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ChessieCat

ChessieCat: so I'm not the only one (Pristiq / desvenlafaxine)

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KarenB

Hey CC,

 

Yes things could be catching up with you - that wasn't so long ago you switched to capsules.  I try to remember to half expect things to be odd on any given day, and then it's not so surprising when it happens. 

 

Could the shoulders and arms aching be due to anxiety about what's gonna happen next?  Just having a wild guess...  Could easily also be w/d.

 

I'm on Effexor, and have found taking two equal doses a.m and p.m helped a little bit, but not massively.  I think the important thing is to keep doses even, so if you are worried about it not lasting the distance split it into two equal amounts.  You could always try once a day first and see how it goes.

 

Are you keeping written notes?  Just in case...    


2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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ChessieCat

UPDATE:  Been taking my dose all at one time (only 1 day I split it).  Always feel tired and no energy so have been resting as needed.  Also still sweating a lot.  I've been feeling since way before my drop in dose so think it is the medication.

 

From tomorrow I will start a "step down" to get to 67.5 mg.  I have decided that I will reduce 2.5 mg each week for 3 weeks then hold.  Obviously I will wait and see how the first little drop goes before continuing.  After reading and learning everything I just think it might be a nice gentle was to help my brain adjust and I have the compounded capsules to make it possible.  Just fed up with feeling so lethargic and I've got general household tasks which need doing.

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Fresh

Chessie , you might think about leaving the drop a little longer.

 

There have been alot of changes for your cns to keep up with , most recently going from splitting your dose

(10mg pm) to one daily dose.   How many days have you been on one dose for?

 

This is where people get caught out rushing things.   Time spent stabilizing before you begin to taper is an

investment in yourself , your future.

I'd give your system a chance to catch up , before you go unsettling it again. 


1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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ChessieCat

I hear you and I agree :blush:  Thanks,your support and advice is much appreciated.  Proves yet again how helpful this site is.  Getting that second opinion can make a big difference.

 

I've just done a calculation on my original dose if I had tapered by 10% and it would be 3 months to taper to 73mg.  This would have taken me to mid-January.  Completed the Excel calculations and on a 10% drop monthly I'll be on 2mg for my 60th birthday!!!  I've just turned 58.  Birthdays come around quickly so I'll just keep that in mind :wacko:

 

Note to self:  Accept the "now", the "then" will arrive soon.  It's for my own good in the long run.

 

Split dose on 5th Dec.  I also have to remember that I went from 100mg down to 75mg (with the 2 weeks at 50mg) so it makes so much sense to hold longer.

 

I've realised over the last couple of days that I am starting to chat to my pets again.  For a while it was too much effort to actually voice any thoughts, and before that I don't think I even had the energy to think the thoughts.  I also realised recently that all this year I had been anxious but had put it down to low self esteem.  That's gone now.  Also enjoyed chatting with my sister last night and am looking forward to meeting up with another old friend for morning tea.

 

Some of the changes happen so subtly that it can be easy to miss them and realise there has been an improvement.

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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brassmonkey

Hi CC-- such an upbeat update, I'm glad to hear it.  Don't think about how long a taper is going to last and you'll be surprised/shocked at how fast it happens.  I can't believe that I have been tapering for over four years now, it really doesn't feel that long. 

 

I have to agree with Fresh, give yourself some time for going to once a day dosing to settle in before tapering again.  Every alteration in dosing up, down, manufacturer or timing counts as a change and has to be allowed to stabilize before the next change is made.

 

Hope you had a good time with your friend at Tea.


20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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ChessieCat

Thanks BrassMonkey,

 

When I first read Fresh's post, I felt very disappointed, but after working out when I should have been at 75 mg it made sense and I accepted it.

 

I had a lovely morning tea with my friend and she was very interested in ADs and their effects.  She knows of a couple of people with a child with Autism who have trialled various diets, eliminating chemicals, and have seen big improvements in them.  I said to her that it does make sense.  The elimination of chemicals isn't going to "cure" the Autism but chemicals could very well cause them issues.

 

Very thankful that I am feeling more like myself than I have for a long while.  I think that will make it easier to have patience and wait.  I even think I'll be able to clean out my roof gutters soon!!!

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Orangecat

Congratulations! Sounds like you are able to stay aware of what is going on with your body and your emotions and to be patient too. 

 

Have you thought about finding someone to clean your gutters for you? It doesn't cost too much! No need to take on more than you can handle if you can afford someone else to help. 


Found this site for real in 2015. Decided to taper slowly.

** I should mention that anytime I haven't been in a wave, I've felt pretty amazing! I only record the waves to look for patterns : ))**

50 mg Zoloft 6/2015, with intermittent fish oil

6/9/15 alternated 50 mg/37.5 mg - doc's idea (she meant well) 6/17 terrible morning anxiety and rumination, flu symptoms, and prickles in legs. 6/18 up to 45 mg liquid Zoloft. 6/26-29 cortisol mornings and bad anxiety. 6/30 started to take mag 100 mg and fish oil regularly with med 7/4 44 mg. 7/8 42.6 mg. 7/16 40 mg. 7/23 39 mg 8/1 32 mg (bad idea).

8/5 fatigue, anxiety, can't sleep, depressed. 8/7 36 mg resolved to be patient and try to keep to THE THREE KIS's. 8/13-15; 8/17- 23 painful physical and mental wave. Started light therapy 20 m in am. 8/25 34 mg, added 80-100 mg liquid mag during day. great window til 8/29 2 day down stretch 9/8 32.8 mg 9/11-14 wave added acupuncture 9/22 31.5 mg teeny wave 10/6 30 mg small grumpy wave 10/19 28.5, same pattern- small wave at day 5. A few tough weeks. Held around 29 until 11/18 when dropped to 28 mg; 11/22 the usual fluey fatigue. 11/30 27 mg 12/14 25.75ish mg "hold til Xmas club" (in my case New Years) Xmas was tough, kept holding: by 1/15, feeling good again. 1/25/16 Mirena IUD out after nearly six years- I think it was affecting my mood and taper- feeling super great! 2/2 down to 24 mg. symptoms much less severe. One day, not too bad wave on 2/8. 2/15 down to 20 mg from 24. A week later, two restless mornings and one morning of brain fog. 3/2 from 20 to 16 mg! Wish me luck.

 

Medicine History:

Currently tapering from 50mg Zoloft. Ten years of SSRI's including Celexa, Prozac and Zoloft, as well as a stretch with Wellbutrin added to the Zoloft. When I started on Zoloft (4 years ago?) I was on 100 but was able to taper down to 50 via 25 mg increments slowly around 2013. Have used light therapy and fish oil intermittently since around 2013. Have tried unsuccessfully to get off the meds since then in what I know now to be too large a taper (for example, jumped from 25 to 12.5 and that did not work). Motivated to do this slowly because that's the only way it will happen.

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ChessieCat

Found this today in Best of SA and wanted to put it in my topic for later reference.  I've always loved the Desiderata.  I hope you don't mind Petunia.

 

 

Desperata (Acute Withdrawal Version)

 

Go reluctantly amid the noise and haste, and remember what peace their used to be in silence, before you got tinnitus.

As far as possible without losing your job, home, relationships and everything which is dear to you, limit contact with all persons.

Speak the truth about withdrawal quietly and clearly, even though others will treat you like an idiot, saying you are telling a story.

Avoid loud and aggressive drug pushing doctors of all kinds, they are a danger to your health.

If you compare yourself with others, you will feel depressed and hopeless because right now everyone seems greater than yourself.

Hang onto any positive memory you can find in the dark murky depths of your mind.

If you still have a career, you are lucky, or you just don’t have withdrawal all that bad.

The business world is full of trickery and crooks, you got scammed by the biggest of the bunch…Big Pharma

But try and look on the bright side, there are a handful of heroes in the world who write books and speak up for us in court and sometimes even answer our emails.

Be yourself, even if you don’t know who you are any more, DP/DR sucks and even the grass looks weird, the whole world has become enchanted by a strange curse.

Take kindly any helpful advice you are offered by well meaning friends and family as the days, months and years roll by, gracefully surrendering your desire for them to really understand what you are going through.

Watch helplessly as your spiritual strength dissolves into a puddle at your feet.

Distress and imaginings will take on a life of their own, as will fear, fatigue and loneliness. A wholesome diet may help, gentle walking and let someone else discipline the kids, you’re just too fragile at the moment. 

You are a survivor of psychiatry, less important than the power and wealth accumulated at your expense, you have no rights.

And valid or not, clearly, your diagnosis now defines a universal truth.

However, God will still love you, as will your cat or dog, whatever the outcome.

Therefore find peace in your pets if noise is too much for your sensitive soul, keep confusion to a minimum, your brain needs to rest.

With all its pain, anxiety and sleepless nights, its still a recovery process. Be happy you are still alive, unless of course you have anhedonia, which would make this impossible.

 

© Petunia 2015

 

Go placidly amid the noise and haste, and remember what peace there may be in silence.

As far as possible, without surrender, be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant, they too have their story. Avoid loud and aggressive persons, they are vexations to the spirit.

If you compare yourself with others, you may become vain and bitter; for always there will be greater and lesser persons than yourself. Enjoy your achievements as well as your plans. Keep interested in your own career, however humble; it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs, for the world is full of trickery. But let this not blind you to what virtue there is; many persons strive for high ideals, and everywhere life is full of heroism. Be yourself. Especially, do not feign affection. Neither be cynical about love, for in the face of all aridity and disenchantment it is perennial as the grass.

Take kindly to the counsel of the years, gracefully surrendering the things of youth. Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe, no less than the trees and the stars; you have a right to be here. And whether or not it is clear to you, no doubt the universe is unfolding as it should.

Therefore be at peace with God, whatever you conceive Him to be, and whatever your labors and aspirations, in the noisy confusion of life, keep peace in your soul.

With all its sham, drudgery and broken dreams, it is still a beautiful world.

Be cheerful. Strive to be happy.

Max Ehrmann c.1920


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

Another interesting find for later reference:

 


from Petu's link :

 

  The 10% method protects everyone and you have the option of tapering faster if you can tolerate it.

Follow this harm reduction approach to starting your taper:

  • Initially, make a 10% reduction and hold there for a MONTH. It can take several weeks for withdrawal symptoms to emerge. Do that again the second month.
  • If you have very minor or no symptoms from these 2 reductions, you can try reducing by 10% (calculated on the last dosage) every 3 weeks. Do that twice. If no problems, reduce by 10% every 2 weeks. Do that twice.
  • If no problems after 4.5 months of very gradual reduction, you may be able to reduce by 10% every week.
  • If significant withdrawal symptoms appear, make smaller cuts or go slower. Listen to your body.

Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

Hi Orangecat, thanks for posting.  Sorry I didn't reply earlier.  I've been feeling "chatless" for a little bit.  Re gutters, unfortunately I'm not in a financial position to get people in to do those sorts of things.

 

UPDATE: Feeling a bit "whacked" from something that happened last night which was resolved fairly quickly.  I had already been feeling a bit stressy and tired.  Taken some paracetamol because I feel a bit achy but mentally I'm fine.


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

Fighting the desire to start tapering.  Thankfully reading others' posts reminds me that it's better to hold.  But it is hard.  Like everyone else I just want to feel better.

 

UPDATE:  Been feeling a bit stressy over the last week and finding myself shallow breathing.  This morning sore muscles, lower half of body and shoulders, not my arms & wrists like before.  Feels like cramps, not weakness.  Left knee sore again - had been good for quite a while.  Had stopped magnesium (think I was taking too much at a time - morning and evening @ 100mg).  Today I will take 25mg doses throughout the day and see how it goes.


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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KarenB

I must warn you that since you signed up to the 'hold till after Christmas' club, any pre-christmas tapering will result in 74 hams and 89 steak knives being sent to your mail-box.  Did you not read the small-print?  :P


2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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ChessieCat

Thanks Karen, very funny!

 

However I am starting to understand how frustrating this whole thing is not knowing what to do when.  I promise I WILL HOLD until after Christmas, it is only another week after all.  BUT how I am feeling now is how I was feeling on 100mg. Tired, apathetic, no energy, aches and pains. I understand that my CNS has been messed around and that WD symptoms might be delayed.  My head keeps telling me to wait until mid January for 2 reasons.  It will be 3 months since I dropped from 100mg and also the time when I would have been tapering to 67.5mg.

 

However, I will be starting back to my volunteering in a month's time and would like to have dropped several weeks before then.  For the moment, I'll wait until 26th December Australia time :P

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Fresh

Ahh Chessie , try re-reading your recent posts.

Yesterday:

"UPDATE: Been feeling a bit stressy over the last week and finding myself shallow breathing. This morning sore muscles, lower half of body and shoulders, not my arms & wrists like before.'

 

If you're getting new symptoms , it's too early to start tapering. End of discussion. Your head

is correct . . . let your intellect guide you , not your impulsive feelings.

 

I was going to quote one of JanCarol's posts about "throwing away the calendar and listening

to your body" , you must have read it , but she wrote something new yesterday.

 

" when you find yourself wanting to speed up the taper - I think it was Petunia who called this urgency a withdrawal symptom. When she found she was wanting to impulsively or urgently push her taper, she wrote it down as a SYMPTOM of WITHDRAWAL and checked her symptoms chart, logged it, and checked it against her tapering info and symptoms."

 

I've found that sense of urgency about all sorts of things is a symptom . . . things are rarely as

urgent as I initially think.

One last thought and I'll get off your back.

In this game of survivor you cannot out wit or out smart withdrawal. The best we can do is outplay

it starting with waiting for symptoms to STOP before decreasing.

I recommend waiting at least 2 weeks AFTER any new symptoms stop , and there's no calendar date for

that.


1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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ChessieCat

Ooooh a rap over the knuckles!  :o  Accepted with many thanks :)  

 

I had a revelation whilst reading your post.  When we aren't feeling as good as we want to we make the assumption that dropping will improve things.  I've read enough on this site to know that it isn't always the case - in fact in many cases just the the opposite.

 

This morning I felt relief when I took my 75mg dose knowing that I had made the decision to stay on it for at least the week.  So after that and reading your post I have decided to stop thinking about tapering.  It seems that it is always in the back of your mind, almost like kids on trips, are we there yet???  And yes, I agree that there does feel a sense of urgency and I also think it is a symptom because we are on edge.

 

Once again I can see the importance of the support we get on this site.  Only people having gone or going through it can really or best understand what is happening.  And consequently make suggestions that we are willing to accept

 

Now to relax and accept it!  ;)


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

NOTE TO SELF:

 

I AM NOT THERE YET!!!


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Fresh

LOL , appreciate that my post was accepted in the spirit it was intended.

 

You know what they say: The truth will set you free , but first it p!sses you off !!

 

;)


1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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ChessieCat

Went shopping yesterday and ended up with aching muscles and sore knees again.  Did some online research of my prescribed meds and it turns out that both Pristiq and Perindopril (BP med 8mg) can cause muscle problems - cramps/weakness.  Cut my BP med in half this morning (thankfully started a new script which has scored tablets).  Don't want to stop it completely because my BP went up higher when I increased to 100mg.  Hoping I might finally have an answer.

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

For future reference:

 

Hello, Joann.

 

....

 

No one knows how to taper off Pristiq. I assembled all the information I could find. In general, doctors know very little about tapering any of these drugs.


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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chia1214

Hello Chessie! Thanks for your kind visit to my thread recently. You have settled in here nicely and I see you are giving lots of encouragement to others too. Good for you. I too am still learning what is the right timing for my tapers. This community is such a great resource for that and more as you now know.

 

I hope you don't get any ham & knife deliveries this month... but I would be tempted with that kind of threat!   :)

 

Keep up the good fight forward!

 

-- Chia


Read my intro here: http://survivingantidepressants.org/index.php?/topic/7569-chia1214-tapering-lamotrigine-maybe-clonazapam-later/#entry110043

1975 Hospitalized and first exposure to psych. drugs age 13-15 Haldol, Tofranil, Cogentin, Thorazine. On and off numerous AD’s & AP’s no records until 2000

2000 Celexa, Clonazepam 1mg – never exceeded 1 mg except occasional emergency use

2004 Lamictal (Lamotrigine), Effexor, recall add-on trials of Lexapro, Prozac, Wellbutrin during this time also

2007 Lithium added, switch Effexor to Pristiq, still on Lamictal (Lamotrigine) Clonazepam. Some cold turkey quits of everything over the years. No knowledge of WD

2011 Lithuim Gabapentin Lunestra, Lamictal (Lamotrigine), Clonazepam

2012 Taken off all but Lamictal (Lamotrigine), Clonazepam, began Zyprexa

2013 Abilify replaced Zyprexa (high lipids) added Wellbutrin, Prozac, Adderall

2014 Discontinued Abilify, Wellbutrin, Prozac, Adderall, added Latuda, Quetiapine, then stopped those.

December 2014 Found SA Began slow taper of the only remaining two drugs I'm taking

Clonazepam 0 mg Benzo free as of May 30, 2017

Lamotrigine 0 mg as of Jan 7, 2018   

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ChessieCat

Well I wonder if that is my issue.  I always seem tired during the day.  Almost every day I want to (and sometimes do) go back to bed.  I've been taking mine around about 7 am.  What are your thoughts on gradually creeping up to evening?

 

From Fresh:


Re pristiq , I started off taking it in the morning.  The effect it has on me is very sedating , and I'd go straight back to sleep. I take it at night so a good whack of the sedation has worn off by the next day.   I feel most alert usually the 2 hours before it's due at night.  I know Alua takes hers in the a.m. because it wakes her up.   Go figure   :) .

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Fresh

If you want to change it to evening , this is how I did it.

I missed the first morning dose.  Around noon I took a booster dose of 1/3 of my daily dose.  Then the full dose

around 9 1/2 hours later.  

Voila , done!    


1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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ChessieCat

I think it might be worth trying.  BUT will that mean I have to hold longer before I taper?  I'm just fed up with feeling tired all the time.  I will also need to be vigilant about taking it about the same time each night.  Thanks Fresh.

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

Just realised that my lockjaw that I had 2(?) years ago may have been due to Pristiq.  It would have been several months after the dose was increased from 50 to 100mg.  It lasted for about a week and if I opened my jaw I had to push up on my lower jaw force my mouth to close.


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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bromor

Such excellent advice on holding!!! I had been in a 2 week window (it was a beautiful thing!!!!) & thought to myself that I wouldn't wait like I had said ~ then of course, been hit with a wave this week. Crazily enough, during the wave I kept feeling urgency to taper ~ I'm so glad I didn't. And glad to read the wisdom on here.


On Zoloft for 10 years (50 mg) for GAD & panic attacks

Weaned off fall of 2013, terrible set back in Feb '14 back on 100 mg & trazadone to sleep.

Did CT off of Zoloft in May 2014 - bad decision!

Back on 50 mg Zoloft & Xanax as needed (was upped to 75 mg by doctor in Feb 2015)

Started to wean off of Zoloft in April 2015 ~ totally off Zoloft in Oct 2015 and now am on Buspar 11.25 mg to help.

I was on a 50 mg pill & 25 mg pill - I cut the 25 mg pill in half (12.5) and took that with the 50 for 6 weeks - 1st week June 2015

 50 mg for another 6 weeks. 25 mg in half and the 50 mg in half (37.5), 25 mg mid Sept for about 2 weeks.,1/2 of the 25 mg last week of Sept/1st week of Oct then off.

Update** 9 mg Zoloft reinstated early Nov 15, along with 1.5 mg Buspar daily. On .50 of Buspar & 9 mg of Zoloft. Oct '16 - off of Buspar, Nov '16 - down to 7.5 mg Zoloft. March'17 - 4 mg Zoloft. July'17 - 2 mg, Sept 1 mg. Oct'17 - off! Done!

I also take magnesium, L theanine, Gaba Calm, L Glutamine, Vit B complex(for methyl issues), Liver & Gall bladder support, Zinc, Whole Food Vit C & Fish Oil. DARE & the bible are the tools I use to help navigate this  process.

 

 

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brassmonkey

Some people can be as sensitive to a schedule change as they can be to a dose change.  So we also recommend taking it slow and easy when changing you schedule. In general we suggest shifting one hour in the direction you want to go and holding there for at least four days (this counts as a dose change event) before shifting another hour.  Before you know it you'll have it moved and your body will be none the wiser.


20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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ChessieCat

Hi Bromor, pleased to hear you had such a long window and enjoyed it.  And thanks for your comment on feeling the urgency.  It just further confirms that this whole business is totally weird  :wacko:  If it wasn't for the information and feedback on this site we would all be going totally bonkers.

 

Thanks BM, I've decided not to mess around with things.  I'm going to wait an see how I go once I do my taper and if I find it is still an issue I'll consider creeping my dose to the evening.  I am sleeping well at night and it seems to be a deeper sleep than what I was getting on my full dose so it seems silly to rock the boat.

 

Best wishes to all for Christmas and hope you feel peaceful during the holiday season.

 

Nearly there!!!  CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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brassmonkey

" I am sleeping well at night and it seems to be a deeper sleep than what I was getting on my full dose so it seems silly to rock the boat."

 

Very excellent point of view.  We all know how important good sleep is.


20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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KarenB

I had TMJ, which I've come to realise is totally w/d related.  There are good you-tube vids which show you ways to relax your jaw.  I found them really helpful, and nowdays I do them almost automatically when I feel tension creeping in.  It astounds me the myriad of ways these drugs affect us.


2010  Fluoxetine 20mg.  2011  Escitalopram 20mg.  2013 Tapered badly and destabilised CNS.  Effexor 150mg. 

2015 Begin using info at SurvivingAntidepressants.  Cut 10% - bad w/d 2 months, held 1 month. 

Micro-tapering: four weekly 0.4% cuts, hold 4 weeks (struggling with symptoms).

8 month hold.

2017 Micro-tapering: four weekly 1% cuts, hold 4 weeks (symptoms almost non-existent).

2020 Still micro-tapering. Just over 2/3 of the way off effexor. Minimal symptoms, - and sleeping well.
Supplements: Fish oil, vitamin C, iron, oat-straw tea, nettle tea.

My story of healing:ContinuedHealing

***I am not a doctor; please do your own research and be able to take responsibility for decisions you make.*** 

           'The possibility of renewal exists so long as life exists.'  Dr Gabor Mate.

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ChessieCat

UPDATE:  Day 1 of 67.5mg.  Okay, so I didn't get to after Christmas but it is Christmas morning here.  Started listening to Ann Blake Tracy last night (Help I Can't Get Off My Antidepressant) and decided that it was time to go down.  Hoping that my muscles will improve and that I haven't done the wrong thing and they get worse.  Had to take the risk.  Can't do much physical stuff at the moment because my back and legs get sore very quickly.  It's been getting worse.

 

BrassMonkey, sleep is very important and I really value it after having had many years of sleeping lightly (snoring husband who would take all of the bed covers when he rolled over during the night) which I think contributed to my poor mental health.

 

Karen, yes it is amazing how these drugs affect so many things.  I'm thankful for the research I have done which helps me to understand how the brain works (or at least is supposed to!).  On the positive side, the body is an amazing thing, especially the brain.

 

Wishing everyone a Happy and Peaceful Christmas.  CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

Signature save: 

My Intro & Update    Antidepressants (various) 25 yrs;  Mid 2012: 50 mg Pristiq
Early 2014:   100 mg  
(from April - aches, pains & sweating, Oct 2015 recognised Serotonin Sydrome)
17 Oct 2015:   50 mg   (foggy head);     1 & 2 Nov:  100 mg       (within hours started feeling more "with it")

3 Nov:            75 mg                            5 Dec:         Split dose   1 day only (65mg 7 am + 10 mg 3 pm)


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Martina23

Hello ChessieCat, I was laughing how you wanted to hold and at once you decided to continue tapering. I really can not blame you, I did the same. I understand if you always feel tired and just need to do a change. I hope that on this lower amount you will start to feel better.


05/2013 Lyrica 100 mg / per day for pain + PGAD resulting from caesarian delivery11/2014 started to taper: 50 mg per day/ for one week then c/tafter one month reinstated at 50 mg /per days of 10 July 2015 drug free-

symptoms OCD

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ChessieCat

Hi Martina, thanks for stopping by.  It's not funny, as you well know! ;)   But I can understand you laughing and I realise you are laughing because you understand and your comment has made me smile.  It is so hard to know whether it is the right thing to do or not.

 

I considered it very carefully and weighed up the pros and cons.  I think I've done well to hold for this long.  Even though it is normal to start thinking about the next step (how long to hold), I realise that I now just need to wait it out and see what happens because nobody knows what will happen.  But my hope is that I will start to feel better physically which in turn will allow me to do things which I can't do at the moment and that will mean that I am not dwelling so much on getting off the drug.

 

Wishing you all the best too Martina.  CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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ChessieCat

UPDATE:  Okay, just went to take my fish oil and started to wonder if that might be the problem so researched and found this from  http://mentalhealthdaily.com:

 

Body aches: Some people claim that fish oil acts as a lubricant for joints and helps ease pain. However, some people actually report a counterintuitive reaction of body aches. You may notice aches in your lower back, chest, or muscles from taking fish oil.

 

and from http://www.drugs.com

 

More common

  • difficulty with moving
  • muscle aches
  • muscle pain or stiffness
  • pain in the joints
  • unusual tiredness or weakness

 

So, I've just gone and topped up my dose to 75mg.  Will be interesting to see how I start to feel.  I've been taking them for at least 5 weeks and have progressively got worse (which has had me wondering why if it was the AD it would get worse).  Hopefully I have now worked it out.

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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brassmonkey

It's interesting how every one of the things we can use to help can also turn on us.  I was having real trouble with my cholesterol meds causing aches and pains, cut the dose and it really helped.  I hope this sorts  itself out soon.

 

Christmas and New Year ((((((((((((((((((((((HUGS))))))))))))))))))


20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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ChessieCat

Hi Tom & thanks for the virtual hugs,

 

Yes it is interesting and I, too, hope it sorts itself out soon.  BTW if you are taking statins it is suggested that you take CoQ10.  When statins were first created they included CoQ10 in the medication.

 

Thank God for the internet, and us being able to use our brains (to the best of their ability <_< ) to research, as well as get the help of others to sort all of this out.

 

Wishing you a Happy Christmas (it over for Australia now) and all the best for 2016.

 

CC


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 12 Sept 2020:  Pristiq 0.625 mg (compounded)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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