(This post is a continuation of the previous one, which you can read here.)
The re-uptake-inhibiting process that SSRIs use to increase serotonin levels in the brain is at the heart of why SSRIs are so difficult to quit. By blocking serotonin receptors on Sending neurons, the natural send-receive synergy has been interrupted, and as a result the brain becomes chemically dependent upon the drug to maintain consistent levels of serotonin. As the brain becomes accustomed to the drug, it no longer resorts to its normal function of producing or regulating serotonin and no longer functions with the normal cycle of sending, receiving and recycling of serotonin.
During the process of tapering, as the SSRI chemical is removed from the now-altered brain, the levels of serotonin fluctuate in the neurotransmitters. The systems gets gummed up and the brain isn’t firing on all pistons, the way an engine in a car would get gummed if some sabotaging agent were thrown into its pistons. This fluctuation causes wide mood swings and uncontrollable emotions, as evidenced in the struggles of the thousands of people on forum web sites.
The brain is trying to adjust to the need to self-regulate levels of serotonin. In the meantime many patients, myself among them, experience a cascade of extreme emotional and physical symptoms that include debilitating depression, anxiety, panic, rage, confusion, agitation, crying spells, insomnia, memory loss, general aches, headaches and heart palpitations. These symptoms can feel quite unmanageable and so intense that you become hopeless in the face of them and see no way out. The electrical impulses in the brain are going haywire and the result is that the standard mechanism used to control emotions is no longer functioning appropriately.
Withdrawal triggers the mind to respond more viscerally and in a way completely disconnected from normal thought processes and standard restraints. In a normally functioning brain, cognition regulates visceral responses moderating in proportion to the circumstances that aroused them. SSRI withdrawal disconnects the mind from this regulatory function so that moderating behavior is overthrown by unmanageable emotional impulses of anger, fear, and anxiety. Anger normally can be managed. For example, when someone cuts you off while driving you may call them an idiot by you won’t pull out a gun and shoot them. Withdrawal removes that moderating behavior and allows rage to become the singular dominant and irrational response, which — in the case of the driver who cuts you off — might explain certain incidents of “road rage.”
Uncontrollable rage springs fully formed in the mind and propels itself toward an unsuspecting target, as if an external force has hijacked that person’s personality, as indeed it has. The compulsion is trying to take over my consciousness.” Other emotional symptoms of withdrawal act in a similar way — inexplicable crying fits, overwhelming panic. Even for the patient who exercises mindfulness and self- awareness, these symptoms come on with little warning causing great turbulence and possessing a visceral realness that most people find alarming. The brain’s chemical balance has been disrupted, so reality itself for the patient has been altered. Instead of an emotional wave that must be conquered or endured, these emotions become reality itself, with a feeling of inevitability that sometimes ends in tragedy. (Some examples of these tragic consequences will be addressed in upcoming posts.)