate parasitosis and activate some defensive processes and so on. But when there is a slight overall balance of the endotoxins in relation to our ability to adjust the circulation and the phagocytosis and so on to get rid of the problem, then the serotonin starts being the main problem. And the serotonin activates other things including the formation of prostaglandins from fatty acids, and the release of nitric oxide. And this cluster of things

00:19:38 > most of which can have an adaptive protective effect when there is not enough energy supply to the organism and too much endotoxin from the bacteria, then the nitric oxide and serotonin create inflammation in the wall of the intestine and blood vessels letting endotoxin get into the bloodstream and the endotoxin causes this effect throughout the body then releasing more nitric oxide and serotonin and these things, the serotonin, then becomes the main factor with aging and accumulated stress effects. Josh Rubin: Can you – that’s fascinating. I think people are listening on that’s maybe if you wind a little bit. Tell us what endotoxin is, because I know from reading a lot, I would say

00:20:40 > from what I’ve seen, you’re probably one of the only people that talks about endotoxin. So lot of people, well, what is endotoxin? Maybe tell us like what is endotoxin and where does it come from and elaborate even more and how it affects us because as far as I know like I said you're the only one that really talks about it? Dr. Ray Peat: It’s normally just part of the bacterial cell structure, the covering of the bacteria that contains a starch-like molecule with some fatty acids attached to it and it happens that these are not only structurally part of the bacteria but organisms have been dealing with them for so long that they are sort of our basic signal of the need to defend ourselves against the environment. And so they are a very good triggers of such things as the production

00:21:42 > of serotonin and nitric oxide, but all bacteria produce the sort of leak, these little molecules as they are forming new bacteria or being stressed, the bacteria will produce more of these chemicals that have a physical irritating effect on the lining of the intestine or through the blood vessels once they get out of the intestine. Josh Rubin: So how do we get exposed to it, so we do get exposed to these from meat? Do we get exposed to these from the foods that we eat? Dr. Ray Peat: Yes, they are constantly being produced in the lower small intestine and colon and the upper part of the intestine normally is completely free of bacteria. But when we eat undigestible food,

00:22:44 > starches and complex fibrous materials, lignans and so on, these feed different combinations of bacteria depending on how undigestible they are. And you can create particular symptoms like when they feed one type of starch that humans can't digest but bacteria do, they find that the rats eating these rather than more digestible starches become anxious and aggressive because of disturbance of things like serotonin and nitric oxide. And so it’s the particular amount and type of bacterial toxin is determined by – mostly by the presence of

00:23:46 > chemicals or things in our foods that we can't digest. And if you think of what happens to vegetables if you keep them warm, uncooked vegetables will very quickly start producing bacterial overgrowth and foul-smelling substances. When they are eaten, if they aren’t reduced to a liquid by chewing or preparation, this material passes along into the lower intestine and supports the same kind of foul bacterial decomposition products. And if that material gets mixed with more proteinaceous things,

00:24:48 > undercooked beans for example, then you get a different category of toxins, the indols, indoleamines, things that resemble serotonin and histamine and things that resemble our natural inflammation- producing chemicals, some of them come directly out of the bacterial interaction with the beans and vegetables. Josh Rubin: So just to elaborate a little to more on the endotoxin because I know you talk about it a lot because we're talking about inflammation how does this effect going into perpetuating the cycle of inflammation? How does this effect the liver, and if the liver is effected, how does that effect other parts of the body in regards to the detoxification of estrogen and leading to more cell proliferation and inflammation? Dr. Ray Peat: The liver should absolutely destroy any of these toxins

00:25:50 > that reach it, that get through the intestine but when the intestine is in bad shape, if the liver isn't well nourished and well supplied with thyroid hormone to give it the energy to produce the antitoxic processes, the poorly nourished liver or the low-thyroid liver let's basically all of the junk absorbed through the permeable injured intestine, let's all of it into the system and then you get things like leakiness of blood vessels which in the brain can cause symptoms like multiple sclerosis and edema and other organs inflammatory processes involving the leaking, movement of big molecules in and out of

00:26:52 > blood vessels and other cellular compartments where they shouldn't be able to get under good conditions. Josh Rubin: So we are talking about

00:27:54 > inflammation, where it comes from, I'm sure a lot of people have going to really kind of listen to this over and over to gather it. We've talked about endotoxins. And we'll go back to maybe some of the other, I should say, inflammatory facilitators in our food and then in our environment that can cause inflammation but with chronic inflammation where does it go from there, like what do we see in our society today when it comes to chronic inflammation? Dr. Ray Peat: When the liver gets weakened by the bacterial toxins and lets them into the system, the liver also begins to fail to regulate the body's own hormones, for example estrogen accumulates when the liver is being stressed by endotoxins such that for example in a fertility clinic,

00:28:56 > the doctors tried giving infertile women an antibiotic and they were checking their hormones and shortly after they took the antibiotic, the women reported that they didn't have their fatigue and premenstrual type symptoms but their blood tests showed that right after taking the antibiotic, their estrogen levels went down sharply, their progesterone went up at the same time and the cortisol and other stress hormones went down, so that they had created a fertile endocrine pattern just by taking an antibiotic and the same thing has been done in rats. Estrogen and cortisol down and progesterone up with an antibiotic, and I’ve see the same thing just with a

00:29:58 > carrot salad because the carrot is an unusual vegetable in being antifungal, antibacterial and very resistant to production of endotoxin, so it works like an antibiotic on intestine reducing endotoxins. And when the liver is failing because of the endotoxin burden and your cortisol and estrogen are high, that goes with a systemic excess of serotonin and deficiency of thyroid hormone, so serotonin lowers cellular oxidative metabolism and the energy production. One of the biological effects of high serotonin is to allow rodents to hibernate when they are under stress and the serotonin goes up.

00:31:00 > These rodents are able to drop their body temperature enough to go into a torpor and get through the stress of bad food supply. And when the days get warmer for example, their system starts destroying the serotonin and bringing their metabolism back up but when people who can't hibernate, when people are constantly exposed to the endotoxin, serotonin, free fatty acid and estrogen pattern, all of these things lower their ability to produce energy and tend to cause the body temperature to fall. And as part of the defensive system, serotonin happens to increase the pituitary hormones to compensate, for example by driving the

00:32:02 > thyroid gland harder, serotonin stimulates the TSH, the thyroid stimulating hormone, but it also stimulates ACTH, prolactin, gonadotropins, growth hormone, everything is just sort of an emergency turning on the pituitary to try to drive everything up to compensate for the fact that the mitochondrial energy systems are being blocked by these same substances. Josh Rubin: So just for everyone listening, he is just basically naming specific hormones and things in our body that will create inflammation, pull calcium from the bone, drop body temperature, inhibit our immune system, just to kind of clarify all that. Dr. Ray Peat: Yes, and all these pituitary hormones in themselves, since they are endogenous, doctors like to see

00:33:04 > them up in a certain range, so they don't like to see a very low level of FSH, LH, TSH and so on and they'll tell you that if you take thyroid to suppress your TSH, you're going to cause problems. But in fact that TSH itself causes most of the problems that are identified with hypothyroidism. High serotonin is associated with low thyroid function and high TSH, but the TSH itself contributes to a great variety of inflammatory processes, atherosclerosis, increased blood lipids and increased blood pressure and the whole range of conditions that seem mysterious to the doctors

00:34:06 > that believe you should have your TSH and thyroid hormones in the so-called normal range, but there is actually part of the inflammatory range. Josh Rubin: Now, I mean, is inflammation, I guess important for the process of healing or should we say it's essentially a bad thing? It’s going to create disease or is it actually a process? Dr. Ray Peat: Well… Jeanne Rubin: It depends on the environment Dr. Ray Peat: The healing process of the Metchnikoff/ Cunliffe view of the immune system, there is always the opportunity when your pituitary is revving up, it does increase the output of your thyroid gland and increased steroid production and such but it happens that

00:35:08 > the counter effect of the energy lowering effect with aging tends to win out and even though the pituitary is potentially having a curative effect, as long as you're continuing to be exposed to endotoxin and unsaturated fats and the toxic prostaglandins, then your adaptive processes are going to be constantly at every moment ported by these inflammatory things rather than the corrective energy producing reactions that would happen to the fetus. Josh Rubin: Thank you. I’m going to take this caller again, see if we can get him back. It’s the same caller we had earlier. Caller from the 858, what’s your name? Where you calling from?

00:36:10 > Hello? This is the reason why I tend not taking callers. I have to be honest with you. That’s why I almost am going to be abolish taking calls. So we talked about kind of inflammation, where it goes, hormones, it's process, but you talked about carrots and really you do talk about carrots a lot and its effect on endotoxin. Can you talk about may be other foods of anti-inflammatory and at the same time you can talk about foods that are inflammatory? Dr. Ray Peat: Well, calcium is sort of a central thing. It stimulates cell energy production and when the cell has what it needs such as sugar

00:37:12 > and vitamins and minerals, the calcium will increase the oxidative metabolism and cause the cell to unbalance, have higher energy and ability to prevent the harmful accumulation of calcium. A calcium deficiency turns on the inflammation related processes to attempt to correct the calcium deficiency and this leads to eventually the calcification of soft tissues that shouldn't be calcified. So this is the main reason that I recommend using milk rather than meat because of the high calcium content. Meat has a very high phosphate ratio to calcium and eggs would have

00:38:14 > the right ratio if people would eat the shell as well as the egg. But with milk you get a very good ratio of calcium to phosphorus. And the parathyroid hormone that is suppressed when we eat enough calcium and get enough vitamin D and vitamin K, the thyroid hormone has some of the inflammation promoting effects. So keeping our hormones low is really one of the goals of eating right. The pituitary should be as quiet as possible. Parathyroid hormone should be low. Estrogen and cortisone should be low, and the steroids that are protective, pregnenolone and progesterone primarily and DHEA in itself, these are produced by

00:39:16 > getting enough vitamin A and vitamin E and the oil-soluble vitamins K and D. Keeping the polyunsaturated fats down is essential for all of these. Too much unsaturated fat will turn off the production of pregnenolone and progesterone for example and increase the cortisol and estrogen.

 

[lilsticky]

"Too much" unsaturated fat.. except i was supposed to be depleting it entirely and this would take me years. nice flip flop ray