Magenta: Withdrawing from Pristiq and looking for support

[Magenta]

Hello all! So I have always struggled with anxiety but it was pretty manageable and something I could get through. In 2016 I went through some tough life things and was put on lexapro with Xanax as needed. My pcp kept changing my dose and after a while I started feeling like it wasn’t working. Switched to a psychiatrist who put me on gabapentin 3x a day with the lexapro and no more Xanax. A little into the pandemic I started suffering from agoraphobia and was switched to pristiq with the gabapentin. Started at 50 mg and then was upped to 100mg pristiq with the gabapentin 300 mg 3x a day. 
 

6 weeks ago I got a stomach virus and was unable to take my medications. For some reason I started being unable to get myself to swallow pills after years of no issues. An at home urgent care was able to prescribe me a liquid gabapentin but as you know there’s no liquid version of pristiq. When I got the Gabapentin in me again I started feeling great and realized how numb I was on pristiq thinking I was stable even though I couldn’t leave the house. I talked to my therapist about it and she said this could be my body telling me this pill was not helping and we should consider not taking it and talk to my psychiatrist about it. I talked to my psychiatrist about it and she said yeah if you’re feeling good let’s give it a try on gabapentin only. No warning about withdrawal or how bad it is to go cold turkey or how you can feel good and then crash. I am now trying to look for a new psychiatrist who can guide me through this better. Overall I was feeling okay and then I hit a wall about 4 1/2 weeks in which I’m now realizing was a wave I think. My psychiatrist said we could add in lexapro or Zoloft or something and then try again in a couple of months to get off of that. When I asked her if how I’ve been feeling is withdrawal or if it’s a sign of relapse she basically said that’s a great question and we just don’t know so might as well add lexapro in and go from there. I didn’t feel good about this so I haven’t taken the lexapro and am looking for a new psychiatrist who can be more supportive.

 

I’ve been really struggling with eating. For starters I don’t really have an appetite. I've never had a food problem before but now I’m never really hungry and when I am I don’t really want solid food, chewing feels overwhelming. I’ve been doing smoothies with protein, popsicles, pudding, yogurt, bone broth and on good days potatoes, noodles, sometimes bites of more exciting things. I’ve been having some emotional swings and struggling with separation anxiety. Everything just feels so big and overwhelming and then it will feel more manageable. I’ve been reading and researching what I can and have learned a lot about the waves and windows. I just at this point don’t know what to do - keep going with just the gabapentin or add something else back in. I don’t want to go back on pristiq because I’ve made better progress with exposures off of pristiq in withdrawal than I have in years taking it.

 

I guess I’m just looking for some support and guidance on what withdrawal looks like and if that’s what I’m dealing with here. I wish I could fast forward through it but I understand it’s a time thing. I just don’t know if I’m just dealing with the difficulty of withdrawal or if I’m “suffering” enough to need more medication. I also don’t want to start something just to have to re do this. Anyways I just feel a little like I’m on this journey alone because everyone seems to say something different so I was hoping for some support with people who know what it feels like. 

Edited September 2 by Emonda
Name to title

[Catwoman73]

Hi @Magenta, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes.   

 

If you could kindly complete your drug signature, we would greatly appreciate it.  Your drug signature is a synopsis of your history that appears at the bottom of each of your posts.  This helps us mods and those visiting your thread to know your drug history at a glance, making it easier for us to answer your questions, and provide assistance.  To do this, click the following link, fill in the box with your history, and click save.  That's it!  This signature can be updated as you make changes.  You can have a look at my signature to see the general format. 

 

Your Drug Signature

 

I'm so sorry for what you have been going through.  You are in good company here- you're absolutely NOT alone! Unfortunately, the vast majority of psychiatrists know absolutely nothing about withdrawal science, and how to properly taper these medications, and most of those who find their way here have had similar experiences to you.  I myself have had more cold turkey stops than I care to think about over the last 30 years!

 

First off, I want to link you to our suggested doctors and clinics thread- you may find a psychiatrist that has a better understanding of withdrawal in your area by combing through this thread.  There is another option as well- Outro health.  They may be able to provide you with the guidance you need to get yourself more stabilized. 

 

Recommended Doctors Therapists and Clinics

Outro Health

 

What you are dealing with is ABSOLUTELY withdrawal.  The link below is a list of typical withdrawal symptoms.  I think you'll recognize some of them.  This is, by no means, a complete list though- you may experience other symptoms as well.  These drugs affect literally every system in the body. 

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Here at SA, we recommend tapering by no more than 10% of your current dose, no more often than every 4 weeks.  This is known as hyperbolic tapering, and is designed to release the receptors in the brain from the drug in a slow, controlled manner, thereby reducing acute withdrawal symptoms, and reducing the risk of developing protracted withdrawal.   You can read more about hyperbolic tapering in the following link.  I know you are already off your Pristiq, but my reasoning for sharing this link will become evident shortly!

 

Why taper by 10% of my dosage?

 

The way I see it, you have a couple of options right now.  Number one- you can tough this out.  I can assure you that it will get better, but I can't give you a timeline.  We all heal at different rates.  There are a variety of things you can do to make the journey more bearable, and to create a good environment for healing that I will share shortly. 

 

Your second option would be to reinstate.  In your case, I would recommend starting a very low dose of Pristiq's sister drug, Effexor.   The idea of this would be to reduce your acute withdrawal symptoms to a more bearable level right now by finding an ideal dose for you, and holding, likely for many months, to give your nervous system time to stabilize.  At that point, you could start to do a proper hyperbolic taper of the Effexor.  The advantage of this is that it might serve to reduce your overall symptoms now.  The downside is that there is no guarantee that it would work, and in some cases, restating has made people worse.  This is the idea behind starting an extremely low dose and updosing very slowly until symptoms are more tolerable- if you feel worse, you can just stop (some people do become hypersensitive when reinstating, which is something you should be aware of).  The doses we are talking about here are very low, sub-therapeutic doses.  You can read more about reinstating and about tapering of Pristiq and Effexor in the following links:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 How long does it take to stabilize after reinstating or updosing?

 Hypersensitivity and kindling

 

Tips for Tapering From Pristiq

Tips for Tapering from Effexor

 

Either way, as you have already read, you will still have to endure windows and waves as you progress towards nervous system stability.  This is a normal part of the healing process.  

 

Windows and waves pattern of stabilization

 

It is a good idea to start a symptom journal, and keep track of your symptoms, rating them on a scale of 1-10 each day.  You can use the list of typical withdrawal symptoms I linked above as a template if you wish.  This can help you identify your windows and waves, and may also help to identify triggers for you.  Mine are intense exercise, coffee (even decaf), many additives/preservatives, loud noises, intense smells, and probably a bunch more lol.  

 

In terms of coping with symptoms as you heal (whether you reinstate or not), we have many threads on symptom management here at SA.  I will link some of them below.  You may find some of your own methods as well.  For me, I practice mindfulness every minute of every day, meditation/yoga Nidra at night, deep breathing, gentle exercise (especially swimming), artistic activities (I'm no artist- paint by numbers for this girl lol), time in nature, and talking to a good, trauma informed therapist.  These have all helped me find a calm centre from which I can tolerate the ups and downs of the withdrawal process. 

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals

 

In terms of what you can do to help with healing, there are a few things, though many of them will sound like common sense.  A balanced, whole foods diet, staying adequately hydrated, gentle exercise, adequate rest/sleep, avoiding neurologically active substances, such as caffeine, nicotine, alcohol and recreational drugs can all help.  We strongly advise against adding any new psychiatric medications to the mix to try to treat withdrawal symptoms, outside of potentially reinstating the drug you are withdrawing from.  The results are unpredictable, and may make you worse rather than better.  And, as you said, it would be yet another drug that you would have to taper from in the future.  We only recommend two supplements here at SA- magnesium and omega 3 fatty acids.  Though do be mindful, those in withdrawal often become hypersensitive to many things- medications, supplements, and even foods.  If you choose to start any supplement- even those we recommend- start at a very low dose, and increase slowly if you tolerate them.  I am a prime example of hypersensitivity- magnesium gives me brain zaps and severely disturbs my sleep!

 

I do want to comment on your gabapentin as well.  This is yet another drug that requires slow tapering.  I would not recommend you make any changes to your dosage at this time.  If you want to taper off of gabapentin down the road, we're happy to help you, but right now, what your body needs is stability.  Changing your dose of gabapentin, either up or down, could make you feel worse.  

 

Tips for Tapering Off Neurontin (Gabapentin)

(look at Altostrata's post part way down the page for more info)

Taking multiple psych drugs? Which drug to taper first?

 

In summary, you have a couple of choices- try a very low dose of Effexor, with the idea of doing a hyperbolic taper down the road once you have stabilized, or ride this out.  Only you can decide what the best choice is for you, depending on your life circumstances, and your tolerance for your current withdrawal symptoms.  You will continue to experience windows and waves either way, and there are many things you can start to do to help you ride out your waves.  Taking good care of yourself right now can only help with the healing process.  I will say that if you do decide to try a low dose of Effexor, hyperbolic tapering is MUCH easier than a rapid taper or cold turkey stop.  This is my very first hyperbolic taper, and I'm doing quite well, despite also dealing with perimenopause and long covid!  I have symptoms, but they are tolerable.

 

Most of all, I want to assure you that you are not alone.  And you WILL get better. ❤️‍🩹

 

This is your introduction topic- each member gets one intro topic.  Please post updates, questions and concerns here, in this thread.  But don't hesitate to expore the rest of the forum.  There's lots of good info here!  And if you feel up to it, do feel free to engage with other members by reading and dropping a supportive comment on their intro threads.  Building a community of people who truly understand what you are experiencing will definitely help you to feel less alone!

 

I look forward to following your journey! 

[Magenta]

Thank you @Catwoman73!! I’ll read through these resources. If I wasn’t having food issues I would be less concerned but I’m just so worried about what my decrease in appetite and eating will mean for me long term if it keeps up this way. I also don’t know if with a little more time it’s something that will even out. I know I’m still early days in the process but it’s so hard to imagine this is not how it will be long term. 

[Catwoman73]

Nothing is forever in withdrawal, @Magenta.  It will get better with time and patience.  I can't say how long it will take, but I can assure you that it will get better!  I have intermittent issues with nausea, where I can't eat, and lose weight.  Going through it right now as a matter of fact!  It's ok- just keep reminding yourself that it's only withdrawal.  Keeping your mind calm, and working hard to stay present, rather than worrying about the long term will not only make this journey more bearable for you, it will help you heal faster.  Stress is the enemy, so just keep breathing.  You can do this!

[Magenta]

Thank you for the kind words, encouragement, and support. I appreciate it so much 😊

[Magenta]

Well I think I'm entering a window for the most part, which feels nice but then I also get nervous about the next wave. My brain just doesn't want to let me be okay. Today my anxiety hyperfixation is on the weather. Here in Cali we are in our worst heat wave this summer and temperatures are only going to hit a little over 100 but I am suddenly very worried about them. I've lived through hot days before and don't have to do anything today except stay inside my house which has the AC on all the time so I don't even know why I'm worrying. I've had to have the same conversation with myself about the fact that I'm safe about 100 times today already. Think I might just try and sleep through the heat of the day at this point.