lexapro cognitive

My Brain after Long Term Lexapro: Chemically Induced TBI

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In December 2015, I was given Lexapro. I had taken Lexapro previously for 12 years, but because of abnormal blood chemistry and building side effects, my doctor suggested that I cease taking the medication. After five months without the drug, I was improving slightly, but because of life events, my doctor and I decided to begin taking Lexapro again. During the reinstatement of the drug, I immediately began to experience serious neurological reactions that I have come to describe as a brain kindling of sorts. It felt like my head was on fire chemically and electrically. Some of the symptoms that developed included: fatigue, confusion, eye pain, leg weakness, headaches, visual processing disturbances, coordination difficulties, lack of concentration, and short-term memory problems.

Within a few weeks of taking the medication, these symptoms were worsening but my physician was not concerned. In fact, he suggested what I was experiencing was normal and that I continue taking the medication. I did, for a while, until the side effects were so bad that I decided to stop. I published my story on Hormones Matter a year ago. You can read it here: A Kindled Brain: Long Term Lexapro Use Reactions. A year and dozens of doctors later, I have become completely disabled. This is a follow up to my story, told with much help from the editor of Hormones Matter.

Two Years Post Lexapro Damage

I no longer take Lexapro or other medications but the damage was done. I still cannot work, watch TV, read, drive or walk more than a few feet. I have had what seems like a two year long headache and severe vision processing issues. It is going to be another great Christmas at my house.

Though I received diagnoses of Chronic Fatigue Syndrome (CFS) and Fibromyalgia they really were just symptoms of something bigger. Shortly after the  CFS diagnosis, an MRI revealed white matter lesions and demyelination. The neurologist dismissed a Lexapro connection. Research suggests otherwise. In the summer of 2017, I was finally given a provisional diagnosis of Lexapro induced neurotoxicity. Just recently, the extent of the brain damage was shown on both on a quantitative electroencephalograph (QEEG) and single-photon emission computed tomography (SPECT) brain scans. Both neurotoxicity and brain injuries were identified by both tests and later confirmed again by additional physicians who reviewed the results independently.

QEEG Results

The QEEG is an EEG with a visual mapping component. It measures the electrical activity or signal transduction between electrodes placed in specific locations on the brain. My test results showed that in certain areas of the brain there was very little organized electrical activity and other areas where there was unusual amount of high activity. What that means is that in some areas of my brain, the signals are very low and essentially not sufficiently strong for the activities that need to be performed but in other areas of my brain, there was way too much electrical activity. Specifically, the report said:

“The patient was found to have a significant amount of low frequency (8-9 Hz) in the right posterior temporal (T6) area. There is an extreme amount of low beta (12-15 Hz) predominantly in the prefrontal and frontal areas that may interfere with executive functioning, organizing, decision making and may also account for fatigue. There is a very unusual amount of high activity for all measured frequencies (1-50 Hz) in the right posterior (O2) area, specifically in the right inferior occipital gyrus (Broadman areas 17, 18, and 19). This may result in sub-optimal functioning in visual processing of color, form, movement, visual perception and spatial processing…

…The analysis of amplitude asymmetries were found to be abnormal for low frequencies (1-12 Hz) stemming from right posterior temporal (T6) area. Also, there are abnormalities for high beta (18-30 Hz) stemming from primarily the right posterior area (02). Both findings are substantiated by LORETA analysis and resembles TBI or other brain damage…

…The TBI index indicated that there was an 85% probability that the patient’s brain is functioning as if there is a TBI 0.95 on a scale of 0-10.”

This was the first confirmation of the cognitive dysfunction that I have been living with for the last few years. Doctor after doctor told me that my symptoms were not real and somehow made up (and some still do, as the QEEG is used mainly in research circles and not always accepted in conventional medicine). The QEEG clearly showed the abnormal electrical activity underlying my symptoms. Next up, the SPECT scan, a test I had to fight for, because again, no one seems to believe that a drug like Lexapro could cause such damage.

SPECT Scans

SPECT imaging shows brain activity (blood flow, which represents local brain metabolism and energy use). The technology uses radiolabeled isotopes that are then reconstructed with algorithms to display in color 3-D images of brain activity. The images below are some of my brain scans. Regions displayed in blue represent a state of very low activity called hypoperfusion and those in red represent hyperperfusion – excessive activity.

SPECT scale
Figure 1. SPECT color coding scale.

 

CF spect scans
Figure 2. Brain activity after long term Lexapro use.

From my images, you can see several areas of both abnormally low and abnormally high activity with very little normal brain function anywhere. From the report:

  • At rest, the overall cortical activity was reduced in a diffuse, decreased, patchy pattern.
  • Focal areas of abnormal cortical hypoperfusion were noted in the bilateral anterior frontal (L>R), left posterolateral frontal, left orbitofrontal, right dorsolateral prefrontal, bilateral anterior and medial temporal (L>R), bilateral superior parietal and bilateral occipital areas.
  • Focal areas of abnormal subcortical hypoperfusion were noted in the anterior aspect of the pontine portion of the brainstem, bilateral caudate and right lentiform areas.
  • Focal areas of abnormally increased cortical perfusion were not noted.
  • Focal areas of abnormally increased subcortical perfusion were noted in the bilateral thalamic and left lentiform areas.

The doctors conclude:

“The nature (diffuse, patchy), location (cortical and subcortical), and pattern (involving all lobes of the brain) of these abnormalities is primarily consistent with the scientific [literature] pertaining to a toxic/hypoxic/neuroinflammatory process and the patient’s clinical history, as obtained, of a medication reaction which was received after the blind review. These results agree in large part with outside EEG data showing hypofrontality and NM report showing left frontal abnormality, likely not to be artefactual.”

What This Means

My brain is a mess. According to the Hormones Matter editor, the areas of low activity in the various regions of the prefrontal cortex would explain my difficulties executive function, things like planning, decision-making and lack of concentration, while the reduced activity in the temporal and occipital lobes would explain my memory and vision difficulties, respectively. The reduced brainstem activity would connect to my walking and balance difficulties, but also, poor to autonomic regulation (the autonomic nervous system controls all automatic bodily functions including things like breathing, heart rate, temperature control, digestion, sleep/wake cycles, etc.). The areas of my brain on hyperdrive may reflect compensatory reactions, last ditch efforts to kick start some of the underactive regions. The thalamus (plural thalami), in particular, acts as a relay station between the brainstem and the rest of the brain for motor, sensory signals and ‘emotional’ signals via its connections to the limbic system. Mine seem to be screaming ‘wake up’ to the rest of the brain.

Please be careful using these medications, particularly psych meds and especially when prescribed for minor issues like a fear of flying or work-related stage fright. If I knew then what I know now, I would have never taken Lexapro.

*TBI: traumatic brain injury

Update: Neurocognitive Testing

In October 2017, I had a battery of neurocognitive assessments. The results have only recently become available (March 2018). According to the report, the decrements in cognitive ability were consistent with the QEEG and SPECT results indicating probable neurotoxicity with brain damage. Some of the findings included:

  1. An approximately 9 point drop in IQ from premorbid (pre-medication reaction) levels.
  2. Impairment of perceptual reasoning, working memory, processing speed, and full scale IQ (FSIQ), which is now at the 7th percentile.
  3. Significant declines memory function including auditory memory, visual memory, visual working memory and immediate memory (2nd percentile).
  4. Significant decline in manual dexterity with performance below the 1st percentile.
  5. Severe decline in executive functioning.

According to the doctor’s assessment:

“The neuropsychological testing indicates disability from gainful employment for the foreseeable future. The results of this work is a diagnosis of Toxic Encephalopathy (ICD 10 G92); DSM-5 Substance/Medication Induced Major Neurocognitive Disorder (ICD F13.97).”

He also indicates that

“…the abnormal neuropsychological findings consistent with neurotoxicity; personality testing consistent with neurotoxicity; abnormal advanced brain imaging and QEEG findings; and no other reasonable explanation for the claimant’s illness and resulting disability, in my opinion, Lexapro and associated drug interactions caused this neuropsychological decline.”

Again, I cannot stress strongly enough how dangerous these drugs are. Please consider my story before taking these medications.

Postscript: In 2020, I had an evaluation by an independent forensic medical examiner. She concluded:

Within a reasonable degree of medical certainty, it is my opinion that the decline in your health has been caused by the combination of DNA variants for several CYP450 genes, with reduced metabolic capacity together with prescription psychoactive medication which caused drug-gene, drug-drug and drug-drug-gene interactions leading to severe toxicity and consequently brain damage.

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A Kindled Brain: Long Term Lexapro Use Reactions

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One year ago, I was living the American dream, a father of two young sons, active, social, traveling sales person. All of that was taken away from me because of a pill. I never had any history of mental illness or even anxiety for that matter. I “sold myself to the devil” as they say by taking a medication that I was told would help me with some fears with public speaking. I am now paying the price for that decision.

Fearless and Careless on Lexapro

I was always the social person. Class clown, outgoing and had a lot of friends. I wasn’t the best student but because of my outgoing personality, sales was a no brainer for a career. In late 1990’s in early 2000’s most of my friends (including me) were getting married. I was often asked to be the best ma. I noticed I was uncomfortably nervous during those speeches. I also noticed I would often experience this feeling during my work presentations. Plus, I had a fear of flying on airplanes which was a job requirement. I decided to talk to my doctor about it and he suggested a psych. I went to see the psych for only three weeks but he changed the course of my life with just a couple of strokes of a a pen on a piece of paper. This doctor prescribed a pill. A pill that many say “re-wires” the brain. The medication he suggested was Lexapro. I had never heard of Lexapro, but back in 2001, anti-depressants were taking off.  You may recall the TV series, The Sopranos.  It was a hit cable series that featured characters that as soon as anyone had any issue pop up, the doctor prescribed an antidepressant. It seemed to me that they were making a joke of the concept that everyone on the show needed a medication to function.

In 2003, during the peak of that wave, I started Lexapro. Within weeks, I was transformed into someone who feared nothing. Everything became much easier for me. I could present to large audiences. My fear of flying disappeared. My career took off. I became even more social, feeling confident in any setting. I enjoyed being the center of attention. I then started making changes in my life. I got divorced. At the time, I felt that I did not need to put up with anything if I didn’t want to. It was hard, as I had two young sons, but I felt it was the right move for me at the time. Looking back it was a cold move (and I handled it poorly) but I was laser focused on what I wanted to do. I became much more comfortable and flirtatious with women (not in an obnoxious way). At the time, I wanted to be free. In so many ways, in my mind, I was an improved person. It wasn’t until the last year that I realized how wrong I was. I took Lexapro for 15 years. I never looked back. Until now.

The Slow Build up of Symptoms: Lexapro Rejection

Fourteen years later, after living quite a normal, active life, I began to struggle with my health. I had a girlfriend (an angel-she’s been by my side throughout), two wonderful sons (now 13 year old twins). However, in the beginning of 2015 I started having a lot of dizziness, stomach issues and low sodium counts in my labs. I was diagnosed with IBS. In addition, doctors thought I had a stroke in one trip to the ER. The possibility of a stroke was  was supported by a CT scan but then later overruled by an MRI. They diagnosed me with a TIA (mini stroke), but I didn’t buy it and carried on with my life. It wasn’t until later that I realized my body was rejecting Lexapro.  In June 2015,  after several months of continued low sodium counts in my blood and dizziness,  my doctor suggested I come off Lexapro. In late November 2015, being off Lexapro for 5 months,  I was improving slightly. However, I was growing impatient with my improvement and was also was planning on starting a new job in January 2016. I wanted a quick fix and wanted to be “grounded” for the job I was so excited for. I went to my doctor and he suggested going back on Lexapro.

A Kindled Brain

The first pill I took something seemed off. There was a burning feeling in my head along with a headache. I started to feel some increased anxiety as a result. My brain felt impaired. I don’t recall this feeling at all during my first go-around with Lexparo. I called my doctor and he said all of this was normal. Increase the dose. I did as I was told.

The burning increased. The head pressure feeling I had was horrific. I was scared. I called my doctor and this time the nurse said he was very frustrated with me. He said not to go off the Lexapro. That these were normal symptoms. I disregarded his suggestion and I went off the medication. The reinstatement was eight days in total. For the next three weeks, I dealt with horrible dizziness, head pressure, and confusion. For example, I backed my car out of my garage before it was finished opening, taking off my antenna and knocking the garage door off the track. My life was falling apart. I was excited to start the new job, but was now nervous I would not be able to do it due to my health.

The Lexapro Firestorm

Then Christmas Day came. The day my life completely crashed. I woke up with cognitive impairment, anxiety, and fear. I later found out the fear, anxiety, stress emotions are controlled in a part of the brain that the medication touches. I knew it was serious and from that point forward, I would never be the same. It was an electric, chemical feeling that was relentless. I was so wired with stress, that severe insomnia set in. After a few days, I went to my doctor, and at this point, he was tired of me. He called me a “complex case” and suggested I go back on Lexapro and suggested I see a psychiatrist. The last time I saw a psychiatrist was 15 years prior for the 3 weeks when I was put on Lexparo for “meeting nervousness.” I reluctantly went. She felt I was making up the symptoms in my head. She would not be the first person to tell me that. She also suggested I go back on Lexparo as well.

I went on disability with my current employer. I continued to decline. I went to dozens of doctors. No one understood. Some felt bad for me. Some said that meds could cause adverse reactions but no one would commit. Some thought just because it was an anti-anxiety med I had a problem with my mental health or I may be making up my symptoms. With no history of mental illness at 49 years old someone who is living the American dream comes up with a mental disorder overnight, the same week of reinstating a medication that is proven to rewire the brain, is it coincidence? I don’t think so. The chemical anxiety and head pressure did leave my system within weeks of stopping Lexparo, which was proof to me that this wasn’t in my head as suggested by some doctors and that it was caused by the medication. However, fatigue did set in, I imagine, due to the stress of all of this. I was eventually diagnosed with Chronic Fatigue and then Fibromyalgia.

One Year Post-Reaction

I wish this story had a happy ending. It is now December  2016 and the fatigue has worsened to a point where I am mostly bedridden. Watching TV is difficult. Luckily, for all you readers, I can still type. After months of frustration of getting limited knowledge of medication reactions, I started researching. I also discovered mitochondrial damage and neurotoxicity. From what I understand, it can happen from infections, chemicals and medications. I have found many like me who have had reactions from anti-anxiety and antibiotic medications, as well as vaccines. I am optimistic as I am currently having a dialogue with a neuropsychologist that actually believes in and helps victims of neurotoxicty. She seems to be in my corner which I’m grateful for. Its a lonely feeling being in this position. I also bumped into Dr. Marrs’ article on Orexin destruction from adverse reactions . I think this is may have been what has happened to me. The physical fatigue is one thing but the mental fatigue/sleeping pill feeling is what is the most disabling.

Based on the research, it is my theory, that I have had an adverse reaction or “kindling”. A kindling is a reaction or stimulus that causes agitation or anxiety, stimulating the brain for a period. Once the chemical (in my case, Lexapro) source is removed, the stimulation will eventually reduce, and the person, more than likely, will be left with severe mitochondrial damage. I wake up daily feeling as if I never slept; more tired than when I went to bed. I struggle to read or follow TV because of the impairment.

My lifelong dreams may be over or at least on hold for a while. When I explain to people what has happened to me they can’t believe someone’s life can be turned upside down by a pill. I am shocked that of the thousands of people I know in my situation, doctors do not know how to either diagnose of treat them. Instead, we are diagnosed with CFS or depression. What I am most shocked about is how doctors can prescribe these pills without understanding what they  do to the brain. Part of me feels this is “karma” as they say — like I sold my soul to the devil to take a pill that would improve my life in many ways, but ultimately, it destroyed me. I pray for a happy ending.

Articles suggest that people with TBI’s often end up with low orexin/hypocretin and excessive sleepiness. Articles suggest that people with suicidal depression often have low orexin. They also say that stress causes orexin deficiency. These same articles, as well as Dr. Marrs’ work, suggests that these levels can improve, by removing stressors and properly repairing mitochondrial functioning. I want to thank Dr. Marrs for allowing me to write this and share my story with you. I hope I didn’t frighten anyone with my story. I doubt “Dateline” or “20/20” will be coming to my house to interview me in the near term, but I do think there will be a day that there will be more public awareness of the damage medications can cause to the body.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Image by Gerd Altmann from Pixabay.