Lulu91: Reinstating after Pristiq WD. How?

[Lulu91]

Hello anyone, I really need advice. I'm 5 1/2 months out of stopping Desvenlafaxine (Pristiq) at 25mg. My psych told me I could just stop obviously and I didn't know any better. Withdrawal hit hard two months later and I am in a terrible space. I've lost a lot of weight. S/I. Crying spells. Bed bound. Body pain. I don't know what to do. I feel I have no doctor to help at all, the same as many of you.

Would it be advisable to reinstate with Venlafaxine (Effexor) liquid at a low dose and see if that helps? I'm worried the longer I stick it out the worse my chances are for medication to help me and I'm getting scared of the S/I and panic attacks. I'm currently on valium and that is barely helping.

Please anyone I am really needing advice

[Jane318]

Greetings @Lulu91 and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications and their associated withdrawal syndromes. 

 

Thank you for completing your signature. 

 

I am so sorry you are experiencing severe withdrawal symptoms, which are, as you suspect, likely due to sudden discontinuation of pristiq.  It is not unusual to have delayed onset of symptoms.

 

It is appropriate to consider reinstating at a lower dose in order to alleviate symptoms.  While reinstatement is best done shortly after stopping, it can be effective even many months later.  

 

Please read:  Reinstatement: About reinstating and stabilizing to reduce withdrawal symptoms and Tips for tapering off desvenlafaxine (Pristiq) - In both, first post on page 1 is important summary of current information, but it is also important to read entire post for context and other helpful information.

 

IF YOU DECIDE TO REINSTATE

 

While some people have successfully tapered off of Pristiq, others have found it easier to switch to Effexor, either the IR tablets, which can be ground and dissolved in water to make a solution taken twice per day, or the XR form, and count beads to taper.  Read: Tips for tapering off Effexor and Effexor XR (venlafaxine).

 

In either case, you want to reinstate at a lower dose - say 50% of last dose to avoid Kindling.  If Pristiq, 50% would be 12.5 mg.  If Effexor, you need to figure out an equivalent dose to use.  It appears there is no clear mandate on dose equivalency, but some use 2 to 1, so you would want 25 mg of Effexor as equivalent to 12.5 mg Pristiq.

 

Once you reinstate, take for several days to see if symptoms improve.  If no improvement after 4 or 5 days, increase a bit more, no more than about 10% at a time.  If necessary, increase again after 4 or 5 days.  It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain.

 

Once symptoms start to improve - HOLD.  You will hold as long as necessary to stabilize before beginning a slow taper.  I am currently into month 4 of a hold after updosing to alleviate extreme WD from too-fast taper of Effexor.  

 

You might want to also check out  LyndaCarter: tapering Pristiq with Outro Health.  LyndaCarter switched from Pristiq to Effexor.

----

 

Once you have stabilized, you can begin a controlled, hyperbolic taper to get off the drug in a safe manner.  At SA, we recommend a hyperbolic taper method, which you can read about here:

Why taper by 10% of my dosage?  You might consider choosing to taper even more slowly, with longer holds or smaller cuts.  Read about this here:  The Brassmonkey Slide Method of Microtapering.  The spreadsheet that you can download from here makes it easy to tailor to your needs.

 

It’s important to keep tabs on your symptoms and adjust your taper amount and schedule as needed.  This will help you identify your windows and waves and reveal your progress, which is encouragement we need!  You can use the following list of typical withdrawal symptoms as a template for a journal, if you wish:  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

You may choose to also track your foods and activities to identify things that trigger symptoms as well.  We do encourage people who are tapering to avoid caffeine, alcohol, and recreational drugs.  Many prescription and OTC drugs can cause problems too and should be avoided as much as possible. 

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

As you taper, and even in protracted withdrawal, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:

Windows and waves pattern of stabilization

 

We have many threads on how to cope with symptoms – I encourage you to check out the various forums / links on the SA.org home page.

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

We look forward to following your journey, and helping out in any way we can.

 

Best wishes.

 

Edited October 27, 2024 by Jane318

[Lulu91]

Thank you so much for your thorough reply. I've read all the links. It's just difficult to decide if I should stick this out or reinstate. The W/D symptoms are severe and don't seem to be getting better.

If I reinstated I would try to get liquid venlafaxine so I could better control the dosing. 

I guess I am also wondering if kindling would happen and how I would know. I can't imagine my symptoms getting worse so it scares me to introduce a drug again that could make me feel worse or set me back. 

My doctor is practically useless so I am doing all this researching on my own and feeling very overwhelmed. I want some relief from the symptoms but am anxious about starting SNRIs again. I have no problem doing a slow taper if I start and it helps, I just don't want reintroducing a drug to cause more severe symptoms. 

Thank you again. 

[Lulu91]

@getofflex 

do you have any suggestions for reinstating at this point?

[Jane318]

On 10/27/2024 at 6:38 AM, Lulu91 said:

I guess I am also wondering if kindling would happen and how I would know. I can't imagine my symptoms getting worse so it scares me to introduce a drug again that could make me feel worse or set me back. 

@Lulu91 - You will find out about kindling and how to recognize it here
 

 

It is not possible to predict how any individual will respond.  But note:  "You may be vulnerable to kindling if you have a history of repeated rapid taper or cold turkey withdrawal and / or a history of heavy or chronic alcohol use, especially binge drinking -- in effect, going on and off the drug, with hyper-reaction when the drug is taken again."  If these do not apply to you, you might feel more comfortable trying a reinstatement.  But of course, monitor your symptoms and stop if they get worse instead of better.

 

Continue to reach out to other members in situations similar to yours, and yes, unfortunately most doctors are useless when it comes to AD tapering / WD.  

 

Please keep us posted on what you decide and how you are doing - Best wishes.

 

 

[Jane318]

@Lulu91 - Just checking in to see how you are doing.  What did you decide about reinstatement?  What are you symptoms?  Best wishes.

[Lulu91]

@Jane318 I decided to not reinstate. One friend I made on here has been working with Outro and they said if you see any sign of progress to try and stick it out so I'm trying to stick it out. Having more "good" days - still symptomatic and the waves are still there and very severe but better than the beginning. My psych prescribed the meds and I have them at home if I really feel the need to reinstate but as of now I'm not. thanks for checking in! 

[Jane318]

@Lulu91 - Thank you for the update - very good news that symptoms have alleviated somewhat.  As you know, they will wax and wane, but it's a good sign that you see improvement already.   

[Vancouver1986]

Hey there.

 

I wanted to chime in and say hello.

 

I remember multiple attempts at stopping the rock-solid 50mg Pristiq "when my life was going better", as advertised. All but one time I had to go back on the 50mg very quickly after reaching a point where I knew I had to reinstate immediately, and my physiology eventually returned to homeostasis on the 50mg. We're talking like 2012-->2016 or so.

 

But one time, I somehow managed to stay off toe 50mg. But it was horrific. For a very long time. I eventually had to go back on ("reinstate") the 50mg Pristiq. I believe I tried Cipralex first. Cipralex wasn't good for my physiology: iatrogenic injuries/decreased mood/decreased quality of life. And I was still in Pristiq Withdrawal. So, I somehow got off the Cipralex and now I was back stuck on the 50mg Pristiq bercuse my physiology was chemically-dependent on it, even though the insomnia was every night, and my fatigue was bad, and the random pains/pulling. Eventually, I believe the 50mg became ineffective, and the fatigue got worse, as did the pains/pulling. So, homeostasis was no longer maintained on 50mg, and I had to ask to increase it to 100mg. And that worsened my mood as well and did nothing for the fatigue and pains, I don't believe. I have many bizarre workplace injuries that are becasue of the Pristiq 50mg and 100mg.

 

I need to update my signature, but I am 3 weeks into a Pristiq deprescribing from 150-->100mg. 25mg isn't avaliable in Canada. I was told to ping-pong dosages for however long - he didn't say, but I am not comfortable with that. The instructions I was given to get off of Lamictal was bad enough, but I survived it. I have no idea how. I was on it for 1.5 years, and the Lamictal made me feel incredibly unwell + Perimenopause physical symptoms.

 

But I just wanted to show that what you're experiencing with Pristiq is common and that someone else there in the world can relate to not giving informed consent to non-evidence-based medicine and receiving medical gaslighting.

 

It may be useful to find a counsellor to vent to who has experience with this subject matter. Some of them I paid to vent to had no idea what I was talking about: iatrogenic injuries while on the Psychotropic Pharmaceuticals and the withdrawal from them. In-person venting is good for humans, as we are social animals. Ironically, isolation is sometimes why people turn to "anti-depressants" in the first place.

 

Keep documenting and journalling. This is really important for Healthcare to see.

[Lulu91]

4 hours ago, Vancouver1986 said:

Hey there.

 

I wanted to chime in and say hello.

 

I remember multiple attempts at stopping the rock-solid 50mg Pristiq "when my life was going better", as advertised. All but one time I had to go back on the 50mg very quickly after reaching a point where I knew I had to reinstate immediately, and my physiology eventually returned to homeostasis on the 50mg. We're talking like 2012-->2016 or so.

 

But one time, I somehow managed to stay off toe 50mg. But it was horrific. For a very long time. I eventually had to go back on ("reinstate") the 50mg Pristiq. I believe I tried Cipralex first. Cipralex wasn't good for my physiology: iatrogenic injuries/decreased mood/decreased quality of life. And I was still in Pristiq Withdrawal. So, I somehow got off the Cipralex and now I was back stuck on the 50mg Pristiq bercuse my physiology was chemically-dependent on it, even though the insomnia was every night, and my fatigue was bad, and the random pains/pulling. Eventually, I believe the 50mg became ineffective, and the fatigue got worse, as did the pains/pulling. So, homeostasis was no longer maintained on 50mg, and I had to ask to increase it to 100mg. And that worsened my mood as well and did nothing for the fatigue and pains, I don't believe. I have many bizarre workplace injuries that are becasue of the Pristiq 50mg and 100mg.

 

I need to update my signature, but I am 3 weeks into a Pristiq deprescribing from 150-->100mg. 25mg isn't avaliable in Canada. I was told to ping-pong dosages for however long - he didn't say, but I am not comfortable with that. The instructions I was given to get off of Lamictal was bad enough, but I survived it. I have no idea how. I was on it for 1.5 years, and the Lamictal made me feel incredibly unwell + Perimenopause physical symptoms.

 

But I just wanted to show that what you're experiencing with Pristiq is common and that someone else there in the world can relate to not giving informed consent to non-evidence-based medicine and receiving medical gaslighting.

 

It may be useful to find a counsellor to vent to who has experience with this subject matter. Some of them I paid to vent to had no idea what I was talking about: iatrogenic injuries while on the Psychotropic Pharmaceuticals and the withdrawal from them. In-person venting is good for humans, as we are social animals. Ironically, isolation is sometimes why people turn to "anti-depressants" in the first place.

 

Keep documenting and journalling. This is really important for Healthcare to see.

 

I'm so sorry you're going through this. It's criminal they don't have a way to taper off these drugs effectively - especially pristiq. Going up and down on dosages every day day will not help! I think there are write ups on here on how to taper down pristiq even though you technically cant but people have done it. It's an awful drug to get off of. I hope you're doing alright. I'm always here to talk if you need. I'm in my 6 month off and it's been a rough ride. I have a therapist who I had to educate about protracted withdrawal but now she's up to speed and I spend a lot of sessions venting and crying. A lot of trust lost with the medical community. 

 

Keep us updated on how you're doing. We can get through this

[Vancouver1986]

Hey there,

 

Thank you for the camaraderie. What's done is done, and it's currently happening to hundreds upon hundreds of people around the world (well, the Western world) right now: becomming hypomanic on the "selective" serotonin medicine/etc, acute withdrawal because of Dr's and Psychi's telling them to C/T or linear taper, and not knowing what the hell is going on, taking themselves to the Mental Health & Substance Use unit of their local hospital, protracted withdrawal syndrome and receiving a monthly disability cheque, stuck on these legal Psychotropics with iatrogenic injuries/decreased quality of life and receiving a monthly disability cheque, etc.) I'm not speaking publicly about this, because of drug companies - although I would go to conferences and support groups if I was okay with hearing about this subject matter + could actually be well enough to go and drive myself there. We need friends with our hobbies, we want healthy co-workers, etc. We want people to have children if that's what they genuinely want, etc. We need to socialize as our anti-depressant.

 

I'm desensitized to this subject matter, although it's still incredibly disturbing, unethical, and bordering on malpractice because they're not practicing medicine with updated information. But I do remember calling the local regulatory board for healthcare professionals and venting and also all messed up on the sky-high Desmethvenlafaxine and the Lamictal. I chose to not file a report. I'm not getting involved.

 

I've recently found a Nurse Practitioner who knows about hyperbolic tapering. She's helped others on this forum with Pristiq/Effexor and the other legal Psychotropics. I've signed up for her next intake of a Skype support group. I hope my body is not too tranquilized that day to attend. I'm not surprised spaces are filling up fast, because of the algorithm helping people find legitimate help with withdrawal coaches, etc. All withdrawal coaches on YT/IG are fully-booked. It's that bad out there. This Nurse Practitioner can help me with hyperbolic tapers, too.

 

I never thought GP's, Psychi's, In-Patient Staff, Hospital Staff, etc ever have had malice intent. They want people working. They're just practicing medicine that's not up to date. It's ironic that some are currently being harmed by these legal Psychotropics themselves. Dr Mark Horowitz talked about that. He even said that he asked his supervisor if he could somehow get in touch with the people he's accidentally harmed to see what ever happened to them. Another post on this forum about Effexor talked about her realizing that these Medical Professionals probably have not been on these legal Psychotropics themselves (iatrogenic injuries) or the acute withdrawal and protracted withdrawal syndrome - hence the medical gaslighting. I had no idea why I assumed they had personal experience. Also, my mom drilled it in to me when I was growing up that it's mandatory that you automatically assume Medical Professionals are 100% right, you're wrong about what's going on in your own body, and if you suffer from a mistake, you keep your mouth shut so you don't bother anyone or inconvenience anyone. lol. That's what most of us were taught. Most parents/partners still think you have a chemical imbalance that an Rx fixes. They assume it will never be an OTC supplement.

 

One Counsellor had zero idea what I was talking about. Good! Another has personal experience and has had other people vent about this. 

[Jane318]

How are you doing @Lulu91?  Wishing you the best for the holidays!

[Lulu91]

@Jane318 Hi, thanks for asking. This past month has been really rough - severe depression and S/I. I considered reinstating many times but haven't. I'm on month 7. Don't know how people get through this but one day at a time I suppose. Lots of crying spells. Holidays make it harder. We cancelled hosting Christmas at my parents house because of me so we can have a lowkey Christmas and I feel lots of guilt. Just trying to get by. How are you doing? Hope you have a happy holiday

[Jane318]

I am so sorry for what you are going through.  It seems so lame to write this, I wish I could find adequate words.  I can tell you that it is unfortunately not unusual for withdrawal to be this severe and last this long, especially after a CT stop.  However, though it doesn't seem like it now, this is NOT forever, you will heal / recover with time.  You may find some explanation and encouragement here: https://www.survivingantidepressants.org/forums/topic/26099-feralcatman-recovering-from-seroquel/page/33/#findComment-715931.

 

Holidays can be so difficult even when we feel good, much less when we are in withdrawal.  Heaping guilt on yourself is not productive - encourage you to look forward to next year, when you will feel sooooo much better.  

 

Thank you for asking, I am doing okay.  The Christmas season is usually hard for me.  Fortunately, I was on month 5 of a hold, so I was able to just put one foot in front of the other and do what I needed to do.  I'm working putting aside my expectations and learning to accept what is.  

 

Please hang in there.  I think you will see some improvement soon.  Keep us posted.