Shock sensation

The reason for this warning is that abrupt cessation of SSRIs produces withdrawal symptoms in about 20 per cent of patients. Symptoms of withdrawal from antidepressant medication include gastrointestinal disturbances (abdominal cramping and pain, diarrhoea, nausea and vomiting), flu-like symptoms, headaches, sleep disturbances, dizziness, blurred vision, numbness, electric-shock sensations, twitches and tremors. Abrupt withdrawal can also produce symptoms of depression and anxiety, which can occur within hours of the first missed dose of the drug.11 Withdrawal symptoms are sometimes mistaken for a relapse, leading patients to resume antidepressant medication and to conclude that they need it in order to remain free of depression. Technically, this is not considered addiction , but it does seem awfully close. 

Patients describe symptoms as flu-like these symptoms include nausea, diarrhea, insomnia, malaise, muscle aches, anxiety, irritability, dizziness, vertigo, and vivid dreams (Coupland et al. 1996). Often, and for unknown reasons, patients who experience this constellation of symptoms have transient electric shock sensations. This unique symptom is diagnostically useful and strongly suggests to the clinician that the patient is in fact experiencing withdrawal because the symptom rarely occurs in other conditions, such as viral infections, or as a side effect of a new medication. 

Authors who reported a case of carpal tunnel syndrome due to pyridoxine deficiency in a patient taking tranylcypromine (SEDA-9, 21) later collected data (6) on six patients taking phenelzine (up to 75 mg/day for up to 4 months). All developed low concentrations of pyridoxine and a variety of symptoms, including numbness, paresthesia, and edema of the hands, as well as an electric shock sensation in the head, neck, and arms. The symptoms resolved completely after the addition of pyridoxine 150-300 mg/day to the treatment regimen. 

A 21-year-old woman whose long-term treatment with paroxetine was stopped a week before starting venlafaxine (37.5 mg daily for 5 days then 75 mg daily for 2 days) developed vomiting, dizziness, incoordination, anxiety and electric shock sensations in her arms and legs within 3 days of starting venlafaxine. She stopped venlafaxine after 7 days of treatment, but symptoms persisted for 5 days until she was treated with cyproheptadine. ... 

The maximum safe Tet go current is less than 10 mA, whereas 20 mA to 40 mA directly across the chest could arrest respiration or restrict breathing currents above 500 mA flowing for as little as 50 ms can be fatal. However, even safe currents at the level of about 5 mA to 10 mA could still give rise to a minor shock sensation and cause someone to fall if working at a height. 

Protection by limitation of energy is in subsections 411-04 and 471-03. The intention is not to prevent the shock sensation but to limit the shock current and/or its duration so as to avoid injury to persons and animals. Common examples of equipment complying with this requirement are electric fence energisers, electrostatic paint and powder sprayers, and tungsten inert gas (TIG) welding electrodes. 

Lhermitte s sign Paresthesias radiating down the back of the extremities with neck flexion also tingling or shock-like sensation passing down the trunk when the neck is flexed. 

In addition, whenever an antidepressant that blocks serotonin reuptake is discontinued, an unpleasant but harmless discontinuation syndrome manifested by abdominal discomfort, instability, anxiety, and occasionally painful shock-like sensations in the extremities can arise. The risk appears to be greatest with venlafaxine and paroxetine. Consequently, switching from one of these medications to another that does not block serotonin reuptake requires a gradual taper of the first medication over days to weeks. 

Adverse effects include gastrointestinal symptoms like nausea, vomiting, epigastric pain, diarrhoea, hypersensitivity reactions like rash, urticaria, angioedema, exceptionally bronchospasm, anaphylactic shock dizzy sensations (caution in driving or use of machinery) moderate increase in ASAT, ALAT and/or alkaline phosphatases cholestatic or more rarely acute liver injury. 

Discontinuing selective serotonin reuptake inhibitors (SSRIs) may induce a syndrome wherein the main neuropsychiatric symptoms are dizziness, shock-like sensations, anxiety, irritability, agitation, and insomnia. These symptoms usually develop 1 to 7 days after abrupt or gradual discontinuation. Antidepressant discontinuation may also induce mania, mainly reported with tricyclics and monoamine oxidase inhibitors but also observed with SSRIs. 

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