Fast Pristiq Taper, seeking guidance after continuing struggles

[VincentA]

Short Story

After 6 months of being on 3 SSRIs and 1 SNRI, tapered from Pristiq for 1 week by cutting 50 mg pill in half. After being stuck in hypomanic like anxiety state for 6 months since i got off, seeking help on next move - small dosage reinstatement, go along with bispurone suggestion from doc, or other? I recognize reinstatement after such long time is contentious.

 

Current Symptoms
Anxiety (maybe hypomanic?), switching from distractibility to hyperfocus, brainfog, difficulty organizing thoughts, planning, lack of drive, motivation and sex drive. In the 6 months since i am off meds I had under a 7 days (total) where i felt present, calm, w/ reset nervous system - after a rare moment i was tired enough to nap. The rest of the time I was in an agitated, restlessness nervous state with distorted perception of time (highly accelerated). The higher stress, excitement, or other trigger like intense work session, the stronger the symptoms, which without significant rest, can lead to greater distress and extreme brain fog.

 

Long Story

I'm in my early 40s. My depression flared up after end of a long-term relationship. Pandemic isolation happened shortly after.  The immense stressors during this period caused bad anxiety.  I asked for anxiety meds but scored high for depression so I agreed to anti-depressants.

 

Cycled through celexa, lexapro, zoloft and ending with pristiq; all helped anxiety with mixed sideffects, such as removed drive and motivation, which specifically remained after the meds. My pristiq taper - was told to half my 50 mg dose for a week and get off.  I was not dissuaded from my suggestion of cutting my 50mg pill in half - i now know that was bad.

In weeks and months since (total 6 months now), I am unable to sustain cognitive performance w/o causing aroused state from which i find almost impossible to return from.  In fact a lot symptoms and triggers to a varying degree, except for the risky behavior, look like hypomania.  It started during the weeks after taper, with a hyper arousal, over-productive brain.  I never experienced something like that before and no bipolar history in me and family.  Psychiatrist's response is that its likely anxiety. Strange, as I never got so anxious I could not calm down before from stimuli of social night out with friends, working with a coworker, from an angry conversation, or even intense workout session.

 

In the early months of withdrawal, any sort of excitement/stress lead to insomnia, short term memory loss, or even disorientation in navigation (new to me) and I'm frightened to see time and my life passing so fast.  I'm unable to perform at any decent rate at work (work as engineer) so much I'm considering quitting or taking sabbatical if they'd allow me. I seem to have lost whatever drive i still had left before i got on the drugs.

 

Sleep stabilized in last 2 months. Most recently once or twice, I reached tired state and got a nap (common in the before-times).  This caused me to finally leave my 'hypomania'/hightened anxiety state, felt present, 'reset' back to normal and thought creatively, calmly for rest of day. Since i left the drugs 6 months ago though, I didn't experience more than 5-6 (individual) days like that.

 

Question

 

I don't know if this is hypomania or just a level of anxiety i haven't experienced or heard of before. I read that although people may get hypomania when getting on these drugs or upping the dosage, in rarer cases its possible to get it when stopping.

 

Given the slow rate of improvement, distress, mental performance at work, and inability to consistently get off feeling anxious state or slow down perception of time (despite doing supplementation, meditation, regular exercise), I'm debating either to go on anti-anxiety med like bispurone psychiatrist suggested, or try small dosage reinstatement to abate some symptoms.  

 

Highly appreciate any suggestions, comments.

Thank you

[LotusRising]

Hi @VincentA

 

Welcome to SA,

 

We are a peer-run volunteer site dedicated to a harm reduction tapering approach in an effort to minimize withdrawal symptoms. As you may have already read, we suggest tapering by no more than 10% of your most recent dose each month. See  Why taper by 10%.

 

Thank you for creating a signature.

 

21 hours ago, VincentA said:

 

Sleep stabilized in last 2 months. Most recently once or twice, I reached tired state and got a nap (common in the before-times).  This caused me to finally leave my 'hypomania'/hightened anxiety state, felt present, 'reset' back to normal and thought creatively, calmly for rest of day. Since i left the drugs 6 months ago though, I didn't experience more than 5-6 (individual) days like that.

 

It sounds like you may be experiencing windows and waves. When we take medication, the CNS responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS must then undo all the changes that were made. As the changes are undone, symptoms may occur. You can expect that they will follow The Windows and Waves Pattern of Stabilization . 

 

These two links explain withdrawal syndrome:

 

What is Withdrawal Syndrome?

 

Video on Recovery from Psych Drugs

 

21 hours ago, VincentA said:

I read that although people may get hypomania when getting on these drugs or upping the dosage, in rarer cases its possible to get it when stopping.

 

I think this is more common then you've read. I experienced this for quite some time, and now only fleetingly. We have a topic:

 

 

21 hours ago, VincentA said:

I don't know if this is hypomania or just a level of anxiety i haven't experienced or heard of before

 

It's credible that this is still WD from drug switches and a fast taper. See Withdrawal or relapse.

 

Reinstatement of a very small dose of the original drug can sometimes help to alleviate withdrawal syndrome. The only other alternative is to wait out the symptoms and manage the best you can while your CNS returns to homeostasis. Unfortunately, no one can give you an exact timeline as to when you'll start to feel better, or if you even will. While some will notice immediate improvement, for others it can take many months or longer.

 

Reinstatement isn't a guarantee for everyone, but it's the best tactic available, aside from waiting it out. Since you are outside the 3 month timeframe where reinstatement reliably works, it might work and it might not. If you decide that reinstatement is an option for you, we would recommend a much smaller reinstatement dose than your last dose. These drugs are strong and your system has become sensitized and if you take too high a dosage, it may be too much for your brain.

 

I've given you a lot of information here. Please take some time to digest. 

 

You can post any updates or questions related to your specific situation right here in your personal thread.