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Hi Everyone,


I'm new here so thought I'd introduce myself.


I've been on the mental health journey since 2007, offically diagnosed with Major Depression.


I've never really had any formal triggers that get me down and naturally the symptoms of depression I battle with are usually more physical, but can be thought related too (tired, poor memory, poor concentration, can't be bothered with anything, guilt etc.).


I was started on Lexapro in 2011 at 10mg and then increased a few months later to 20mg, I don't remember building up gradually or any side effects of the bump up in dose.


In 2014 I checked myself into hospital and was commenced on Pristiq 25mg. I remember tapering off Lexapro over a weekend and starting Prisitq on the monday. While in hospital, for 6/7 weeks I was gradually brought up to 200mg Pristiq, as well as being started on lithium (450mg then 900mg) and Euthyrox (100mcg) to help speed up metabolism and body processes.


Once discharged my meds were still tweaked to 300mg Pristiq (+900 lithium, 100 euthyrox) and I have been on them from mid 2014 until recently August 2016.


I'm now going to be changing from Pristiq to Effexor.

Initial plan is taper 300mg --> 200mg Pristiq over the weekend then commence 300mg Effexor next week.

So far I'm just experiencing low grade headache (not going away with sleep, water or paracetamol), lethargy and fuzzy vision.

In the past when having accidentally missed a dose of meds or run out, I've experienced headaches, nausea, lethargy, poor vision, need to keep moving (??), electric shock type feelings under my skin and in my brain. I usually just try to sleep until its over or can get some meds.


I wonder if anyone else has changed from Pristiq--> Effexor and what worked from them in regards to the swap and limiting withdrawal/new drug ill feelings?


Look forward to getting to know some of you  :)

Edited by JanCarol
Highlight drug changes, symptoms, add tags

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GC79 this is your lucky day Well done on finding sa.

Please dont do anything until the moderators come in and give you some critical advise.


In the meantime while you wait you might like to check out this thread ..its worth reading

Tips for tapering off Pristiq (desvenlafaxine)


Would you be so kind to put all the drugs you are taking in the interaction checker and copy and paste the result into this thread.



Glad you found sa.



later ...

goodness thats a large dose of pristiq and the equiv dose of effexor is staggering.

Have you considered making a complaint against your doctor. You might like to make contact with moderator Fresh an aussi and tapering pristiq.

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Hi nz11, thanks for the link!

I've found a bit in tapering to no meds but not a lot switching between similar drugs (venlafaxine/desvenlafaxine).

I wonder whether it's because traditionally experts say you should completely taper off before swapping?


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The only experts on this are the Alto and those on this site actually doing it.


The thread above is the extent of it.

Those who should know have long ago taken the pharma ghostwriting and scientific misconduct monies and run for the hills.

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Hi GC.  Welcome to SA.  Could you perhaps share a little more of your story . Why were you hospitalized and started on Lithium and Euthryrox ?  What is the reason for wanting to change from Pristiq to Effexor?


This is a site for helping to withdraw safely from psych drugs. Is your ultimate aim to gradually taper off ? Are you under a doctor's supervision? Is the changeover his idea ?

You were on 300 mg Pristiq. How much have you tapered already and in what time frame ?


Sorry for all the questions but it helps to have all the information, so as to understand concisely and therefore help more effectively.


You're probably experiencing withdrawal symptoms as it sounds like you are tapering far too fast. These links give an overview of withdrawal :

What is withdrawal syndrome?

The Windows and Waves Pattern of Stabilization

Healing from antidepressants. Patterns of recovery/


When we have a bit more information we can help with a plan. This is your thread to journal progress and ask more questions. Please have a read of the links. It will help to explain the process more fully.


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Hi AliG,

I was hospitalised because I was suicidal, and I couldn't really see myself anywhere but gone... so my psychiatrist at the time agreed that hospital was the best idea at least until I was more stable. He changed me onto pristiq because he thought the symptoms I was having would be better treated by an SNRI rather than SSRI. Then through mood / well being surveys and questionnaires over my stay my dosages were changed. It was found that my body metabolized pristiq quite quickly, so I'd feel a benefit from a dosage increase initially but after a day or two my mood and depressive symptoms were back with a vengeance.

As far as I understand I was started on euthyrox to increase my metabolism (which was slowed by my depression) so I felt hungry and had a bit more energy. And the lithium was introduced as a mood stabiliser. Although I don't have bipolar, my psych was noticing pretty rapid shifts in my depressive moods, and my current psych also reckons that a lot of people with severe depression at such a young age are likely experiencing the lows of bipolar, and the highs can occur later in life, so she 's fine with me on it despite my unipolar diagnosis.


The reasoning for the switch for pristiq to effexor is that for the last year or so, I've been experiencing depression again (after being stable for over 12mths). And I put it down to stressors in my life ( I just moved across the country) but I haven't been able to shake the bad feelings and how quickly I know I can go from bad but stable to awful and suicidal. 

Efexor is the first choice because the way my psych explained it to me, is that the change over is the quickest/easiest. So I figured I'd try this first because I'm currently trying to juggle work and uni and I don't have many social supports around me. 

So the plan is drop from 300P to 200P over a weekend then on Monday start with 300 effexor. the Dr said it wouldn't be too bad withdrawal wise this way and not too dangerous serotonin-syndrom-wise as the drugs are very similar


Down the track I'd love to at least reduce my doses of various meds I'm on, if not wean myself off them completely. But for right now I'm just working on being stable and functioning like a normal human being (so perhaps this isn't the forum for me??).


Thanks so much for commenting!

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GC.  I'm so sorry for what you have gone through.  Reaching stability is our aim too and we can help you with that.  I'm not sure of your changeover plan  but will check in and get a second opinion and then get back to you.


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Hey GC - I'll try and go as gently as I can, but what we have learned here about the drugs isn't taught many places.  You and I are looking at an elephant, I have other people with me, so I can see the trunk, the ears, the legs and the flank, but you are holding the tail.


So when you say:

Lexapro in 2011 at 10mg and then increased a few months later to 20mg


Then you say:

In 2014 I checked myself into hospital


I was hospitalised because I was suicidal


You probably don't see the connection between these two events.  These drugs are not tested in the long term - you and I and millions of others are the largest in vivo lab experiment ever conducted.


Lexapro is well known for driving people to suicidal extremes.  This feeling is often attributed to akathisia, described here: Akathisia Nightmare  


When a friend tells me s/he is taking the drugs (any of them, really) I suggest that s/he only stay on them for 6 months (since I won't be able to stop him/her from taking them).  The longer you take them, the more risk for adverse events.


At 3-5 years, these effects start to come in to play (if you are lucky.  Some people get them after 1 day).  The drugs "poop out" (don't work as well) or you get side effects - which can seem mental/emotional (and therefore "mental illness" is diagnosed, or "relapse," or "drug resistant") as well as physical (restlesseness, breathlessness, fatigue) in nature.


So, when someone on 20 mg of Lexapro for 3 years says they went to hospital on a suicidal crash course, I am unsurprised.


I am also unsurprised that then, they decided to increase your cocktail.  That's what usually comes next, when drug side effects are "diagnosed" as "life-long conditions."  


So - you had a cold switch to Pristiq.  Nice of them to keep you in hospital for 6-7 weeks to do that.  A little unusual, too, you must have been in extreme distress.  I'm sorry for that. 


Sure - you were suffering when you first took the drugs.  But how do you know that the suffering wouldn't have resolved in a year on its own?  You don't.  And it is likely that it would.  The drugs work 25-50% of the time (depending on whose studies you believe), and placebo works about the same. (ref:   Kirsch I, Moore TJ, Scoboria A, Nicholls SS: The Emperor’s New Drugs: an analysis of antidepressant medication data submitted to the US Food and Drug Administration. Prevention and Treatment 2002)


The reason these drugs work, is because you feel something different while on them.


Most depressions resolve when you make the life changes that caused the depression in the first place.  You say you had no stressors, but it doesn't have to be a death, or divorce, or loss of job - it might just be a tough schedule, difficult job, draining relationship, or poor nutrition, or maybe you didn't learn good coping skills while growing up.  But what the long term studies are starting to show is this:  If you want to stay sick, and get sicker the rest of your life, then stay on the drugs.  (ref: Robert Whitaker, Anatomy of an Epidemic).


Now, about 2-3 years later you are wanting to switch again, while also on lithium and T3.  You know the next drug, when things go belly up at this point, is either an anti-convulsant (Lyrica, Depakote, Neurontin), or, more likely, an anti-psychotic, (Abilify, Zyprexa, Seroqel).  


First, read about Delayed Onset of Withdrawal Symptoms - and notice that you can get symptoms from withdrawal 3, 6,12 months out.  Or longer.


And you want to make the change over the weekend?  This is not a "taper," it is a cold switch. (like a cold turkey, only changing drugs instead of going off.)


We recommend tapering no more than 10% of current dose per month.  Why taper by 10% of my dosage?   This is the only way we know how to have a symptom free transition from one drug to another.  Or off of a drug.  


Yes, Pristiq is "kin" to Effexor, but - 


How badly do you want that Effexor?


Then, you give your own prognosis of what is to come, by telling us what happens when you decrease your Pristiq:

So far I'm just experiencing low grade headache (not going away with sleep, water or paracetamol), lethargy and fuzzy vision.

In the past when having accidentally missed a dose of meds or run out, I've experienced headaches, nausea, lethargy, poor vision, need to keep moving (??), electric shock type feelings under my skin and in my brain. I usually just try to sleep until its over or can get some meds.


These are what you have to look forward to, on a bigger, more intense, more long term scale.


Maybe the Effexor will "cover it."  But  then, in 3 years time, what will you go to next?


I'll say it again:

The reason these drugs work, is because you feel something different while on them.  We use Non Drug Techniques for Coping with Emotional Symptoms - exercise, sunlight, sleep, there are many ways to feel something different that don't involve restructuring your brain.  


What you are proposing to do - what your doctor is proposing, is very dangerous, destabilising and disruptive.  And  outrageous in the face of the symptoms you've already described.


Here are a few more links you can use to understand the way we see that elephant - and see if you can perceive more of what I am talking about here:


Intro to Antidepressant Withdrawal Syndrome

Healing from Antidepressants - Patterns of Recovery (by Toxic Antidepressants)


Is It Relapse or Withdrawal?


Additionally, you might check here to see if any of your "side effects" match up with this list of "common withdrawal and side effects" of these drugs:  http://survivingantidepressants.org/index.php?/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/


If you find there is a lot you are familiar with on that list, then there is a very good chance that your "depression" and "symptoms" have been caused by the drugs.


Let me know your thoughts on this.  We don't require that anyone "come off the drugs," that would be infeasible.  But even if you can reduce, or come to understand better how you came to this place - then there is plenty here to help you.

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Very well explained JC - thanks.

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Welcome, GC.


Are you truly taking 300mg Pristiq? And this has been prescribed to you by a doctor?


A high dose of Pristiq is 100mg. You are taking 3 times that amount. This is an excessive dose. (In my personal opinion, it is stupid and dangerous.) What does your current doctor think of this dosage? What does he have in mind for an Effexor XR dosage?


Have you had any side effects? You are probably a fast metabolizer of desvenlafaxine aka Pristiq. Fast metabolizers run the risk of being overmedicated, as they don't respond to lower doses. However, higher doses can do a lot of damage to the body. Have you had your liver and kidney function checked recently?


If you've already decreased to 200mg Pristiq, I would not go back to 300mg. If I were you, I would wait until the withdrawal symptoms dissipate before attempting another decrease.


Why does your doctor want to switch you to Effexor?


Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html
and copy and paste the results in this topic.

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Hi Altostrata,


Yes I'm truly taking 300mg Pristiq. This was prescribed to me by a doctor after starting at 25mg with no benefit and gradually increasing until benefit was discovered. I have since changed doctors (I moved interstate) and she is fine with me on this dose, and has kept me on it since she's known me (approx 16mths). 

From my understanding, through doctors and my own research, the therapeutic dose of Pristiq is 50mg-400mg. While obviously you'd want to be on the lowest dose that works for you, at some point I believe the risks of a suboptimal level of meds on my mental health is more dangerous than the physical issues that could come with high doses for along periods.


I get blood tests every few months to determine lithium level, iron levels  as well as liver, kidney and thyroid function, so I am being monitored closely and have been throughout my whole journey (since 2010).


My doctor is thinking 300mg Effexor XR (again a high dose, but it is similar to Pristiq). This comes with blood test monitoring and regular dr visits to make sure everything is okay, and things will be tweaked as necessary.

The main reason for the switch is that I currently sleep (10-15hrs) and work, and that's it and I want more out of life. I'm also struggling with memory and concentration (things I used to pride myself on).


The only side effects I've noticed are nausea and headaches when I first started a drug or changed the dose. But once I had been on it for a while I didnt notice anything, unless I missed a dose or was late with a dose, in which case I get a headache, brain zaps, eye sensitivity, but again, within an hour of taking my dose, it goes away.


Does anyone know of anyone/have any knowledge of Pristiq to Effexor XR WITHOUT tapering down to zero and building back up?




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As long as you are on an antidepressant for years, you will experience emotional anesthesia or deadening. It is a common side effect of the drugs, particularly if you've been on them for many years. Essentially, your nervous system is at maximal serotonergic downregulation and can't go any further.
Andrews, 2015 Is serotonin an upper or a downer?

Andrews, 2011 Blue again: Perturbational effects of antidepressants...

Katz, 2011 Tachyphylaxis/tolerance to antidepressants...

Amsterdam, 2009 Does tachyphylaxis occur after repeated antidepressant...

El-Mallakh, 2011 Tardive dysphoria: The role of long term antidepressant use...

Price, 2009 Emotional side-effects of selective serotonin reuptake inhibitors...

Opbroek, 2002 Emotional blunting associated with SSRI-induced sexual dysfunction...

Sansone 2010 SSRI-Induced Indifference
As you believe that you must take psychiatric drugs -- "therapeutic dose" by the way, is a fiction -- you should ask your doctor about cross-tapering as a way to switch from one to the other. If she doesn't know how to do this and doesn't make the effort of learning how to do it, you need another doctor. It is the safest way to change psychiatric drugs.
Examples of cross-tapering: The Prozac switch or "bridging" with Prozac
Essential information: Tips for tapering off Pristiq (desvenlafaxine)

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The only experts on this are the Alto and those on this site actually doing it.


The thread above is the extent of it.

Those who should know have long ago taken the pharma ghostwriting and scientific misconduct monies and run for the hills.

Standing ovation..... 

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Does anyone know of anyone/have any knowledge of Pristiq to Effexor XR WITHOUT tapering down to zero and building back up?


GC, at those high doses, you are playing fiddlesticks with dynamite.  This is your body, are you sure you want to blow it up?


I reckon, that you are wanting to switch because you are having "poop out" or "side effects" from the Pristiq.


Why do you want this so badly?  What makes you think this is a good idea?  What is the pressure to make this sudden, precipitous move?


MOST cross-taper schedules are too fast (my p-doc cross-tapered Effexor with a tricyclic over about 6 weeks, and that was too fast, but bearable.).  THIS cross-taper schedule is, well.  Dangerous and potentially insane.  Especially given the high doses involved.


If you read around this site, you will see people suffering, some of whom suffer from a 20% drop, or a cut in half.  Or a taper over 4 months, instead of longer.  A weekend, is a cold turkey switch.  It is not recommended.


The best recommendation is to learn to live without the drugs, as you gradually taper off of them.  But you have to choose it.  You are welcome to stay in here and report what happens, if you pursue this course, it would be an excellent cautionary tale for new members who don't understand the costs of these drugs.


I hope I am wrong.  I don't wish suffering on anyone.  But it is my wish to prevent suffering which has me suggesting that this course you & your p-doc have chosen - is not a good one.  I don't want anyone else to suffer.


Additionally, once you "fall apart," it is much more difficult to put Humpty back together again, than it is to keep him from tumbling to begin with.  

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I know most the people in here are at the stage in their treatment where they are coming off meds or choosing not to take meds for their conditions.

For me however, my primary goal is to stay 'afloat' enough, using meds and other strategies I've learnt, until I feel ready to decrease and everntually not rely (so heavily) on my medication. Until then my choice is to stick with what is working (imo).


If anyone is interested, my swap between pristiq and effexor has so far been okay. The 2 days I dropped from 300mg to 200mg pristiq I had a headache and was very tired, but since Monday (start of 300mg effexor) I haven't noticed any side effects.

I appreciate people's concern regarding my path and I understand it isn't for everyone, however it is what I'm choosing FOR NOW.

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> Does anyone know of anyone/have any knowledge of Pristiq to Effexor XR WITHOUT tapering down to zero and building back up?


Yes.  see my thread  http://survivingantidepressants.org/index.php?/topic/5418-ktp-weaning-from-4yrs-50mg-pristiq/ 


Feb 2014 I switched from Pristiq to Effexor XR in order to take advantage of easier dosage control with effexor.  (you can't cut pristiq tabs but you can open effexor capsules and count beads, so it's easier to wean.)


IIRC I had no trouble just switching, but I did do a few days of taking more effexor than i needed.  I came out thinking about 125mg effexor = 50mg pristiq, but if i had to do it again I think i'd do 100mgE = 50mgP.  But look around the web for pristiq vs effexor dosage or better desvenlafaxine vs venlafaxine dosage, there's much more info out there than there was in 2014.


i can also gladly report I had no new side effects.  


[my layman understanding is that they're the same drug, pristiq is the des-isomer of effexor.   (effexor's more likely to cause side effects, it's both isomers)]


switching from pristiq to effexor was the easy part of my wean (which was going splendidly well until i got excited and over-reduced in 10/2014, so now it's two pages of what i hope amount to warnings re too-fast weaning, sorry about that part.  


good luck!  not a doctor but i stayed at a holiday inn once.

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