DWeb: tapering off Pristiq

[DWeb]

Hello there, 

 

After becoming disenchanted with antidepressant usage (blunted emotions, low sex drive) after 15 years, I finally decided to try and go off them. I am taking Pristiq 50mg and Wellbutrin 200mg. I'm not worried about the Wellbutrin for now and am attempting to get off Pristiq. 

 

Here is what happened recently. I went to my psychiatrist told her I'd like to go off the medicine and she had me go to Pristiq 25mg for two weeks, and then 25 mg every other day for one week and then stop completely. As you all must know, this was a total disaster. I had horrible withdrawal symptoms (dizziness, brain fog, confusion, irritable, and so on). I thought at first, this would go away. Then, I started becoming severely depressed and anxious. I was crying everyday and panicking. 

 

I thought perhaps this indicated that my brain was just "broken" and I had to be on an antidepressant because this is what I was like when off. I went back on 50 mg of Pristiq and I am still recovering from the shock to my system. Still dealing with depression and anxiety after 3 weeks back on. But I had the suspicion that it was just way too fast a taper, and not just my normal brain that had a such a low baseline of depression, so I began to research online, which is how I found SA.

 

I had my doctor add Prozac (she prescribed 20mg) because I thought the bridging method would be best. I think this was a bad idea because starting both antidepressants at the same time was very hard on my system, created lots of jitterness and so on. So, I discontinued the Prozac. Now, I'm off the Prozac and still waiting for the Pristiq 50mg to at least get me back to where I was. 

 

Meanwhile, I've called all over Washington State to find a compound pharmacy that will create time release capsules of Pristiq. Everyone either says they can't or they won't (I called places out of state and none will ship out of state anymore, at least Texas and California). So, I've moved on to the idea of switching to Effexor, even though I'm frightened of the impact of switching medications at this point. I'm dedicated to getting Pristiq out of my system though and getting off antidepressants.

 

The plan will be to get on Effexor once I'm more stable and then slowly taper off that over the next year or so (10% a month) using the bead counting method and the other methods detailed in the Effexor thread. 

 

This has been totally demoralizing and I cannot believe there isn't a class action lawsuit against Pfizer for creating a drug that cannot even be tapered off of and creates such severe withdrawal. I really should have been in the hospital this whole time being monitored but luckily my job is very understanding and I can work from home, as well as call on friends for support. 

 

I will keep the thread updated as I move through the process but it will probably be quite a few weeks before I try to switch to Effexor. I'm not sure, as I haven't ran any of this past my NEW psychiatrist. 

[DWeb]

I'm reading this topic now: 

It continues to say it takes a "very long time" to heal the nervous system. How long is a very long time? I was thinking 6 weeks back on the Pristiq and then I'd probably be feeling back to normal. That, to me, is a long time. But perhaps it takes much longer?

 

 

[ChessieCat]

Hi DWeb and welcome to SA,

 

It's good that you know about tapering safely.

 

I will post below the information I provided via PM (excluding my chemist's details) so that other members can see the information which has already been provided:

 

"My personal opinion is that it is better to stay with Pristiq.  We had a member baroquep who switched to Effexor and had great difficulty.

 

It is possible for Pristiq to be compounded with slow release formula and as I posted in response to your first post I have been doing this for 3+ years now and have got down to 4mg.  We don't have 25mg in Australia, so I've been taking all compounded Pristiq once I got below 50mg.

 

Please keep this information to yourself because I don't want my location to be known.  Thanks.

 

"Yeah, I went to PCCAR and looked for compounding pharmacies. Called about 10 or 12 and none would work with Pristiq."

 

Reading this has made me feel angry.  You said that you phoned them.  I think it would be better to visit them in person and be assertive.  They have to advise for the capsules to be disposed of after 6 months but my compounder said that isn't necessary.

 

My compounding pharmacist can be contacted via the chemist website below.  I think it would be a good idea to see one of the compounding pharmacists from the site I gave and you could ask them to contact my compounder.

 

(removed the link to CC's compounding chemist)

 

The other option would be to contact my compounder yourself and ask for him to respond so that you can print out that it can be compounded and take it with your to the compounder.

 

Because you are in American you might have to get your doctor to write the script for the compounding.  In Australia we can take our tablets in and request it directly.

 

I considered changing to Effexor but decided to stick with Pristiq.  When Pristiq became available in generic, I decided to stick with brand.  As far as I am concerned the less chopping and changing we do the better.

 

I hope that information helps.  I don't see why you should have to change from Pristiq because a few compounders have said it can't be compounded when in fact it can be."

 

 

[ChessieCat]

Q:  Are you aware that there is a major interaction between the drugs you have listed in your drug signature?

 

Interactions between your drugs

Major

buPROPion desvenlafaxine

Applies to: Wellbutrin (bupropion), Pristiq (desvenlafaxine)

BuPROPion may rarely cause seizures, and combining it with other medications that can also cause seizures such as desvenlafaxine may increase that risk. You may be more susceptible if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol while being treated with these medications. Also avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

[ChessieCat]

On 3/15/2019 at 7:42 AM, DWeb said:

It continues to say it takes a "very long time" to heal the nervous system. How long is a very long time? I was thinking 6 weeks back on the Pristiq and then I'd probably be feeling back to normal. That, to me, is a long time. But perhaps it takes much longer?

 

 

Dr Joseph Glenmullen's Withdrawal Symptoms

 

Here's some additional information which might help you to understand what is happening:

 

Recovery isn't linear it happens in a Windows and Waves Pattern

 

Withdrawal Normal Description

When we take a psychiatric drug, we are adding chemical/s to the brain.  The brain then has to change to adapt to getting the chemical/s.  It might have to change something to do with A and then once that change has been made it affects B so another change has to be made and so on down the line.  It is a chain reaction, a domino effect.

 

The same thing happens when we take the drug away.  That's why it's possible to experience such a vast array of withdrawal symptoms, and they can change, and be of different intensity.

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

AND

 

On 12/4/2015 at 2:41 AM, apace41 said:

Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower - WHILE people were coming and going and trying to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.  

 

[ChessieCat]

On 3/15/2019 at 7:10 AM, DWeb said:

I went to my psychiatrist told her I'd like to go off the medicine and she had me go to Pristiq 25mg for two weeks, and then 25 mg every other day

 

Skipping days / alternating doses is not recommended.  The brain likes consistency.  Steady State Chart (Cymbalta)

 

Important topics in the Tapering forum and FAQ

[ChessieCat]

I've just noticed that you have a quote (link to your intro topic) in your drug signature which takes up a lot of space.  Please remove it and copy and paste this link instead:  dweb-tapering-off-pristiq

 

This link goes directly to your drug signature:  Account Settings – Create or Edit a signature   Remember to click Save.

 

Thank you.

[ChessieCat]

On 3/15/2019 at 7:10 AM, DWeb said:

I've called all over Washington State to find a compound pharmacy that will create time release capsules of Pristiq. Everyone either says they can't or they won't

 

I have contacted the pccarx because I think it is important for them to know that 1) it is possible to compound Pristiq if they don't already know this, and 2) to advise their members that it is possible

 

I have provided my compounding pharmacist's contact information in the above and following correspondence.

 

I have also contacted these pharmacies:

 

https://paramountpharmacy.com/contact/

 

https://www.keycompounding.com/contact/

 

I will let you know if I get a response from them.

[Altostrata]

Chessie, you can't crush Pristiq and compound a capsule with the same extended-release qualities. Your pharmacy may be putting something in to make the release a little slower, but it's not extended-release like the Pristiq tablet is.

 

A little slower release is better than immediate release, to be sure, but it's not going to last as long as an intact Pristiq tablet.

[ChessieCat]

21 minutes ago, Altostrata said:

Chessie, you can't crush Pristiq and compound a capsule with the same extended-release qualities. Your pharmacy may be putting something in to make the release a little slower, but it's not extended-release like the Pristiq tablet is.

 

A little slower release is better than immediate release, to be sure, but it's not going to last as long as an intact Pristiq tablet.

 

I am well aware that the compounded Pristiq capsules do not have the same extended-release qualities as Pristiq tablets.

 

My compounder does add slow release to the crushed tablets.

[Andie]

Hi Dweb, 

 

Welcome. I’ll be following your Thread as I am coming off Pristiq too. My doctor tried to taper me off over two weeks and I had a similar experience to you. I had to go back on 50mg and slowly taper down from there. 

 

 

[DWeb]

Thanks all for the info. I'm essentially in a holding pattern now, waiting for the Pristiq to kick BACK in so I can figure out how to taper slowly. 

 

It's probably going to be many weeks before I post an update but I certainly will once things get going again.

 

 

[ChessieCat]

On 3/17/2019 at 11:27 AM, ChessieCat said:

I have contacted the pccarx

 

I got a response: