Updated: Nov 8
I was often asked by patients: "Have antidepressants fried my brain permanently? is it brain damage?" My answer has always been no, it's neither brain damage nor is it irreversible. But to be honest, that answer is meaningless without first agreeing on a common understanding of what is considered "permanent brain damage". This is what I will address in this article. (I will also share my very recent MRI w/ contrast result.)
The first half of the equation: Brain Damage
Let's get the semantics straight out of the way: brain damage, or brain injury as a preferred term, is the destruction or degeneration of brain cells. This can either be chemical (i.e. neurotoxicity), physical (i.e. traumatic) or genetic/congenital in nature.
MRI and CT scans can very effectively detect gross brain injury. "Gross" here is an anatomical term that means macroscopic injury, which is counterpart to microscopic or histological injury.
The second half of the equation: Permanence
Recovery from brain injury depends largely on neuroplasticity. The brain is a reactively "plastic" organ, with neuroplasticity playing a significant role in re-shaping the brain depending on the type of injury and its severity.
Neuroplasticity is also responsible for learning, memory, and development of brain areas relative to one another.
Gross brain injuries aren't reversible or at best partially reversible given the state of current medicine. Okay, so is PSSD a (brain injury) and is it (permanent)? Now that we agree on the semantics, let's qualify PSSD.
1. PSSD is caused by chemical agents, right? A chemical brain injury is better termed as "neurotoxicity".
Antidepressants are not frankly neurotoxic substances. They do not cause gross anatomical damage identifiable by MRI or CT scans. Unlike several other neurotoxic drugs that do leave detectable changes (i.e. chemotherapy drugs, Olney's lesions, etc).
At most, I would qualify PSSD as a "maladaptive" response to a chemical agent, involving neuroplasticity. That's, in part, my hypothesis.
I do not qualify maladaptive neural responses as "brain injuries"; even certain life circumstances can actively shape your brain in maladaptive ways (i.e. PTSD, anxiety disorders).
Neuroplasticity is simply not neurotoxicity, no matter how little we understand about PSSD. Therefore, PSSD is not brain injury. Unlike, for instance, ALS, Alzheimer's or other neurodegenerative diseases that show frank brain injury on MRI.
2. What about the nature of PSSD? is it permanent?
This, too, comes down to the state of your neuroplasticity. There are so many cases of PSSD patients who have recovered spontaneously (and fully), but there are also those who have had PSSD for even decades without showing any signs of relenting.
Since I believe that PSSD is fully reversible despite profound maladaptive neuroplasticity, and that we just need to study and research its roots to be better equipped for treatment, then I'd reply by saying "Yes, it might be permanent in some cases, but not fully irreversible or unmanageable".
This is my evidence:
I've done several MRI scans throughout the years and they always showed normal results. There are also so many PSSD patients whom MRIs show normal result on PSSDforum, and some who shared theirs personally.
This is one I've done recently (a week ago), after ~half a decade of having PSSD:
Here's my full answer: PSSD is much more likely to be a maladaptive response to a chemical agent. It's definitely NOT gross neurotoxicity. It might be permanent without intervention in some cases, but I believe it's neither irreversible nor unmanageable given the right treatment.
Thanks for reading