JaneDoe: coming off Pristiq

[JaneDoe]

Hi everyone,

I've been lurking around this site for over 6 months now, so I figured it was time to finally make an account and introduce myself.

 

I was 'formally' diagnosed with depression in 2007, and started on prozac 20mg.  I say 'formally' because it was discussed that I probably had had it for a few years.  I was 17.  Prozac worked really well for me, and I had no side effects.  I can't really remember how but I came off (well, I think I tried, then realised I needed it, continued to take, for a while).  I know that I was off of it by 2010.  About 6-12 months later I realised I was quite depressed again, so back to the dr and I started 20mg Prozac.  It didn't help.  

 

Increased to 40.  This was effective and I was feeling back to 'my old self'.  I was on this for 6-12 months, and I moved to a new city, a new job and left my very close work friends behind.  I was unhappy with my new job, and the move hadn't worked out well for me at all - I hadn't realised how lucky I was to work with my good friends.  It seemed that the prozac had stopped working for me, but I hadn't realised.  Until I 'crashed'.  Started crying and couldn't stop for about 3 days.  

 

So I went back to the dr, who started me on effexor and referred me to a psychiatrist (for the first time) and send me to a psychologist.  The psychologist was useless so I stopped pretty quickly with her.  When I got into the psych she started me on Pristiq, 150mg.  This was late 2012, I think.  I did find this a bit better than effexor - the short half life of effexor caused a few problems if I was even a few hours late with my dose.  I'm a shift worker so it's hard for me to remember to take it at the same time each day - especially when they say 'take it in the morning'.  (I've switched to evenings and that's much easier.)

 

For a while I was bumped up to 200mg - typically I struggle throughout the winter months, so I think this was over 2013.  After winter and being stable, I dropped back down to 150mg on the advice of my psych - which was 'alternate 150 and 200 daily for a fortnight and then drop to 150'.   Not suprisingly, this didn't work.  I was lucky enough to not have too many symptoms apart from fatigue.  Massive, deibiltating fatigue - I was working and sleeping and that was it.

 

I thought there was something wrong with me, and i saw my gp and had a bunch of blood tests and ended up being referred to a specialist.  I had a consult with him and he did a thorough examination and discussion, and he ended up saying 'I could run a whole bunch of tests on you, but I really don't think they are warranted.  It could be the shift work.  I would suggest getting your ferritin up to 40 or 50' (iron fluctuates low to normal, and it was normal but at the low end of the range).  It was frustrating to not have a reason but i did appreciate his honesty - he felt tests were unwarranted.  We didn't discuss the drop in anti depressants.

 

Eventually I realised that the fatigue started when i dropped to 150mg and I just couldn't keep going like this, so I re instated.  After I felt I could cope again, I dropped - still alternating daily, but instead of a fortnight I did it until I was coping again.  ("Coping" = having enough energy to do more than work and sleep).  Then I went 3 days 150, 4th day 200.  Then finally dropped to 150.  This seemed to do the trick.

 

Last year I realised that we want to try for a baby around 2018 (possibly), which means coming off the drugs.  As I was googling how to deal with the fatigue I came across this site and read a whole lot of stuff and had my eyes opened!  No alternating, 10% taper... compounding pharmacies??  Amazing.  Starting in Jan this year I have tried to reduce.  At first I was cutting the pills in half but really hated that, so I found a compounding pharmacy and got them made into 10mg and 5mg.  

 

I found that for about a week after dropping I would feel pretty rubbish - tired, extremly vivid dreams (to the point I didn't know if I had dreamt something or if it happened), headaches... generally crap.  Then, like a lightbulb, a week later i was ok.  At some point I was reading about supplements on here and added a few in - now I take a prenatal multi vitamin daily (for the folate and the b vitamins),  3000mg fish oil, and sometimes iron supplement or curcumin (I have curcumin because I own it.  I don't love taking it but I think it helps).  

 

The drop after adding in these went much more smoothly.  I've also added in 3 x evening primrose oil for fibrocystic breast changes (GP suggestion).  I got to 110mg without too much trouble and held that for over a month.  Then I dropped to 100mg and that was pretty rough.  I just didn't seem to recover, and felt pretty low.  I was feeling quite hopeless/anxious/depressed but started taking melatonin and had a good nights sleep - worked wonders.  

 

Still feeling flat/empty but not as overly emotional and unwell.  The problem with feeling like this is knowing that my end goal is pregnancy really adds in some self doubt 'what if i can't get off? can't get pregnant... or i can but it's risky for the baby and that's selfish and I don't want to have a baby addicted to these meds' etc and go into a big spiral.  When before, it's like 'well if i can drop, good.  if not, oh wells.'

 

I've been on 100mg since mid-May.  I saw my psych 6 days ago and was still feeling flat, so she has decided to make the switch to zoloft, then reduce the pristiq.  For the past week I've been taking 100mg Pristiq adn 50mg zoloft and I think i'm feeling a bit better (apart from all the side effects!!)

 

The plan is, as of Monday, I go to 100mg zoloft and start to taper the pristiq by 10mg each week.

I'm not sure how I feel about this.  Any advice/suggestions?  When I got the zoloft, the pharmacist was quite concerned about serotonin syndrome.  I'm not sure that I need to go to 100mg zoloft this week, maybe I taper my pristiq down and then up the zoloft when needed?

I'm also seeing my psych every 3 or 4 weeks for now, until I"m stable again.

Edited June 17, 2017 by KarenB
added white space

[Altostrata]

Welcome, Jane.

 

You're tapering Pristiq with the aid of 10mg and 5mg compounded capsules? How are you taking your daily dose of Pristiq now?

 

If I were you, I would not switch to Zoloft. That doesn't make any sense, there's no advantage to it, it could incur withdrawal syndrome from the switch, and they you would be in a pickle.

 

You should be aware that when Pristiq is compounded, it is crushed and loses its prolonged-release quality. It is possible your "feeling flat" is because the compounded Pristiq does not have as long-term an effect as the Pristiq tablet. "Feeling flat" is a consequence of how you're tapering, not a symptom to be treated with another drug. Adjusting your tapering method might do the trick.

 

Also, Pristiq is stimulating. When the stimulant is reduced, you might well "feel flat." Your body may need to adjust to the lack of the stimulant.

 

Please read this carefully:

 

Tips for tapering off Pristiq (desvenlafaxine)

[JaneDoe]

Hi Altostrata,

 

I want to apologise for my posts as my brain is swiss cheese at the moment so they could jump all over the place and not make sense.  But I will try my best!

 

I am taking 100mg Pristiq - so just the one tablet.  I take it around 7pm as it doesn't impact my sleep, and with shift work the evening is the best time for me.

The switch to zolof is because my dr thinks that I need an AD and zoloft is 'pregnancy safe', so if I am stable and on zoloft I can get pregnant when it suits me.  (Although 'pregnancy safe' ADs are a whole other issue, aren't they??  The CMI says that zoloft should be avoided in pregnancy).

 

The pharmacy that did the compounding added in their own extended release -  so they said that obviously, it's not the same as pristiq, but it is as close as they could make it.  And try it and see how it goes, I might need to split up the dose.  But I felt fine - it was much better than when I was cutting the pill in half.

 

When I say 'feeling flat', I mean that it feels like depression - how it's felt to me before.  That's not to say it couldn't be the withdrawal but I after 7-8 weeks of being on 100mg, I was getting worse, not adjusting.  (I need to edit that first post but can't see how? - I said I dropped from 110 to 100mg mid-May, but it was mid-April).

 

I will have a re read of the tapering thread - it's been a while.

[Altostrata]

None of the SSRIs are "pregnancy safe." That's your GP's wishful thinking.

 

Why does your GP think you need an antidepressant? Have you looked into Non-drug techniques to cope with emotional symptoms for that "flat" feeling? How much daily exercise do you get?

 

Is it the winter where you live? Have you looked into light therapy? Are you taking hormones to get pregnant?

 

Was it possible you skipped any doses of Pristiq in the last couple of months?

 

How are you going to take the 10mg and 5mg compounded capsules? Do you have a prescription for 50mg Pristiq tablets?

 

 

 

 

[JaneDoe]

25 minutes ago, Altostrata said:

None of the SSRIs are "pregnancy safe." That's your GP's wishful thinking.

Agreed!

 

26 minutes ago, Altostrata said:

Why does your GP think you need an antidepressant? Have you looked into Non-drug techniques to cope with emotional symptoms for that "flat" feeling? How much daily exercise do you get?

She thinks that I am just 'wired' that way, for a simple explanation.  An issue with serotonin metabolism or something.  Based on my history, that does appear to be the case.  I would ideally like to be medication free, but happy.

I've looked at the non drug techinques and I do try to utilise as much as possible.  But the last month or so, as I've struggled, I end up not doing anything (not eating, exercising, etc) which of course makes things worse.  It's a vicious cycle.

 

28 minutes ago, Altostrata said:

Is it the winter where you live? Have you looked into light therapy? Are you taking hormones to get pregnant?

Yes it's winter, there's still plenty of sunlight around (most days are 20-25 degrees and just beautiful)  and I am trying to hang out in the sun as much as possible.  I have heard of light therapy and looked into it in the past but not recently.  I'm not taking hormones to get pregnant, as that's the plan for late next year - I had read the tapering thread on here and realised I need PLENTY of time to ditch the pristiq before trying.  And I'd like to be nice and stable, not rush.  I do have a Mirena IUD, and have had that for 4 years.  Not sure how much impact those hormones have on mood, but it just seemed to eliminate the PMS that I would get.

 

30 minutes ago, Altostrata said:

Was it possible you skipped any doses of Pristiq in the last couple of months?

 

Nope!  I do get a raging headache and brain zaps if I do miss, so I am quite sure.  (If I'm at work and forget my medicine, I have a headache by the time i get home at 10pm to remind me.  It's annoying but also helpful, I guess).

 

31 minutes ago, Altostrata said:

How are you going to take the 10mg and 5mg compounded capsules? Do you have a prescription for 50mg Pristiq tablets?

 

Yes i have the 50mg script - I was taking 150mg in the form of 100 and 50.

Do you mean what time of day/how far apart for the compounded capsules?

By the time I got them compounded I had dropped to 125 mg by cutting a 50 in half.  So I switched to 1 x 100, 2 x 10mg and 1 x 5mg.  I trialled taking them all at once and it seemed effective (much more so than cutting it in half).  I thought I would split the compounded ones and take throughout the day if I felt like the extended release wasn't working, if that makes sense... If i was getting headaches or zaps.  I know that when I cut the tablets in half it felt like it all hit my system at once (even though, from what i've read, the extended release isn't in the wrapper but embedded in the matrix??).  

I expect the differences will be more noticable when I drop to 90mg, as I will be taking 1 x 50mg and 4 x 10mg compounded (or 2 x 20mg, if I can get those made up).  My plan is to take the 50mg in the evening, as I have always done, and if needed split up the other 40 mg so take 20mg in the evening and 20mg when I wake up.

The reason I prefer evenings is that with the shift work I do, my wake up times HUGELY vary.  This week, I am starting work between 5 and 6am.  Last week, I was starting work at 2pm and finishing at 10 - so waking up much later.  If I try to take them at say, 10am, I often forget to do so if I am working morning shifts, or I forget to take the medicine to work with me.  Also, I often work overnights, finishing at 5am, so 10am would see me asleep.  So thats why i prefer to take everything at 7pm, if I can.

 

So I've taken 50mg of zoloft this week as well as 100mg pristiq.  You suggest not taking zoloft - after 1 week is it safe to simply stop it?  Or do I need to taper and withdraw off that too?

 

(Really wish i had joined up a week or a month ago... *sigh*)

[scallywag]

You can probably discontinue the Zoloft right away. If you want to be more cautious, try taking a half-dose (25 mg) for 4 days, if no symptoms then you could either stop or reduce to ¼ dose (12.5 mg) for 4 days then stop.

[JaneDoe]

Hmmm.  I'm getting symptoms from taking the zoloft so it's hard to know if I was to take a half dose and got symptoms whether they are from taking it or decreasing it.

If that makes sense?

 

Forgot to answer Altostratas question about exercise - I aim for pilates 3 times a week, but lately it's been more like once.  Also trying couch to 5k but I'm quite inconsistent with that (but that's not depression or WD related.  That's just me!)

[scallywag]

If you're getting adverse effects ("side" effects) from Zoloft, they'll decrease when the dose decreases. That's one do-it-yourself test available to you at this early stage in taking Zoloft.

[JaneDoe]

I wasn't sure if cutting or quitting Zoloft would cause WD symptoms in addition to the side effects creating just a big annoying mess. If that makes sense...

anyway I skipped it today after struggling to sleep last night because I was too hot again, and my head felt so much clearer.

 I functioned much better at work.  So I'm hoping that I don't have any trouble over the next few days and there will be no withdrawal as I was only on it for a week.

i will continue on 100mg pristiq and see how my mood goes between now and my next appt.

Given the pretty awful way I felt on Zoloft (well, for a week) I would really like to just quit pristiq (slowly, of course) and be done with the meds once and for all.

 

is it common to have more side effects for each new anti depressant you try?  Or is it simply the individual? 

 

 

[scallywag]

Due to the time it takes for your body to metabolize Zoloft, after 5 days, your serum (blood) concentration will be approx. 3% of what it would be if you had taken the medication each day. Please keep an eye on your symptoms and keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:

Take notes of doses and symptoms.

[JaneDoe]

An update: I stopped Zoloft and felt much better.  I then seemed to stabilise on 100mg pristiq and after putting it off (because I was enjoying the stability) I have recently dropped down to 90mg. And it's a struggle again.  Sleeping 10hours+ a day and not getting to Pilates (or anything).  I'm feeling not great, but not terrible, and I'm trying to find the balance between taking it easy and being pro active.  So time to do some more reading on here about techniques and methods.

thanks for listening (reading).  I started decreasing at the start of the year and I think my friends are sick of hearing about it.

[mammaP]

Hi Jane, after your trial with zoloft your brain needs to adjust so it will be better to wait for a while before tapering pristiq. I knpow you want to be off as soon as possible but right now you need to recover from the effects of the zoloft. Even when you feel ok your brain is still healing and trying to regain normality. A good long hold is often the best thing. When you have been stable for 2 or 3 months you can start again. Patience will be your best quality when this is over! 

 

Doctors say zoloft is safe in pragnancy and there are no reported physical defects but that doesn't mean there aren't any.  What they do not tell you is that there is increased risk of stillbirth and sudden infant death. Babies also suffer from withdrawal when they are born but drug companies don't want people to know that so 'hide' it. I was reading statistics a few days ago, I will try and find the info for you.

 

Scroll down this page and you will find the part about zoloft in pregnancy.

http://www.rxlist.com/zoloft-drug.htm#warnings_precautions  

It says that women who discontinue zoloft during pregnancy suffer from relapse of major depression which means it is safer to continue taking it. The RELAPSE is actually withdrawal! 

Edited August 11, 2017 by mammaP

[JaneDoe]

Thanks

i only took Zoloft for 1 week, and only recently dropped down a level of pristiq so I think that's about 6 weeks between stopping Zoloft and going to 90mg.

 

totally agree about the "pregnancy safe" aspect.  I've been told by (multiple) drs that "pristiq isn't that bad, it's just that there haven't been that many studies on it".  Considering the discontinuation symptoms I get, I'm certainly not putting a baby through that!  (Not sure how much crosses the placenta but still...). Although the last time I was told this was just my dr after I said I did not like the Zoloft, sort of like a reassurance thing.

[JaneDoe]

Regarding fish oil, is it important to take it in smaller doses throughout the day or can it be taken in one large dose?  Is the absorbence better in smaller doses?

i take 6 x 500mg tablets and try to have 2 at each meal, however some days I forget and I don't know if I should take them all when I remember or if there's little to no point.

 

I've just worked out how long it will take me to taper off at this current rate and it's made me a bit miserable...  I just want to get it over and done with, but I know from reading others stories on here it's a terrible idea.  I'm currently looking at what supplements I can add to help - currently fish oil, curcumin, evening primrose oil and multi vitamin. And some iron tablets when I remember.

[JaneDoe]

Well it’s been a while... (I’ll update my signature tomorrow.)

I spent about 12 months tapering off Pristiq, and it felt like that’s all I had done that year and the rest of my life suffered. I took another 12 months dropping a lot more slowly, and when I got to 50mg stayed there. I’ve been on that for about 2 years I think.  In the meantime my psychiatrist stopped working, referred me to someone else who I saw twice and didn’t like.  I’ve now found another psych who specialises in perinatal psychiatry (I wasn’t sure if I needed one but GP suggests it’s a good idea especially with pregnancy in my near future).

she wants to switch me from Pristiq to Zoloft or Lexapro.  Her plan would be stop Pristiq for 2 days then start Zoloft/lexapro on a lowish dose.  My other 2 psychiatrists have said Pristiq will be fine for pregnancy but she really doesn’t like it (and I’ve done more reading again and to be honest, neither do I).

I have no sick or annual leave from work, and I suspect this plan will make me useless for at least a week so I don’t know that I like it.

I think the best plan could be for me to continue to taper off, and do so throughout a pregnancy, but I’m concerned about the risk of relapsing afterwards (the psych I saw twice said it’s better to just stay on and stay stable-ish...).  I hate tapering though because even at 10% (or less) it impacts me and I changed jobs 2 years ago to something that requires a lot more thinking and concentrating.  And I basically can’t do it whilst tapering (another reason I stopped at 50. The drop from 55 to 50 I did after being settled in for a few months and I really struggled at work.)

[JaneDoe]

I was able to have a consult with a perinatal/antenatal pharmacist this morning (I didn't know this was a thing until my psychiatrist referred me).  She said although there's more evidence for lexapro and zoloft in pregnancy, as they're older medications, what's available seems to show similar evidence for Pristiq (in a nutshell, probably not very well explained on my part).  But from her POV there's not enough benefit for me to warrant changing from Pristiq to Lexapro or Zoloft.

Which is what I thought.

It's just a ridiculous plan, and makes me kind of angry that I get this advice...  If you have a reaction with one type of antidepressant they try another because they're different.  If I forget to take my antidepressant one day I can't just take whatever my friend has because they're different.

So why on earth would I be able to just stop one and start another in 2 days and be ok??  The only reason I would stop one and start another would be if the other is easier to get off of... but i feel like I would still have discontinuation from the pristiq so it would be pointless anyway.

I will continue the plan to slowly taper, when I can.  I started keeping a very brief journal when I was tapering and it was good to flip back through that just now - and during the tapers.  Often would write 'I don't think I can do this' or similar, and clearly, I could and did.  This website is such a helpful wealth of information but I limit my time on here because I get sad and angry.  I wish there was a compulsory antidepressant registry that everyone had to be enrolled in (de-identified) as soon as they start taking them, and that information could be readily accessed for long term studies.

[Altostrata]

@JaneDoe I don't know if this will be much of a consolation to you, but despite what they tell you, the risk to the fetus is probably the same across all the newer antidepressants.

 

If you need a bridge to go off Pristiq -- the 25mg dosage might not be available in your country and the tablets cannot be split -- Effexor XR is a reasonable substitute. You can taper Effexor XR by opening the capsule and removing beads. See

 

Tips for tapering off desvenlafaxine (Pristiq)

 

Tips for tapering off venlafaxine (Effexor)

[JaneDoe]

Thanks Altostrata.

 

Thats what the pharmacist said too - I think it's just that there's more data on lexapro and zoloft.  25mg isn't available in Australia, but I've had pristiq compounded in the past and that worked well for me.  It's in my mind though that I can switch to Effexor if needed    I didn't like that I had to take effexor on the hour when I first started it, or I'd get brain zaps - Pristiq gives me a few hours leeway with taking the dose.  But with the job I now have it's a bit easier to take it at the same time each day anyway.

I was just reading about another method (may have been called the Bridging method?? maybe not... ) where instead of a 10% drop you drop by 2.5% a week, and I thought that may work better for me, but at this stage would mean I'm having 1mg tablets made up.  Does anyone have experience with tablets that small?  I'm concerned about the accuracy of the compounding... I guess I could always ask the pharmacy that's doing the compounding but wanted to see if others had experiences too.

[ChessieCat]

I'm in Australia and have been tapering Pristiq and I'm now down to 0.5mg.

 

I've recently discovered that the compounded capsule contents will dissolve in water with no problems.  I've tried cutting up a tablet but the lumps just went gluggy and of course they are 50mg tablets so there would be a lot of waste.  My previous reduction was to 0.56mg so the 0.06mg was homemade liquid and it seemed to work okay.  This was the first time I've used the liquid.  It seemed to work okay.

 

The lowest dose of Pristiq that my compounder will do is 0.125mg.  It is possible to make less but as he said the time and the cost make it very difficult, and personally I don't think I would trust the accuracy.

 

Once I got to 10mg I started taking my dose twice a day (interdose withdrawal because of short half life once compounded - even with slow release formula added).  But I probably should have been doing that once I got below 50mg when I started on all capsules.

 

I've posted a lot of information about how I've tapered in this topic: 

 

tips-for-tapering-off-pristiq-desvenlafaxine

 

And there is probably more in my Intro topic but I've tried to get the most relevant info in the tips topic because Pristiq is a pain to get doses and there are not many people here tapering it.

 

I decided to stick with Pristiq because I wanted to stay with a drug that I knew that I had no major issues with.  If I hadn't been able to get them compounded I might have copied Fresh's method of cutting and weighing.  She's another Aussie.  She did eventually get hers compounded.

 

1 hour ago, JaneDoe said:

I was just reading about another method (may have been called the Bridging method?? maybe not... ) where instead of a 10% drop you drop by 2.5% a week, and I thought that may work better for me

 

It's called the Brass Monkey Slide.

 

1 hour ago, JaneDoe said:

would mean I'm having 1mg tablets made up.  Does anyone have experience with tablets that small? 

 

As I said I've documented my tapering method in the tips topic so this information is already there.

 

Basically I was getting capsules made up in the largest 10s amount, eg 40 and getting smaller doses to make up the rest.  There is a table of my doses there.  I was tapering according to the doses of the capsules not the 10% reduction but kept it under 10%.

 

Here's the post with the table:

 

tips-for-tapering-off-pristiq-desvenlafaxine

 

And there is this topic too:

 

getting-custom-dosages-at-compounding-pharmacies-us-uk-canada-and-elsewhere

 

Here's my Intro topic:

 

chessiecat-so-im-not-the-only-one-pristiq-desvenlafaxine

 

 

Edited November 15, 2020 by ChessieCat

[ChessieCat]

1 hour ago, JaneDoe said:

It's in my mind though that I can switch to Effexor if needed

 

Be aware that the dosage is different for Pristiq and Effexor.  There is no definite information about the dose equivalency but it is estimated to be somewhere around 50mg/100mg or possible even higher.  Some say 50mg/150mg.

 

There was one member whose doctor substituted 75mg Effexor for 50mg Pristiq and it wasn't enough.

 

I think there was another member whose doctor crossed over from 50mg Pristiq to 112mg Effexor.

 

There is some information in Post #1 of this topic:

 

tips-for-tapering-off-pristiq-desvenlafaxine

 

And you can search on the internet using this search term:  dose equivalency pristiq effexor

 

[JaneDoe]

Thank you - I have your post open and am slowly working my way through reading it all

[ChessieCat]

I'm following you so that is no need to tag me.  I will be notified when you post anywhere on the site.