Mattie: tapering off Pristiq

[Mattie]

@Altostratathe lightheaded and dizziness has intensified since I’m taking split doses but I feel a little better earlier since I’m taking split doses however my symptom pattern has changed. My usual evening windows are not as soothing, I still feel the depression and basically I’m up and down all day where as before on my once daily dose I was extremely tired and drained and depressed all day but would almost completely lift in the evening but I was less lightheaded. When I was on 25 mg, I was lightheaded as well but I think it’s worse now, some days are worse than others, do you think possibly because by taking split doses the inconsistency of the amount of drug in each dose could be affecting me since I’m so sensitive? My compounding pharmacy told me it is not possible to get exact dose to dose, close but not exact.what are your thoughts 

 

 

 

[Altostrata]

Your symptoms may simply be the effect of Pristiq.

On 11/22/2022 at 4:42 PM, Altostrata said:

If you felt lightheaded and foggy when you were taking 25mg Pristiq and you feel lightheaded and foggy now that you're reduced to 20mg or 18mg, it doesn't sound like "lightheaded and foggy" are withdrawal symptoms from Pristiq.

 

It sounds like you were either lightheaded and foggy from cold-turkeying Prozac in December 2021, or Pristiq makes you feel lightheaded and foggy.

 

Since you've made so many drug changes and probably had withdrawal syndrome all along, you might consider a switch again to Prozac, and simply take 5mg Prozac for some months to stabilize before tapering again -- from Prozac.

[Mattie]

@Altostrata, so in August 2021 I took Prozac 10mg for 58 days and I was very depressed and ill on it ,Could that have been from previously taken pamelor for a few months withdrawals and not the 10 mg Prozac, like if I would have taken 10 mg Prozac longer I would have stabilized?

[ChessieCat]

Pristiq / desvenlafaxine is an SNRI - serotonin norepinephrine reuptake inhibitor

 

Prozac is a an SSRI - selective serotonin reuptake inhibitor

 

Pamelor / nortriptyline is a TCA - tricyclic antidepressant

 

The following might explain a bit more about the differences.  However I am not sure how accurate/scientific the information is:

 

https://teacherscollegesj.org/what-is-the-mechanism-of-action-of-tricyclic-antidepressants/

[Altostrata]

24 minutes ago, Mattie said:

@Altostrata, so in August 2021 I took Prozac 10mg for 58 days and I was very depressed and ill on it ,Could that have been from previously taken pamelor for a few months withdrawals and not the 10 mg Prozac, like if I would have taken 10 mg Prozac longer I would have stabilized?

 

I have no idea what was going on in August 2021. It seems likely you have had Prozac withdrawal since you went off in 2020 and every drug you've taken since then has made it worse, including doses of Prozac that were TOO HIGH for your sensitized state.

 

Quote

2020 slow taper to 4.25 mg crashed.

 

Since you had withdrawal from going off Prozac in 2020, it's more likely you have had continuous withdrawal from Prozac than a new withdrawal syndrome from Pamelor or anything else.

[Mattie]

@AltostrataSo should I make a direct switch from pristiq to 5mg Prozac?

[Altostrata]

I don't know. As long as you're taking Pristiq, you'll have adverse effects from Pristiq. Tapering off may take many months. On the other hand, a switch to Prozac might be bumpy. What do you want to do?

[Mattie]

@AltostrataWhat about switching to Effexor extended release and removing beads would that be an option or no 

[Altostrata]

Pick whatever you think will work best. Your guess is as good as mine. Stay on Pristiq if you want.

[Mattie]

Sorry, but I’m very scared, I’ve been through so much and I get real panicky about switching meds but I know I can’t stay like this , I hope I haven’t offended you, I really don’t know what to do 

[Altostrata]

If you've been "lightheaded and foggy" all the time that you've been on Pristiq and you're still "lightheaded and foggy", it appears Pristiq is either causing those symptoms or not helping them.

 

What symptoms have improved since you started taking Pristiq? Do you want to stay on Pristiq and continue to taper it?

[Mattie]

I don’t feel like I can continue with the pristiq because I’m not stabilizing and it’s been a few months on this current dose. The only improvement since I started taking it twice a day is I’m less fatigued . I’m scared if I make another drop I’ll feel worse than now and I can barely survive what I’m going through now 

[manymoretodays]

Hi Mattie,

Oh boy.....you are thinking of a drug switch now?  I always thought the devil you know is better than the devil you don't know.......or it goes something like that.......the saying.

Do you want to do a day of NOTES, or 2?  That would show us more, most likely.  Are you feeling up to that?

I'm reading you are feeling very distressed lately.  Is it the holiday season having it's way with you?  You know, regrets, loneliness, or old family wounds come alive again??  That can happen for some.  And in a super-enhanced way during WD.

 

Have we gone over perhaps trying to move your doses back together again?  I'm just getting up to speed after being on the road and out for a little bit.  So......if you don't mind, update me a bit here./

 

Non-drug coping?  Anything that helps now.  What practices do you do?

 

Okay, hi and hugs Mattie.

 

L, P, H, and G,

mmt

Edited November 26, 2022 by manymoretodays
it not is is

[Altostrata]

3 hours ago, Mattie said:

The only improvement since I started taking it twice a day is I’m less fatigued .

 

That's a good sign. You were taking it incorrectly for a long time. 

[Mattie]

@manymoretodays, Yes I will do a couple days of notes for y’all, I know switching meds will be leaving one nightmare for another and the unknown is so scary especially with my past experience of switching meds, I can literally feel the poison for a few weeks with all the start up side effects, I really don’t know what to do.I know I can’t stay like this, I have to make a decision. If I stay on pristiq, at what point do I make another step down? I’ll start my notes today and post in a couple of days, thanks to you and altostrata and cheesiecat for trying to help me. I greatly and sincerely appreciate all of you ❤️

[Altostrata]

10 hours ago, Mattie said:

I really don’t know what to do.I know I can’t stay like this

 

Is this the thinking that has led to so many drug changes?

[Mattie]

@altostrataBeing misinformed from my Pychitrist is what led me to all the drug changes, every time I would see him and he would ask how are you feeling and I would tell him terrible he’d change my meds. I trusted him. Boy was I stupid 

[Mattie]

I’ve made a horrible mistake, I tried reinstatement of 25 mg from 18mg pristiq CANT FUNCTION. It is day 13 , can I go back down to 18 

[Altostrata]

You can take any amount of Pristiq that you want. 

 

You may note we have cautioned you repeatedly against more drug changes. As peer support, we cannot keep you from making your own problems.

[Mattie]

I hadn’t stabilized in almost 4 months on 18 mg once daily and then 2 and 1/2 months split dose total of almost 7 months on 18 mg and depression getting worse and worse the last few weeks and unbearable dizziness so I panicked, my family and friends kept saying you have to do something, so I just caved 😞

 

 

[Altostrata]

@Mattie I've explained to you many times why you didn't "stabilize" on 18mg Pristiq once daily -- you have to take it twice a day. 

 

You need to understand that you cannot cut up a Pristiq tablet and take it just once a day. Increasing the dosage of a once-daily split tablet is not going to help. You have to take it twice a day.

 

We're just an Internet peer support site. You have to do a lot of the understanding and work yourself. We can't fix it if you do not have control over your own dosing.

 

I am sorry that your situation is too complicated for Internet peer support. We're not going to be able to help you with your problem.

[Mattie]

But I’ve been on split dose Over 2 1/2 months, and seemingly getting worse and worse, should I have waited it out and would have eventually stabilized? I’m sorry if I upset you, that’s the last thing I intended to do

[Altostrata]

58 minutes ago, Mattie said:

should I have waited it out and would have eventually stabilized?

 

YES

[Mattie]

So last time I posted I had reinstated from 18mg compounded pristiq (split dose 9mg am and pm) to 25mg pristiq once daily (big mistake)my body and brain completely rejected it. After 15 days I went back down to 18 mg split dose and started to feel a little better after a couple of weeks. I then decided to bridge to lexapro 5mg . It was very rough the first 4 weeks but has since calmed down. I feel a lot better now than I felt on the pristiq. With that being said I’m nowhere near baseline. I’ve been on lexapro for 8 weeks now . My question is at what point do I start tapering off ? Do I give my body a couple more months to see if it settles more? I have all the same symptoms as I did on pristiq but to about a 30% lesser degree which is so much more bearable. Thanks 

[Altostrata]

On 3/27/2023 at 8:10 AM, Mattie said:

After 15 days I went back down to 18 mg split dose and started to feel a little better after a couple of weeks. I then decided to bridge to lexapro 5mg . It was very rough the first 4 weeks but has since calmed down. I feel a lot better now than I felt on the pristiq. With that being said I’m nowhere near baseline. I’ve been on lexapro for 8 weeks now . My question is at what point do I start tapering off

 

See Tips for tapering off escitalopram (Lexapro)

 

Please confer with your prescriber about what to do next.

[Mattie]

Altostrata, my prescriber will definitely give me the wrong advice as he has already suggested add ons . This will be the last antidepressant I will ever be on , I can promise you that. I apologize for not following your advice in the past but I had to get off the pristiq, it was literally killing me. I read about bridging and I felt like it was my last hope and fortunately it worked for me. I want off this poison and I hope you would reconsider helping me because I have the utmost respect for you and your peers and this group, thanks 

[Altostrata]

On 3/27/2023 at 8:10 AM, Mattie said:

After 15 days I went back down to 18 mg split dose and started to feel a little better after a couple of weeks. I then decided to bridge to lexapro 5mg . It was very rough the first 4 weeks but has since calmed down. I feel a lot better now than I felt on the pristiq. With that being said I’m nowhere near baseline. I’ve been on lexapro for 8 weeks now .

 

As explained to you repeatedly, you cannot take immediate-release Pristiq only once a day. You were causing your own problems by doing that.

 

Then, when you changed to twice a day dosing, you were doing better -- but I guess too impatient to stabilize, so you decided to switch to escitalopram.

 

Since 2019, this would have been your 30th (?) drug change. I lost count after June 2022. You've been posting here since September 2022 but have paid little attention to the many tips from our staff and moderators.

Now you're "nowhere near baseline" and wanting to know when you can go off escitalopram. The answer is not now, probably not in the near future, probably not for months, because you're still destabilized from the dozens of drug changes you've insisted on over the last few years.

 

I understand that you want a solution, but sometimes it's not the drug or the doctor, it's the drug consumer who's the problem. It looks like you'll be nothing but frustration for peer support. We're not miracle workers, we're not saints, we give our free time to help people, and when we waste our time, this feels like exploitation.

 

Here are Tips for tapering off escitalopram (Lexapro). Good luck.

[Mattie]

Alto, In all fairness I have not insisted on all the drug changes in the past I put all my trust in Pychitrist like most of us do due to ignorance . Once I discovered this group my eyes where opened to the truth about Pychitrist and big pharma but I was in full blown withdrawals, sick, scared, almost nonfunctional. I stayed on pristiq for over a year and yes I was taking it wrong but didn’t know I was until I was informed and after taking it the right way I was still very ill and depressed and honestly couldn’t tolerate it any longer not because I was impatient but because it was making me ill and suicidal and besides that my pharmacist couldn’t make doses low enough to do the 10% or less taper. I did make a bad move when I tried to reinstate to 25mg but thankfully I felt back to how I was feeling on 18 mg in about 3 to 4 weeks which was terrible but better than 25 . I felt hopeless and stuck so I read up on bridging  on this website , after reading about bridging I decided to bridge to lexapro after reading a success story that I would give it a try because it comes in liquid form . I am stabilizing but not at baseline but more than I ever was on pristiq so I would say that’s positive and I have hope for the first time in almost 3 years. I’m sorry you feel I’m wasting your time and I would never ever intentionally exploit you or anyone . I appreciate you answering my question in spite of being so frustrated with me. I will hold for a few months and see if I can stabilize more before beginning my taper. Thanks again for your time. 

[Altostrata]

Let us know when you've taken 5mg Lexapro for 30 days, take the same dose at the same time every day.

[Mattie]

Alto, thanks , will do

[Mattie]

It’s been 95 days since I bridged from pristiq to lexapro. My symptoms have improved about 45to 55% most days  I’d say. The light headedness and over medicated feeling has lessened. I still feel tired and drained through out the day but to a lesser degree, my depression has lessened as well. I still get a very bad day here and there where I feel horrible, depressed, hopeless etc but definitely not every day like before. My motivation is slightly better, I can do more, push myself more but my mood is for the most part is blah , can’t feel excitement etc . I want to eventually start tapering off I just don’t know how long I should let things settle. Any suggestions? Thanks 😊 

[Altostrata]

Good to hear. How's your sleep? What times o'clock do you take your drugs, with dosages? Are your symptoms worse at any particular times of day?

[Mattie]

@altostrata, sleeping ok most nights averaging 6 to 7 hrs. Take meds (5mg) escitalopram every night 8pm. My symptoms are worse in the morning hrs and still have better windows in the evenings

[Altostrata]

How do you feel before and after you take escitalopram?

[Mattie]

@altostrata, before taking my meds I’m usually having a pretty good window after about 30 to 40 minutes I get a bit groggy and usually fall asleep on my chair. 

[Altostrata]

On 5/8/2023 at 11:01 PM, Mattie said:

I’m usually having a pretty good window

 

How long is this window? When does it start?