Stellie: looking for guidance - think I'm in the right place!

[Stellie]

Greetings to all learned ones!

After 22 years of one  AD or another, I have just begun my taper off my last med, 100 mgs. of Pristiq.  🤸‍♀️    My doc set me up with a 12.5 mg reduction.  I'm taking a 50 mg, a 25 mg and a halved 25 mg.  Didn't give me much specifics as to when I should move to the next taper.  He said "three to four weeks" but that feels a bit loosy goosey for me.  So, first question, what do I look for with withdrawal (or lack thereof) before moving on to next taper?  Are there other "signals" or symptoms that are better markers?   Today is day 23.  First, two weeks, nothing I couldn't manage with withdrawal, mostly anxiety, but that's been my claim to fame for 22 years.  Last few days however, anxiety had upticked.  Of course, like most Americans, I just came through the madness of the election and the ongoing pandemic so who's anxiety wouldn't have been piqued!! But, at 23 days into the taper, is anxiety an expected withdrawal symptom??  I am in NO hurry here.  Just want to mitigate the discomfort of the anxiety all day long.  What have folks tried for soothing the anxious stuff?   I have benzos available but want to avoid 'em.  Also, trying to plan for the ongoing taper and what else is in the bag of tricks known as withdrawal.  Any help is greatly appreciated!   Power to the Taper! 

 

[ChessieCat]

Hello Stellie and welcome to SA,

 

I can say YES absolutely, you have come to the right place.  And you've also got the right mod on your case.  I only say that because I've been tapering Pristiq and I'm about to reduce to 0.5mg this weekend after starting at 100mg.

 

Anyway down to the routine stuff.  Please create your drug signature.  Include ALL drugs/supplements, current AND previous.  Follow these instructions:

 

Instructions:  Withdrawal History Signature
Account Settings – Create or Edit a signature

 

SA's recommended taper is to reduce by no more than 10% of the current dose followed by a hold of about 4 weeks.  This allows the brain to adapt to not getting as much of the drug.

 

It is really good to see that he is tapering your drug.  Your current dose of 87.5mg is a 12.5% reduction so is slightly more than SA's recommended 10%.  However, when you are taking a higher dose of a drug people can sometimes make a larger reduction.  My suggestion would be to hold for a total of 6 weeks before making a 10% reduction.  Calculation 87.5mg x 0.9 = 78.75mg.  If you decide to round, round up, not down so as to stay under 10%.

 

Pristiq is a nuisance of a drug to get off because of the limited doses available.  In Australia we cannot get 25mg.  But it is okay to cut the tablets (see Post #1 of the Pristiq topic linked below) but because of the shape you might not be able to get consistent doses and consistent dosing is very important.  I get my tablets compounded.  I have posted about this in the Pristiq topic.  You will be able to use tablets and make up the balance of the dose with compounded tablets if you can get them.  I get slow release formula added.  Once you get under 25mg it would be better to dose twice daily to reduce interdose withdrawal.  I didn't dose twice daily until I got to 10mg.  I just didn't think about it.  And I've been taking uneven doses, not halved.  Anyway check out the Pristiq topic.  I think I posted all about it there.

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Tips for tapering off desvenlafaxine (Pristiq)

 

This is your own Introduction topic which is the best place to ask questions about your own situation and to journal your progress.

 

And a message from SA's founder, Altostrata.  There is a link in my drug signature to a recent podcast interview she did.

 

  

On 11/7/2020 at 8:23 AM, Altostrata said:

 

This is such a vital community because members help each other. It wouldn't be what it is without that mutual kindness and attention.

 

One of the things that's very important to each person here is knowing that healing is possible. Please don't just go away when you feel better! "Pay it forward" by updating your Intro topic with your progress and come back to post your success story when you are finally clear of all those awful symptoms.

 

 

 

 

Edited November 11, 2020 by ChessieCat

[Stellie]

Hello back Chessie Cat and thank you for the warm welcome!  I popped a tear reading your response...just so grateful to be among others who know the score and bonus for me, you too are doing the same dance away from Pristiq.  Congrats on your taper.  I brought the 10% taper info to my doc and well, he didn't make a change.  Just suggested the 12.5 reduction was "close enough."  Well, the anxiety after 3 weeks is also really close.  AARRGH!   Anyway, it is easier to get the Pristiq here in smaller doses.  I'm quite a distance from the compounding need but it's good to know it's out there.  I hope I provided the signature info you requested properly.  Please advise if not.  I will keep up at this level now for two more weeks.  I like the six week plan, then onto as close to 10% as I can get.  Thanks for that tip.

Best regards.

[ChessieCat]

You are very welcome.  I'm glad I've been able to help.  If you look at my Intro title it is "so I'm not the only one".

 

Another member, Fresh was cutting and weighing her tablets before she started compounding.  It's important to get a consistent dose, especially the lower you get.

 

The only supplements which SA recommends are magnesium and fish oil.  Try a small amount one at a time to see how you react.  Only make one change at a time, and that includes making a reduction.

 

Magnesium

Omega-3 Fish Oil

 

SA strongly encourages members to learn and use non drug coping

 

Non-drug techniques to cope

 

There are lots of existing topics.  Use a search engine and add site:survivingantidepressants.org to the search term.

 

I also suggest that you do your research BEFORE starting anything, and that includes prescription drugs.  Do a drug interaction and check side effects and search on SA.

[ChessieCat]

On 11/11/2020 at 12:09 PM, Stellie said:

What have folks tried for soothing the anxious stuff?   I have benzos available but want to avoid 'em.

 

Magnesium can help with anxiety.  Link in previous post.

 

If it was me I would be avoiding benzos like the plague, or covid!  It can take as little as 2 weeks to become dependent and if you go on and off them continually you can become kindled.  You can also experience interdose withdrawal which is often worse anxiety.  Benzos also only really work for a short period of time and then after people stay on them because they suffer withdrawal symptoms going off them.  We do have members taking benzos but most of them have been on them before joining SA.

 

It is better to taper at a slow enough rate so that at the worst you only experience mild withdrawal symptoms.  Some members have tried to go too fast and in the end it has taken them longer ,and some have ended up on an extra drug which then has to be tapered, than if they had done a nice and careful taper.  Throw out the calendar.  I was hoping to be off by my 60th birthday, I've just turned 63 and I've still got about another year to go.  But I'd rather do it and not suffer unnecessary that to go too fast and be miserable.

 

Stability

 

WDnormal

 

It is important to listen to your body/symptoms and hold when needed.  This can be at times of sickness or added stress.  Even good stress, like holidays/travelling.  We have members who hold over Christmas.  If you are still menstruating you might consider aligning your taper to your cycle. 

 

aligning-tapering-to-menstrual-cycle

[Stellie]

Thanks for the message!  Been doing Magnesium for about a month at the suggestion of my acupuncturist.  It definitely helps.  It's a powder mixed in liquid 2 x day.  I'm going to slow this first taper to a six week period, after thinking a four week frame. Then go to a 10% reduction and see how that goes.  I haven't taken a benzo in over a year.  I've made it through some pretty difficult days of kick ass anxiety without one so why start now?   If I want to weigh my cut doses, what do folks use?  some kind of digital scale I'm guessing.  Any recommendations?    I like this facebook upload.  Fell free to share.

 

[Gridley]

28 minutes ago, Stellie said:

If I want to weigh my cut doses, what do folks use?  some kind of digital scale I'm guessing

Many members who weigh use the Gemini-20 digital scale available on Amazon.

[Stellie]

Happy New Year to all!  Like many, my journey continues.  So far, so good!  Began tapering from 100 to 87.5 in mid October.  Stuck with it for six weeks.  I made my second taper from 87. 5 to 81.25 on November 30, 2020 after four weeks and my latest taper to 75 mg on December 4.  I will see how I'm doing after four weeks but in no hurry and will take it to six weeks depending on the mood.  I've used many of my skills and practices.  Daily meditation, walking for at least 30 minutes, and taking an online course in anxiety disorders and their biology. Very helpful to understand how our brain manages anxiety and what our thoughts can do to exacerbate it.   Also recommend two books: Lost Connections by Johann Hari and Deconstructing Anxiety by Dr. Todd Pressman.  Mostly I continue to learn to be with my anxiety and the ruminating as it comes...accept, accept, accept.  Blessings to all.

[Stellie]

Greetings to all.  It's been awhile since I've checked in.  My taper, which I began in October 2020, is still on track for now.  I've gone from 100 mg of Pristiq to 56.25 as of this past Monday.  The taper is 6.25 every four weeks.  The past two months or so, I've felt a slow uptick in my anxiety.  It started with being sort of snappish, easily irritated and has built into much heavier anxiety. Overthinking is my stock and trade...I thought I was mostly doing okay but this past week, I've hit a bump in the mood; Lots of crying, waking up with a tight stomach and already anxious before I hit the floor. I've continued to take magnesium and attend acupuncture weekly.  I've been missing my therapist for over a month due to her own health issues and that has not helped.  Lots of polyvagal breathing exercises, meditations and walks.  I hate like hell to go back up on the meds, even if it's just back up to 62.5 mgs. 

I'm encouraging myself to just keep at it.  Eventually, my brain will adjust to the smaller amount as it has done for five months already.  Keep up the good work everyone. 

 

[arbor]

Hello Stellie--I really commiserate with these awful w/d feelings.  You seem to be taking wonderful care of yourself.  I'm hoping this adjustment stretch calms down for you soon.  How is your sleep?  Are you able to get out and walk?  I appreciate your chart (above).  In fact, I'm going to consult with it for myself right now--

Thinking of you,

Arbor

[Stellie]

 

1 hour ago, arbor said:

Hello Stellie--I really commiserate with these awful w/d feelings.  You seem to be taking wonderful care of yourself.  I'm hoping this adjustment stretch calms down for you soon.  How is your sleep?  Are you able to get out and walk?  I appreciate your chart (above).  In fact, I'm going to consult with it for myself right now--

Thinking of you,

Arbor

 

[ChessieCat]

Once you got below 62.5mg, your reductions increased to more than SA's recommended 10% of the current dose.

 

If you have noticed withdrawal symptoms, then it is a sign that you are tapering too quickly.  My suggestion would be to do a nice long hold now, possibly 2 to 3 months and get stablised.  Once you reach withdrawal normal then it would be better to start tapering by no more than 10% of the current dose.

 

All the mentioned links have been posted by me previously.

 

Please update your drug signature whenever you make a change so that it remains current.  Thank you.

[Stellie]

Just now, Stellie said:

 

 

Thanks for the good thoughts Arbor. I get to sleep usually okay  but last few days, a little hard falling back if I'm up for the rest room. Walking is doable. Need a bit more consistency daily!! Appreciate your reaching out. It helps to have others helping  even from a distance. Blessings to you!

[Stellie]

12 minutes ago, ChessieCat said:

Once you got below 62.5mg, your reductions increased to more than SA's recommended 10% of the current dose.

 

If you have noticed withdrawal symptoms, then it is a sign that you are tapering too quickly.  My suggestion would be to do a nice long hold now, possibly 2 to 3 months and get stablised.  Once you reach withdrawal normal then it would be better to start tapering by no more than 10% of the current dose.

 

All the mentioned links have been posted by me previously.

 

Please update your drug signature whenever you make a change so that it remains current.  Thank you.

 

[Stellie]

Just now, Stellie said:

 

Thanks Chessiecat. I did only a 10% reduction this last time, which was just this past Monday. So, the NEXT taper should be by 10% of 56.25, my current dose, right?  Should I just go back up to 62.50 or leave it be?

Also please remind me how to change the drug signature.

[ChessieCat]

I'm a bit confused.  So that I know exactly what you have done, please post listing the dates you made your reductions and the dose you took at that time.  If you do not know the exact date just state early, mid, late and the month name.  Thank you.

[Stellie]

Thanks you ChessieCat.  okay here's the scoop.

 

Started at 100 MGs.

October 16 ,2020 to November 30, 2020   tapered to 87.5  (12.5 reduction)  over Six Weeks This was my Dr.'s call.  It was greater than 10%.

November 30, 2020 to December 28, 2020  tapered to 81.25 (6.25 reduction)  over four weeks

December 28, 2020 to January 25, 2021  tapered to 75  (6.25 reduction)  over four weeks

January 25, 2021 to February 22, 2021 tapered to 68.75 (6.25 reduction) over four weeks

February 22, 2021 to March 22, 2021 tapered to 62.50 (6.25 reduction) over four weeks

March 22, 23, 24, 25 began newest taper from 62.50 to 56.25    (6.25 reduction)  

March 26 (last night) Added back 6.25 mgs because of anxiety and possible return of symptoms which began earlier in the week.  Back up to 62.50

The last time I felt less anxiety overall was probably back in February sometime, possible around the time I was still at 68.75.  Doing the best I can to manage with the tools I have.

[ChessieCat]

Okay, so your reductions have been fairly close to 10%.  And you have been holding for about 4 weeks.

 

But you started feeling symptoms worsening early March.  When that happened it would have been better to hold for longer.  When we are tapering we need to listen to our symptoms and throw out the calendar.

 

Please be aware that it takes about 4 days for a dose to get to full strength in the blood and a bit longer for it to register in the brain.  Please do not go back to 68.75mg.  Your brain will already have made some adjustments to the lower dose.  Generally when you updose it is better to only increase by a small amount and not go back to the last dose (so instead of going from 56.25mg to 62.5mg you might have been able to go up to 58mg or 59mg.  However, because you had only been on the new dose for 4 days  going back to 62.5mg may be okay.

 

I think it would be a good idea to hold on 62.5mg for at least 8 weeks even if you feel that your symptoms have improved.  It is better to hold for longer than to start reducing again too soon.

 

One thing to understand is that Pristiq is an SNRI, whereas most other ADs are SSRIs, including all the other ADs you have previously taken.  That means that the action on your brain is different from an SSRI.

 

I have found Magnesium helps with my anxiety.  However if you wish to start taking it, wait at least 1 week before trying it, start with a small amount and only make one change at a time.  Also make sure that it is only magnesium.  Some contain B vitamins and some Calcium.  Magnesium works better for anxiety if taken throughout the day.  Also note that it needs to be take 2 hours apart from calcium.

 

 

 

[Stellie]

Thank you.  I'm throwing out the calendar.

 

Rather than screwing around any more, I went back to the 62.5 again last night (two nights in a row) and I'm going to stick there for awhile. I had only been 4 days on the 56.25 and I definitely felt some wonky stuff over the last few days.  I don't know how to determine how much 2 additional mgs. is, even if I wanted to add up to 58 or 59 like you suggested. I can split the 25 mgs. tablets only so far with the pill cutter. 

 

Question:  Do I start counting the 8 weeks hold on the 62.5 from Friday last week when I went back up to 62.5, or from Monday when I started the taper down to 56.25?

 

Yesterday, I really felt out of it, but got through the day,  rested much and recreated nicely in the p.m. with family and a good meal.  Today, midday as I write, there has been some improvement.  Evenings tend to bring more relief. Doing a lot of practicing challenging the intrusive thoughts.  I use a magnesium powder recommended by my acupuncturist.  And the beat goes on...

[ChessieCat]

3 hours ago, Stellie said:

Today, midday as I write, there has been some improvement. 

 

That's good to hear.

 

3 hours ago, Stellie said:

Question:  Do I start counting the 8 weeks hold on the 62.5 from Friday last week when I went back up to 62.5, or from Monday when I started the taper down to 56.25?

 

The hold starts from the last change you made, so when you went back up to 62.5mg.

 

3 hours ago, Stellie said:

I don't know how to determine how much 2 additional mgs. is, even if I wanted to add up to 58 or 59 like you suggested. I can split the 25 mgs. tablets only so far with the pill cutter. 

 

I suggest that whilst you are hold you investigate ways to get smaller doses.    If you cannot weigh the powder you could crush one (1) tablet in a mortar and pestle and then divide the powder up manually on a flat surface(see below about using paper) and use a flat blade, eg one sided razor blade.

 

You could try using 2 square of equal sized paper and fold them down the middle (and fold them back and forwards so that they will lay flat).  Place them one on top of the other with the bottom one sticking out further and divide up the powder on the top layer and then use the blade to move the portion you need onto the bottom paper.

[Stellie]

I just ordered and already received a mg. measurement scale.  Hopefully, this will make the tapering a bit more accurate. 

 

[Stellie]

Hi again!  so I'm still holding at the 62.5 mgs.  Will be three weeks this Friday that I've gone back up from the 56.25.  Anxiety is really hard the last week or so.  I did pretty well into Easter weekend and the Monday after.  Then, since Tuesday last week into today, the anxiety is rocking me out.  I'm still doing the Magnesium and added 300 mgs. of L-theanine.  Any thoughts about the taper and where I am right now with anxiety?  I don't really want to call the dr. about this. Don't want another drug.  I've avoided taking a benzo.  Don't like 'em and have gotten through without them before.  Just feeling crappy.  Any help is appreciated!  Thanks!

[Stellie]

Any responses greatly appreciated!  Since my last post, my anxiety has not improved.   I haven't changed the Pristiq; still at 62.5.  I talked with my Dr. a week ago.  He said, I can hold where I am, go back up on the dosage although he's suggested jumping right back to 75 mgs. from where I am at 62.5 or continue the taper.  Still haven't taken a benzo, so I'm glad for that.  I wonder about going back up...Any thoughts?  Worried (the anxiety talking) that it's a setback and disappointing but maybe an action I need to get some relief from this anxiety which is really taking a toll.  I'm just so confused...how did the taper go so well for four months and now I feel like I've fallen down a hole??   thanks!

[Stellie]

Hi again.

I could use some help!  Still holding at 62.50.  Advised by Chessie Cat to do 8 weeks from the last dose change which was March 26.  Today is 7 weeks.  Talked to my Dr. yesterday.  Options still the same; go up on the Pristiq, stay the course or continue the taper.  Anxiety is present, pretty much all day.  No real relief.  Just confused and obviously, the anxiety talking big time.  I'm disappointed to think about going back up but it's a quality of life issue for me.  So tired of it.  May have to go up to regain my composure and then start again to taper.  Thanks for any support and info.

[Altostrata]

@Stellie, how are you taking 62.5mg Pristiq, at what times o'clock? Are your symptoms better or worse at any times in the day?

[Stellie]

Thanks for the follow up!  I take the 62.5 every night around 10:30. I feel the worst anxious stuff upon waking in the morning. Not much improvement during the day. If you checked my previous posts, you'll see I went down on the med in March and after only 4 days, went back up to the 62.5. 

 

[Stellie]

Also I take a 50 mg tablet and a half of a 25 mg as a dose. I don't want to go back up but I need some anxiety relief. Is going up by 6.25 (10%) recommended or a smaller bump? My Dr. said go up to 75mg. So confused and annoyed trying not to make it worse...

[Stellie]

Pristiq Taperers! Please offer up any suggestions. I'm holding at 7.5 weeks at 62.50 mgs. Anxiety bad throughout. Do I go back up to last dose or carry on with taper?  I'm worn out. Any help or feedback os appreciated. 

[Altostrata]

Does the anxiety go away after you take Pristiq every evening?

[Stellie]

Not than I notice since it's right before bed. I wake up with the anxiety however, and accompanying nausea. 

[Stellie]

Fellow Pristiq users...

It's been a while since posting.  After what I'd hoped was the beginning of the end of use, I was encouraged by my dr. and psychiatrist to bump back up on the Pristiq.  Big disappointment but holding for over two months at 62.50 wasn't improving my anxiety and I feared continuing the taper.  Now, back at 75 mgs. after 8 days, my anxiety is a hot mess.  I'm still avoiding the Ativan but feel like crap most days.  I'm dosing in the a.m. which probably accounts for the hard anxiety in the morning.  Is this normal to have an uptick in anxiety when going up on the dose?  I'm doing about everything in my power to manage.  Meditation, breath work, exercise, magnesium.  Sleep is okay, thank god. Any support or ideas would be welcome. 

 

[Rhiannon]

Hi Stellie--

 

I know this isn't the kind of help you need, and I am so sorry for your suffering and sorry I can't offer anything that will alleviate it quickly or even very fast at all. But with your history it really looks to me like what you need now is a long hold, many months, maybe a year, and then a very gradual taper. 

 

Here's something I put somewhere else that I think applies: 

 

 

Please remember that your body was not prepared for the kind of chemical disruption these drugs cause and it has done its best over the decades but it's a very imperfect and approximate process.  Unlike healing bones or other injuries, our bodies have never evolved ways to detect and heal the kinds of cellular biochemical changes caused by these drugs. They use the tools they have but it's like trying to fix a crumbling wall with--musical instruments. Not the right tool so it's not very efficient.

 

However we DO see that even people like you and me with multiple decades on these potent drugs can recover, gradually. It's just not a quick process.

 

My very best wishes to you. Please love yourself and be patient and avail yourself of all the good support you can get, here and elsewhere in your life.

[Stellie]

On 6/19/2021 at 5:04 PM, Rhiannon said:

Hi Stellie--

 

I know this isn't the kind of help you need, and I am so sorry for your suffering and sorry I can't offer anything that will alleviate it quickly or even very fast at all. But with your history it really looks to me like what you need now is a long hold, many months, maybe a year, and then a very gradual taper. 

 

Here's something I put somewhere else that I think applies: 

 

 

Please remember that your body was not prepared for the kind of chemical disruption these drugs cause and it has done its best over the decades but it's a very imperfect and approximate process.  Unlike healing bones or other injuries, our bodies have never evolved ways to detect and heal the kinds of cellular biochemical changes caused by these drugs. They use the tools they have but it's like trying to fix a crumbling wall with--musical instruments. Not the right tool so it's not very efficient.

 

However we DO see that even people like you and me with multiple decades on these potent drugs can recover, gradually. It's just not a quick process.

 

My very best wishes to you. Please love yourself and be patient and avail yourself of all the good support you can get, here and elsewhere in your life.

 

[Stellie]

Hi Rhiannon and thank you so much for your kind and helpful reply.  I really fought the good fight to not increase the dosage but eventually just made the move.  It's day 12 of the increase and my nausea and anxiety are bad.  I think there may be some tiny improvement in that I'm not having crying jags about the situation and how tough the going is.  That helps me not make it feel so catastrophic.  I appreciate all you said about how rough these meds are on our sweet brains and changes are no easy walk.  I haven't lost hope that some day I may revisit the taper process but for now, I'm here.  I'm glad you responded; I value the fact that you have been there and can possibly lend some guidance and support for those of us still out here doing our best.   Thank you again.