Andie: tapering off Pristiq

[ChessieCat]

Might be time to change doctor.

[Andie]

2 hours ago, ChessieCat said:

Might be time to change doctor.

Agree.

[Andie]

Hayfever clearing. 

 

Had two bad days in a row with poor sleep and terrible anxiety upon awakening. Lots of extremely vivid and emotional dreams that leave me shaken up until lunch time. 

 

I have also noticed I can’t stand bright or flashing lights and I’m jumping at loud noises. 

 

I can see how effected I am by some of the stress and worries I’ve had lately. I can usually just grin and bear it and power through but I just can’t at the moment. I’m taking this as a sign that my nervous system is fragile and I need to give it stability. 

 

No change to any of my medications and holding at 12mg. 

[Andie]

I think I’ve realised that 15mg and under is where my ‘uh oh’ zone. The symptoms of being in withdrawl aren’t as obvious as they used to be at higher doses. The intense brain zapping and nausea, vomiting, sweating and eye uncoordination don’t seem to happen anymore. It’s all much less violent and in your face. 

 

I now know my body is protesting by muscle spasms, vivid dreams, muscle pain, anxiety and cognitive issues. I think I have been having signs of withdrawl but missed them as I had been acutely unwell for weeks. I also need to stay well away from antihistamines. 

 

Woke up with intense anxiety and vivid dreams this morning. Felt strange until 1pm and then everything clicked back together again. Doing better overall on a split dose but the morning anxiety and dreaming is quite disabling at the moment 

 

 

 

[Andie]

Still having a lot of vivid dreams and this is making me tired during the day. Spasms and twitches still present but less intense. 

[ChessieCat]

1 hour ago, Andie said:

I was sweating 24/7 and I was having periods of intense tachycardia and high blood pressure.

 

I too was taking 100mg Pristiq and experiencing sweating in the middle of winter.  My diastolic blood pressure went up after my dose was increased from 50mg to 100mg and I would experience what I felt as my heart flipping, which I think others call missing a beat.  As my dose got lower I also realised that I had been feeling confusion and agitation.  I believe this to be mild serotonin toxicity.

 

My doctor did not make the connection between the increased dose and the increase in blood pressure.

[Andie]

This sounds all too familiar to me. I was sweating in the middle of winter, sweating under bright lights and sweating having hot drinks. Just sweating ALL the time. I would carry a hand Fan in my bag and I’d have to pull it out at the most embarrassing times. I was also covered in excema from the constant sweating. I went to Singapore when it was at its worst and that was a very interesting time to say the least! 

 

Then my blood pressure and heart rate shot up and I was getting that heart flipping you describe. To me it felt like heart lurching. My GP was concerned (but didn’t make the connection to the Pristiq)  and I was  then sent to a  Cardiologist. It was the cardiologist that then advised that I must try and come off the Pristiq. He said he sees many women around my age (early 30s) on SSRIs and SNRIs presenting to him with similar complaints. 

 

Like you Chessie, I was very agitated and I felt fogged out and disconnected. In hindsight I was probably  having bouts of confusion too. 

 

I never realised any of this until I started coming down. To me that is the thing that upsets me the most- not knowing myself. I was clueless. Totally and utterly clueless about what were and weren’t adverse effects of Pristiq. I feel really very shell shocked. 

 

[ChessieCat]

10 minutes ago, Andie said:

It was the cardiologist that then advised that I must try and come off the Pristiq. He said he sees many women around my age (early 30s) on SSRIs and SNRIs presenting to him with similar complaints. 

 

That's interesting.  I met someone recently who was taking 200mg Pristiq and showing signs of serotonin toxicity.  She may have been taking some other drug as well, I can't remember, maybe something for sleep.  Watching her agitation and scattered thinking during lunch time reminded me of what I had been like.  I wrote down the information of SA and also the name serotonin toxicity for her and told her to speak to the doctor about it.

[Andie]

19 minutes ago, ChessieCat said:

 

That's interesting.  I met someone recently who was taking 200mg Pristiq and showing signs of serotonin toxicity.  She may have been taking some other drug as well, I can't remember, maybe something for sleep.  Watching her agitation and scattered thinking during lunch time reminded me of what I had been like.  I wrote down the information of SA and also the name serotonin toxicity for her and told her to speak to the doctor about it.

Yes, the doctors aren’t making the connection. All of them have small snippets of information relevant to their field of interest.

 

I went to see a sleep specialist during that time and even he mentioned to me that they were well aware of the sleep issues that withdrawal from Effexor and Pristiq cause. They can see it on the Sleep study EEG with delay going into REM and then REM rebound toward the morning(mine looked like this). 

 

Whenever I hear information like this, I send it to my doctors. 

 

I dare not even imagine myself on 200mg of Pristiq. I think I’d spontaneously  combust. My psychiatrist did mention someone was sent to him with seratonin syndrome at 200mg that was prescribed by their GP. 

 

I only very recently heard of someone taking 400mg!!! 

 

[ChessieCat]

12 minutes ago, Andie said:

I only very recently heard of someone taking 400mg!!! 

 

I thought 200mg Pristiq was bad enough.  400mg that is outright criminal.

[ChessieCat]

I've just done a quick google search and found this here https://www.rxlist.com/pristiq-drug.htm#indications

 

(10 mg doses?  Must have been made specially for the clinical studies.)

DOSAGE AND ADMINISTRATION

General Instruction For Use

The recommended dose for PRISTIQ is 50 mg once daily, with or without food. The 50 mg dose is both a starting dose and the therapeutic dose. PRISTIQ should be taken at approximately the same time each day. Tablets must be swallowed whole with fluid and not divided, crushed, chewed, or dissolved.

 

In clinical studies, doses of 10 mg to 400 mg per day were studied. In clinical studies, doses of 50 mg to 400 mg per day were shown to be effective, although no additional benefit was demonstrated at doses greater than 50 mg per day and adverse reactions and discontinuations were more frequent at higher doses.

 

The 25 mg per day dose is intended for a gradual reduction in dose when discontinuing treatment. When discontinuing therapy, gradual dose reduction is recommended whenever possible to minimize discontinuation symptoms [see Discontinuing PRISTIQ and WARNINGS AND PRECAUTIONS].

[Andie]

2 hours ago, ChessieCat said:

I've just done a quick google search and found this here https://www.rxlist.com/pristiq-drug.htm#indications

 

(10 mg doses?  Must have been made specially for the clinical studies.)

DOSAGE AND ADMINISTRATION

General Instruction For Use

The recommended dose for PRISTIQ is 50 mg once daily, with or without food. The 50 mg dose is both a starting dose and the therapeutic dose. PRISTIQ should be taken at approximately the same time each day. Tablets must be swallowed whole with fluid and not divided, crushed, chewed, or dissolved.

 

In clinical studies, doses of 10 mg to 400 mg per day were studied. In clinical studies, doses of 50 mg to 400 mg per day were shown to be effective, although no additional benefit was demonstrated at doses greater than 50 mg per day and adverse reactions and discontinuations were more frequent at higher doses.

 

The 25 mg per day dose is intended for a gradual reduction in dose when discontinuing treatment. When discontinuing therapy, gradual dose reduction is recommended whenever possible to minimize discontinuation symptoms [see Discontinuing PRISTIQ and WARNINGS AND PRECAUTIONS].

My jaw dropped when I heard this person was on 400mg😱. She is also now on some sort of medication for ADHD. I’m not surprised.  I always feel I have to tread really carefully, she really does believe She has a chemical imbalance requiring that dosage she trusts her Doctor.  I just encouraged her to get a second opinion. 

[Andie]

😉

[Andie]

Unfortunately I am definitely going to have to consider a change over to either Fluoxetine or Venlafaxine for the rest of my taper. I have sought the opinion of three different Pharmacists and all are in agreeance that I am struggling with the time release and metabolising the Compounded Pristiq too quickly at low doses. It is possible that I had gone into withdrawal during the period I was unwell as having a high fever would have sped up my metabolism even further. 

 

They all say that Pristiq is very tricky to compound (one won’t even attempt it) because the time release is removed when the tablet is crushed. Even though compounders add their slow release agents, Dosing is highly dependant on an each individuals own body chemistry and metabolism. 

 

So the plan for now is to try and stabilise as much as I can before making a switch. There is also an option of trying the enteric coated capsules to see if that helps. 

 

I’m having blood taken for Pharmacogenetic screening and then take it from there. 

 

One of the Pharmacists found this case note from the University of  British Columbia Pharmaceutical Sciences Journal.

 

There is also mention of dosage equivalencies between Venlafaxine and Desvenlafaxine. 

pssj-v03-i01_attfield.pdf

[Andie]

Started taking 400mg of Vitamin E Mixed Tocopherols from Metagenics. Vitamin E being trialled to see if it can ameliorate my my spasms and twitches. 

 

Poor sleep and intense dreams=BONE WEARY FATIGUE!!!

 

 

[ChessieCat]

Have you started taking 2 new things at the same time?  Keep it Simple, Slow and Stable

[Andie]

1 minute ago, ChessieCat said:

Have you started taking 2 new things at the same time?  Keep it Simple, Slow and Stable

No just the vitamin E. 

[ChessieCat]

That's good! 😊

[Andie]

Yes. I just updated my signature to add the Magnesium. Today is the first day I have taken the Vitamin E. Fingers crossed. 

[Andie]

Had a good day yesterday. More energy and less spasms. 

 

Woke up up this morning and spasms are back. 

[Andie]

On 4/24/2017 at 11:25 AM, Altostrata said:

Hi, Andie, I moved your post here as your history gives it context. Please put all such questions and updates in this, your Intro topic.

 

Generally, if your withdrawal symptoms do not go away in a few days, that's a sign you've reduced too much. Sometimes a small updose is all that's needed; if you went from 32mg to 30mg, going back to 31mg might have been sufficient to stop the withdrawal symptoms.

 

You may wish to hold for a while at this level to let your nervous system settle down from all the dosage changes in the last 6 months. Please post in this topic and let us know how you're doing.

Note to self- held at 32mg for 4 months. 

 

Currently Holding at 12mg

 

 

[Altostrata]

You've come a long way, Andie!

 

Yes, let your nervous system coast for a while on 12mg, rest up for the last leg.

[Andie]

1 hour ago, Altostrata said:

You've come a long way, Andie!

 

Yes, let your nervous system coast for a while on 12mg, rest up for the last leg.

Thanks Alto!

 

A big thank you to you for all your hard work! You are amazing. 

 

My Doctor is no longer prescribing Pristiq due to the horrendous withdrawl she has witnessed her patients go through ( I was patient zero). I’ve shown her lots of journal articles from this site and she is spreading the word to her colleagues. Antidepressant Withdrawal is now a major area of interest for her. 

 

 

[ChessieCat]

20 hours ago, Andie said:

My Doctor is no longer prescribing Pristiq due to the horrendous withdrawl she has witnessed her patients go through ( I was patient zero). I’ve shown her lots of journal articles from this site and she is spreading the word to her colleagues. Antidepressant Withdrawal is now a major area of interest for her. 

 

F. A. N. T. A. S. T. I. C.  If you can't read what it says, it says fantastic!!!

 

 

 

Edited December 21, 2018 by ChessieCat
change can to can't

[Altostrata]

20 hours ago, Andie said:

Antidepressant Withdrawal is now a major area of interest for her. 

 

I'm sure you can teach her a lot!

[powerback]

Vitamin D3 5000iu with K2  

Hi Andie, is this strength of D3 everyday.im not exactly questioning it but its a big  dose.you mite get away with a smaller and cheaper dose  ,im taking 3000iu myself .

Had a little read of your thread ,your doing good ,hold and live life for now .ile come back soon and read a bit more ,massive fatigue just now .

Take care .

 

[Andie]

On 12/25/2018 at 12:41 AM, powerback said:

Vitamin D3 5000iu with K2  

Hi Andie, is this strength of D3 everyday.im not exactly questioning it but its a big  dose.you mite get away with a smaller and cheaper dose  ,im taking 3000iu myself .

Had a little read of your thread ,your doing good ,hold and live life for now .ile come back soon and read a bit more ,massive fatigue just now .

Take care .

 

Unfortunately I have to take high doses of Vitamin D because I have regular iron infusions. If the D is too low, it’s too risky to have the iron infusions as it causes low levels of phosphate in the blood.

 

[Andie]

So I went to see Psychiatrist today. Was told I shouldn’t be having any problems on my current dose as it was ‘so low It wouldn’t be doing anything’. Ahem. 

 

I pulled out :

 

Am J Psychiatry. 2004 May;161(5):826-35.
Serotonin transporter occupancy of five selective serotonin reuptake inhibitors at different doses: an [11C]DASB positron emission tomography study.
Meyer JH1, Wilson AA, Sagrati S, Hussey D, Carella A, Potter WZ, Ginovart N, Spencer EP, Cheok A, Houle S.

 

and

 

An open-label positron emission tomography study to evaluate serotonin transporter occupancy following escalating dosing regimens of (R)-(-)-O-desmethylvenlafaxine and racemic O-desmethylvenlafaxine.

 

 

The question /statement I got was ‘ so why are we overdosing our patients then? ‘ 🤦🏻‍♀️

 

No words 😶 

 

[ChessieCat]

3 minutes ago, Andie said:

 

The question /statement I got was ‘ so why are we overdosing our patients then? ‘ 

 

Yes, so why???  Please tell ...

[Andie]

7 minutes ago, ChessieCat said:

 

Yes, so why???  Please tell ...

 

I asked that very question. 

 

The only response was a look of shock followed by some swear words. 

 

 

 

 

[ChessieCat]

Hopefully the message is starting to get out to the medical community.

[Andie]

I mentioned we don’t even know what’s happening with NET in the case of SNRIs because the marker technology used to show uptake of NET in the brain Has not been developed. 

[ChessieCat]

Hi Andie,

 

Just wondering how you are now.  Are things settling down?  How about the dose splitting?  Does that seem to be working?

 

I reduce to 4.75mg tomorrow.

[Andie]

Hi Chessie 

 

wow thats low! 

 

I am still splitting the dose, but I’m finding I have to take a large dose at night before bed. So I am still taking 10mg at night and then 1mg at 7am and 1 mg again at 3pm.  I am definitely having some trouble with the time release and 10mg was as low as I could go for the night time dose without waking up really ill in the morning. As a last ditch attempt to stay on Pristiq, my next lot of capsules will have the enteric coating. 

 

Things are most definitely  settling down after the bump I had in October and November. I’ve still got muscle spasms and twitching but nowhere near as bad as it was. 

[ChessieCat]

It's good that you've worked out a way to take your dose so you don't feel so bad.  It's strange how it can be different for different people.

 

I've been splitting my dose unevenly since I got under 10mg.  I've recently been taking 4mg am and 1 mg pm and will be changing to 4mg am and 0.75mg pm.  When I get to 4mg I will have 6 x 4mg capsules left and then I'll be taking 2 x 2mg each day.  I think that now I'm getting so low I might open the 4mg capsules up and take part am and pm.  I can't afford to waste capsules and I've already worked out my schedule.

 

I'm pleased that things are settling down for you.

[Andie]

I’m still very heat sensitive. Grrrr. I had been waiting to see what this Summer would be like. 

 

No where near as bad as at 100mg and 50mg where I was constantly sweating. 

 

Still having muscle spasms and struggling a little with the lifting of emotional anaesthesia. Feeling really peed off about this medication and it’s impact on my life. The up and down is just so incredibly frustrating. 

 

Holding at 12mg to see if it settles further and give my poor body a break. Spasms are definitely improving but at a snails pace.