I created this page back at the end of 2015 and, after speaking with several other victims of metronidazole toxicity, have decided to update it.
Make sure to check out “Treatment” that will go into more detail about the mechanism behind metronidazole toxicity and ways to possibly improve or resolve all symptoms, including anxiety!
Metronidazole toxicity isn’t just about physical symptoms. According to medical literature (see homepage for links), approximately 1-in-3 sufferers will experience serious psychiatric side effects. After conducting more research and speaking to other sufferers, it has become clear to me that this statistic is just plain wrong.
Psychiatric issues are the most common symptoms of metronidazole toxicity.
Or, better put, having an “altered mental state.” Altered mental state is more accurate terminology here, because what is causing these symptoms is not due to an external stressor or chemical imbalance. It is due to injury to the back of the brain (see homepage for more information).
These are the most common psychiatric symptoms of metronidazole toxicity:
- anxiety (nonstop panic attacks)
- mental confusion
- disassociation (*derealization/depersonalition–definitions below)
- brain fog (can’t concentrate)
- crying spells
- obsessive thoughts (brain won’t quiet)
- insomnia (you start to fall asleep and then jerk awake in panic)
- lowering of your stress threshold (you can’t tolerate any minor stress)
- light and/or sound sensitivity
- suicidal thoughts
* Disassociation is the sensation that you are either detached from your surroundings (derealization) or detached from your body (depersonalization). I had derealization for after my toxicity; it felt like walking in a dream where all my surroundings were fake. I did not have depersonalization, but I have had many metronidazole toxicity sufferers complain about an “out of body” sensation–this is depersonalization. However, disassociation is not psychosis; you are aware that this sensation is not correct. The logical part of your brain is working, but the emotional side is not. With psychosis, you can’t tell.
In addition to these symptoms, there are some physical ones that go along with it:
- head pressure (typically either all over the head or at the back of the head)
- brain zaps (it feels as if there’s electricity running through your head)
- neck pain (usually starts at the base of skull and runs down neck to shoulders)
- heart palpitations (unable to calm down racing heart)
- constant, uncontrollable adrenaline rushes
For myself, the anxiety started two days after my initial reaction, but I’ve come to realize this is unusual. Most people experience the psychiatric issues before other symptoms manifest or at the same time.
Unfortunately, simply discontinuing metronidazole does not necessarily resolve these symptoms. Like other side effects, the emotional distress can linger until the brain has an opportunity to heal (aka, reroute neuro pathways from damaged tissue). Understand, this is why you are having psychiatric symptoms–your brain has been injured by this drug. It causes lesions to the back of the brain, including areas that affect personality:
- cerebellum (most hit area, less involved in personality than other regions)
- basal ganglia (affects a minority of patients–heavily affects personality)
- brain stem (affects 26% to 56% of patients, and controls the fight-or-flight response)
- nerves at the back of the brain, including the vagus nerve that’s been called the “2nd brain” (disclaimer: this is a speculation from other patients but not documented in medical literature)
Psychiatric distress is the way the brain reacts to trauma and, despite how absolutely horrible this is, it’s completely normal. It is also something out of your control. One of the first symptoms of neurological distress is a change in mood and personality. Concussions cause depression and impulsive behavior. The first sign of Parkinson’s is not tremors–it’s anxiety. The first sign of Huntington’s Disease is not involuntary movements–it’s aggression. Almost all neurological conditions have psychiatric symptoms. It is the same with metronidazole central nervous system toxicity.
It is not a matter of willpower. You are not weak; you are hurt.
For some, these symptoms will last a few days to a few weeks; for others, it’s a few months. Most people do recover or at least improve from the psychiatric effects. These issues seem to have the best rate of recovery compared to other issues of metronidazole toxicity, but this is something that can’t be guaranteed.
I know what a nightmare this is, and I am sorry you’re going through it. After I discontinued taking metronidazole, I could not calm myself down and didn’t understand why. I had almost all of the symptoms listed above, and it was the worst experience of my life.
Some patients can “wait it out.” Some try holistic supplements (sorry, I don’t know the specifics of those) and/or acupuncture. After six weeks, I was finally seen by a psychiatrist, who put me on mirtazapine, an antidepressant for major depression (before metronidazole, I was on nothing). By that point, I could neither eat nor sleep; I spent my nights staring up at the ceiling, feeling like electricity was rushing through my skull. I had lost 20 pounds. My legs twitched; my hands trembled. I would go into crying spells with no warning, and physically could no longer function at my job. My mother had to drive me to the psychiatrist because I was too weak to do so.
I had experienced a mental breakdown. I knew it then, but could do nothing to stop it. I tried cognitive behavior therapy, seeing a counselor at work, and was prescribed two other antidepressants by my primary care physician. Even though I insisted repeatedly that it was the metronidazole, they dismissed my symptoms as an anxiety disorder, and would not treat me for my adverse drug reaction.
My doctors told me that I should have been fine after the metronidazole was out of my system. “Surely it can’t be the drug,” they said repeatedly. Now that I’m mostly recovered and have done my own research, I can tell you with absolute certainly–it was the metronidazole.
After reviewing several case studies, speaking directly to dozens of other patients and reading hundreds of reviews, I have concluded that psychiatric effects are the most common issues with people suffering from this toxicity will experience. The words “mental confusion” and “confused agitation” had been used to describe the symptoms in medical literature. One case study is titled “Metronidazole-induced Psychotic Disorder.”
In fact, on the website, www.askapatient.com, metronidazole is the most reviewed drug on that site, and when it comes to psychiatric issues, there is no other drug that has the highest number of complaints.
So if you are suffering from psychiatric symptoms, know that it is the drug. It is not your fault. Even if you have ever suffered from anxiety or depression in the past, it is not your fault; in fact, you might be more pre-disposed to the effects of metronidazole toxicity.
As a patient, it’s difficult for me to offer a lot of suggestions on how to help with this condition. But I will say, when it comes to mental health, primary care physicians are NOT well-educated in what to do. They have a handful for antidepressants they know to prescribe; the drug I ended up on, mirtazapine, was one my primary care physician had never even heard of.
A couple of things:
- If you want to know the mechanism behind your psychiatric symptoms and how to treat it, then visit my blog’s Treatment Page. My research, including metronidazole toxicity treatment, has now been published on Hormones Matter, a medical online magazine (click here to read my article) and it has received a response article by Dr. Lonsdale, the co-founder of the Hormones Matter website (you can see his response article here). The treatment is cheap and easy, and something you can start TODAY.
- Know that, of all the symptoms of metronidazole toxicity, psychiatric disorders have the highest chance of complete recovery. It may just take some time.
- If possible, see a psychiatrist, not a primary care physician, for your mental health. A psychiatrist will have a better idea what drug (if any) you need to help you get through this. As an example, because of my acute, severe insomnia, my therapist put me on mirtazapine, which has a sedating quality. And yes, it helped greatly, but antidepressants have their own side effects. You are taking a risk with any drug you put in your body, so you will have to decide what is best for you. I highly recommend starting at a low dose; I was on half of the lowest dose and that did the job. It also made tapering off of it much easier.
- Don’t listen to your inner voice right now–it’s temporarily out of order. Distract yourself with comedies, relaxing/inspirational music, and guided meditations. Keep your own voice muffled as much as possible.
- If the weather’s good, take walks. Exercise can help.
- When you feel exhausted/fatigued, don’t push yourself. I tried to do this because everyone told me it would help–your body has gone through a traumatic event. Do what you can, but lay down when you feel the fatigue hit you. Other people don’t know what this feels like; you are the best judgment of your limits.
- You might have flare up’s. You will have good days and then a bad day–don’t let this discourage you. It’s part of the process and completely normal for damage to the central nervous system. Over time, you should see gradual improvement, but you will need to be patient.
Today, in August 2017, I am recovered from the psychiatric issues of metronidazole toxicity. It took about nine months from the initial reaction before the psychiatric symptoms faded, but it was not a coin flip of improvement, where one day I was horribly sick and the next I was all better. I was functioning and enjoying the “little things” in life after about four months, with episodes of emotional distress in-between. I had flare up’s, but even those subsided over time. After several months of tapering down, I stopped taking the mirtazapine at the beginning of 2017 with no negative effects. Today, I am happy and emotionally back to where I was before my reaction.
Your story will be different–your recovery might take less time or more. But if it does take longer, that doesn’t mean it won’t happen. Have hope, hold on–you’re doing great. Just hang in there.
Below is a video that really helped me. I listened to it when I tried to sleep, and while I still had insomnia, it greatly helped me get at least a little bit of sleep. Her voice is very robotic, which helps when you’re trying to sleep.
I hope this page has helped you. I am sorry you’re going through this and I wish you the best in your recovery. –Erin