FindRest: 30+ Years on ADs. Effexor to Pristiq. Now what?

[FindRest]

Thankful to have come upon this forum and I’m thankful for all those contributing their time, experience, help, and care to so many. I just wish I would have found this a very long time ago. I consider myself an educated, intelligent woman. That I have been duped for so long could easily lead me to take it out on myself. I imagine it’s something I’ve known for a long time, but the “professionals” kept telling me that the recurrence of severe depression/anxiety after stopping the meds was just proof that I needed them, forever, and after so many failures, I believed them.

 

I am about to turn 59 and have been on antidepressants for over 30 years. I will add a timeline to my signature very soon. My most-immediate issue involves the past 9 months and I was needing your help to try and decide what to do next. My next appointment with my psychiatrist is in mid-February. I’ve only seen him once before, but it was obvious he didn’t believe in slow tapers, although he did acknowledge withdrawals.

 

In April, 2019, after being on Effexor for about 20 years, my then psychiatric nurse practitioner decided that I must be bipolar 2 since the medication was no longer working. She tried to convince me, even though I had never experienced hypomania. What transpired after that was a nightmare. I made a big mistake trusting her. Here’s the timeline of these past 9 or 10 months in a nutshell:

 

• April, 2019:  Effexor 37.5 (had been on that dose for 2 years, but on Effexor for about 20)

• April 11, 2019 Latuda 20mg added to Effexor. 

• April 22, 2019 Latuda increased to 40mg. Terrible panic (hadn’t had a panic attack in 20 years), terrible nausea, doom and gloom, facial ticks, etc.

• May 14, 2019: Latuda reduced back to 20mg. Still on Effexor 37.5. Panic and doom and gloom continue. 

• May 27, 2019: Latuda reduced to 10 mg for 3 days then ct (per dr’s orders). Continue on Effexor 37.5. 

• June 10, 2019: Rexulti added. Started w .5 mg a few days then increased to 1mg.

• June 5, 2019: Rexulti reduced to .5mg. 

• July 1-24, 2019. Rexulti reduced to .25mg over couple of weeks then off.

• July 24, 2019: New psych had me CT off Effexor. When I brought up the idea of tapering it slower, she laughed, saying I was on almost 0 already.  I should have trusted my gut, but didn’t. Within two weeks, I was in a crippling depression with lots of anxiety/panic and suicidal to an extreme. I can’t recall ever being this depressed, or that it was even possible to feel this bad.

• September 9, 2019, began Viibryd (low dose, not sure mg) via original psych NP. CT per dr’s orders on September 19 due to side effects.

• September 23, 2019, began Trintellix. Terrible nausea, pain. CT per dr’s orders on September 27.

• September 28, 2019, began 10mg Prozac. Helped calm the depression, but made me very anxious. Legs shaking up and down, inner agitation (not anger)

• October 24, 2019: Saw a new NP at the clinic of a new-to-me psychiatrist since I couldn’t get in with him until the end of December. She had me do a rapid taper of Prozac while starting on Pristiq 25mg for 10 days, then 50mg after that. Began having tinnitus, muscle pains, headache, neck pains, but depression and anxiety much better.

• December 26, 2019: Saw new psychiatrist. He wanted me to stop Pristiq (because of the side effects) by skipping it every other day for a week then switch to Cymbalta. I declined, knowing that my cns was already in an uproar. He then lowered my Pristiq down to 25mg. Without him knowing, I thought maybe cutting my pills to gradually lower to 25mg would be better. I took 25mg + 1/8th of a 50 (6.25) in the morning then another 6.25 12 hours later. I did this for 3 or 4 days but couldn’t take the side effects (stomach pain, tremors, flu, headache, etc). Decided cutting the tabs wasn’t going to work. Began just taking the 25mg tablet after those 3 or 4 days. Symptoms improved immediately. Have been on this dose since.

 

So, here I am now. The Pristiq 25mg is feeling like it’s too much, but, then again, I don’t know if it’s the Pristiq or withdrawals from all the other junk my body has been fed the past 8-9 months. It’s really not too bad, though. I have tinnitus, muscle pains in my upper body and arms, some mild restlessness, itchy eyelids, and I feel kind of drugged. I really expected to feel worse. 

 

I’m a poor metabolizer of serotonin (SLC6A4), poor metabolizer at CYP2D6, plus I have slow motility of my intestines due to surgery for a small bowel obstruction 7 years ago (caused by adhesions). Small dosages go a long way in my body. 

 

The other huge factor is this medicine is causing high blood pressure (162+/82+) and I just had open-heart surgery 1.5 years ago to repair a rare congenital birth defect. I cannot afford to have anything messing with my heart. I’ve been off all heart medications since 3 months after surgery. The psych and NP new all of this information. I had even checked with my cardiologist to make sure Pristiq was ok (before taking the first dose). He said it should be, stating that only a small % had issues with it. 

 

I need to get off of Pristiq and AD’s in general. I just don’t know what to do. I want to have a plan thought out before my next appointment mid-February (or sooner, if you think it’s needed). After spending a lot of time reading this forum, I believe my three best options are:

 

1. Stay on Pristiq and taper down using compounded dosages. The problem is that I live in the middle of nowhere, rural community, and have tried to find a compounding pharmacy in my state who will compound Pristiq. So far, I haven’t found one who would agree to do it. I’ve used the compounding pharmacy finder link here in SA. I have not heard back from everyone, though. My body does not tolerate the cut pills. The main drawback to this option is my blood pressure. I think the reason Effexor didn’t affect my BP much was because at the low dose, the norepinephrine didn’t kick in. But, with the Pristiq, it must kick in at the lower dosage. This is my theory, anyway.

2. Switch to Effexor. I like this option solely because it would be easier to taper, in my opinion. It would also be better for my heart, unless I had a bad reaction switching back. That’s the main disadvantage of this option...not knowing if I’ll have a bad reaction getting back on the Effexor after being off 5+ months. My hope would be that the Pristiq is close enough to Effexor and my CNS wouldn’t be too angry. 

3. Do nothing and stay on the Pristiq 25mg for a few months, waiting for things to calm down. Again, the main disadvantage is the unknown. I’m not sure I can stand this dose for too much longer. It just feels like too much. My fear is that if I stay on this dose it will wreak more havoc on my system. Then again, maybe what I’m feeling is withdrawals. Also, if I stay at this dose, chances are that my BP will remain high. I can go on BP medicine, but that’s another can of worms.

 

What would you recommend? I’ll admit that I’m very scared. I know that, all-in-all, I’ve been pretty lucky these past few months. I also know it could go south at any moment. Thank you for taking the time to read this and sharing your expertise. 

 

Note: I also take Ambien 10mg nightly, clonazepam .125mg nightly, omeprazol 20mg daily (but in process of reducing to Pepcid otc), Synthroid 125 mcg and Premarin .625 daily (long story). Also 1000 vitamin D3. After reading this forum, I know I need to address the ambien, clonazepam, and acid reducers, at some point. Was taking B complex, a multi-vitamin, and fish oil for years before these past 9 months. Can no longer take them due to side effects. Tried taking a very small amount of b12 and a very small amount of magnesium glycinate. Both gave me a bit of anxiety so stopped taking them.

[manymoretodays]

Hi FindRest, and welcome.......you have had quite the journey thus far, and glad you have joined us.

 

That is a very nice introduction, with all your concerns, and salient history laid out. 

On 1/18/2020 at 10:05 PM, FindRest said:

That I have been duped for so long could easily lead me to take it out on myself. I imagine it’s something I’ve known for a long time, but the “professionals” kept telling me that the recurrence of severe depression/anxiety after stopping the meds was just proof that I needed them, forever, and after so many failures, I believed them.

 

And I know, many of us have felt the same when we first caught on.  And I am so sorry for the medication merry go round that came about for you.  I went through much of the same myself.  You are 59 years young!

 

Thank you for getting your signature done.

 

Could you plug all your present medications in at Drugs.com.  There is an interaction checker there.  And then share the link to that report or copy and paste it, right here on your introduction page.

 

And then........ to give us a better idea of what your daily schedule of drugs and symptoms are like presently:

Give us a day or two of daily notes, in the format shown in that link.  Date.  Then time on the left.  On the right list your drugs by name and dosage, as well as symptoms as they occur throughout the day.  Include sleep and any supplements taken.

 

General links to more about tapering and withdrawal:

 We generally recommend  tapering just one drug at a time,  by no more than 10% of the current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.

Why taper by 10% of my dosage?

 

Tips for tapering off Pristiq(desvenlafaxine)

 

 

Brain Remodelling

What is Withdrawal Syndrome?

 

Daily checklist of Antidepressant Withdrawal Symptoms, Dr. Glenmullen's symptom list  (PDF)

 

The Windows and Waves Pattern of Stabilization

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil).

 

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, you've now introduced yourself to the community, and this is where you can answer my initial questions/requests, and also continue to ask questions around your specific case.  We're  so glad you found your way here.  And I'm glad you are doing somewhat better at this point in time.

 

For right now, as you've just been on the Pristiq 25 mg dose since January 3rd, if I were you, I would stay put, or HOLD. 

Give us a chance to get to know you.

 

Again, welcome aboard FindRest!

Love, peace, healing, and growth,

manymoretodays(mmt)

 

Edited January 20, 2020 by manymoretodays
elaboration, grammar, clarity

[FindRest]

Thank you, @manymoretodays for all of the information. As much as I hate it and the way it’s making me feel, I agree that I probably need to stay on the Pristiq 25 for a bit longer, giving my cns a chance to stabilize more. I hate the thought of adding a blood pressure medication to the mix, though, so my hope is that we can figure out some kind of change that will prevent that from needing to happen. I also hate the fact that the longer I continue to take it, the more my body/brain is getting dependent on it. I so regret agreeing to the Latuda and, subsequently, not trusting my gut regarding the dr’s CT off the Effexor. Good thing I’m in therapy at the moment. I think I know what I need to process next week! 

 

Here is the link for my drug interactions. I’m relieved I didn’t have any in the red considering all the drugs I’m taking. Reading through the “moderate” interactions, however, makes me realize that perhaps my memory and laziness/lack of motivation isn’t entirely withdrawal/depression related. It was eye-opening seeing how many of my medications promote drowsiness/confusion/etc.. I’ve been on them so long that I don’t notice much effect except with my nightly cocktail. As I’m reading many of the posts here, I also realize how some of the things these medications were diagnosed for are probably a side-effect of the AD’s...especially my severe rhinitis/Eustachian tube dysfunction. If I didn’t have that, I could take away many of the antihistamines. Yes, sadly, I did read here about the antihistamine issues and AD’s, acid reducers, etc.. I’m trying not to get my anxiety revved up thinking about all the things I need to change. I will do it, one step at a time.

 

https://www.drugs.com/interactions-check.php?drug_list=2796-12488,2333-1544,1463-869,2360-381,703-0,1750-0,1066-0,1893-1224,2418-0,569-0,646-5790

 

 

Edited January 28, 2020 by manymoretodays
none, quoting only

[FindRest]

Here are timelines of the past several days. Yes, my sleep schedule is all messed up! I need to go back and read that thread on ways to improve it. Overall, the tinnitus is by far my most bothersome symptom, some days lasting all day. It sounds like a mix of cicadas on a summer evening and high-pitched ringing. If I wasn’t crazy before, I’ll soon be that way. Ugh!  It only started about a week after I began Pristiq and just seems to be getting worse.  High blood pressure is another main concern, especially after my open-heart surgery.  That too only started after the Pristiq.

Sunday, Jan 19, 2020

• 12:30am   Anxious, tinnitus, tremor in left arm along w muscle weakness, BP high;   Ambien 10mg, Cetirizine 10mg, clonazepam .125mg. Mirilax. Bed
• 8:15am   Slept 6 hrs.
• 10:30am  Premarin .625mg, d3 25mcg, fluticasone nasal spray, Pristiq 25mg, Synthroid 125mcg
• 11:45am.  famotidine 20mg;  probiotic; tinnitus, stuffy head, headache, high bp
• 3pm. Feel pretty good. Tinnitus less.
• 4pm. Throat starting to hurt
• 6pm. Depressed, tearful, a bit shaky from weak left arm muscle/bicep pain since starting Pristiq. Hard to grip things with left hand. Numbness and tingling in left arm/hand, angry (mostly at drs and myself)
• 8:30pm. Tinnitus there but not as bad, brief wave of great anxiety and hopelessness, left arm pain, tingling, etc. continues. Headache. Took 1 acetaminophen.
• 9pm  tinnitus back full strength
• 11:30pm. Anxiety, tinnitus continues

 

Monday, Jan 20, 2020

• 3:30 am.   Ambien 10mg, Cetirizine 10mg, clonazepam .125mg. Mirilax.   Lower back pain. Bed
• 10:30.  Slept 5 hours.  Premarin .625mg, d3 25mcg, Pristiq 25mg, Synthroid 125mcg, probiotic
• 2:45pm. Nap, at least tried. Lots of anxiety, rumination. Better once I got up. Lots of tinnitus, bp better;   uticasone nasal spray, Famatodine 20mg
• 5:30pm.  Strong tinnitus, anxiety
• 7:30Pm. Lower back pain, tinnitus continues
• 9pm. Tinnitus. Worst day of tinnitus in long time. Constant. Low back pain
• 11pm. Left arm pain/tingling (first time today!)

 

Tuesday, Jan 21, 2020

 

• 12:30am. Tinnitus, heartburn,
• 2am. Right eye itching, tinnitus. Ambien 10mg, Cetirizine 10mg, clonazepam .125mg. Mirilax   Bed
• 10:30am.  Pristiq 25mg, Synthroid 125mcg; tinnitus 
• 12:30pm. Tinnitus, no anxiety
• 12:45. Premarin .625mg, d3 25mcg, probiotic, futicasone nasal spray; brief stomach pain
• 2:00pm. Ok. Tinnitus bit better, loose bowels (a good thing)
• 3:45. Omeprazole 20mg; stuffy head, did sinus rinse (netipot), itchy right eye. No anxiety 
• 6:10pm. Tinnitus, left arm biceps ache plus weakness
• 7:45. A little anxiety
• 9pm. Left arm and biceps continue to ache. Tight, weak, with numbness/tingling to fingers and slight tremors in arm
• 11pm. Left arm pain continues w tingling

 

....continues in next post

 

[FindRest]

Wednesday, Jan 22, 2020

• 12:30am. Very emotional, anxious, left arm biceps ache plus tingling/numbing down to hand
• 1am.  Ambien 10mg, Cetirizine 10mg, clonazepam .125mg. miralax.  Bed
• 10:30am. Woke up several times last night w joint pain.  Pristiq 25mg, Synthroid 125mcg; tinnitus. Took .125 clonazepam for anxiety.
• 12:45pm. Premarin .625mg, d3 25mcg, probiotic; more anxious today, restless, ruminating
•  2:00pm. futicasone nasal spray; anxious
• 3:45pm. Famotidine 20mg, tinnitus has been pretty good today so far, anxiety decreasing, crying and emotional, left arm/biceps ache and is weak, heavy, pins and needles
• 6:45 tinnitus still pretty good, right eyelid itching, left arm better now
• 7:15pm. Tinnitus is loud now. 
• 8:30pm  itchy right eyelid, pulsating lower lip, tinnitus
• 9:00pm  tinnitus, left arm/biceps ache/weak/heavy/numb and tingling down to fingertips, low grip in left hand
• 10pm. Netipot
• 11:30pm tinnitus

...will post more in a few hours

[FindRest]

Thursday, Jan 23, 2020

• 1:15am.  bottom lip numb, tinnitus. Ambien 10mg, Cetirizine 10mg, clonazepam .125mg, miralax.   Bed
• 10:30am.  Pristiq 25mg, Synthroid 125mcg,  fluticasone nasal spray; tinnitus, otherwise good.
• 11:00am  Premarin .625mg, d3 25mcg, probiotic; left eye twitching
• 3:15pm. Good day so far, only mild tinnitus, right eye itching
• 5pm. Famotidine 20mg, tinnitus 
• 8pm. Pretty good day. Tinnitus is there but not real bad. No pain or weakness in left arm.
• 9:15pm. Left arm/biceps aching, tight
• 10:40pm. Left bicep/arm ache, tinnitus but not real bad, weakness/tremor on exertion in left arm
• 11:20 some anxiety regarding withdrawal 

Friday, Jan 24, 2020

• 12:20 am. Ambien 10mg, Cetirizine 10mg, clonazepam .125mg, miralax.   When smile a weak smile, my right side of face quivers. Tinnitus is worse now than all day. Numbness, tingling, ache in left arm plus weakness and low grip strength. Bed
   
• 8:15am Had a good sleep last night
• 9am. Fluticasone nasal spray
• 10:30am. Pristiq 25mg, Synthroid 125mcg
• 12pm Probiotics, Premarin .625mg, d3 25mcg; feeling good, not much tinnitus or pins/needles!
• 1pm. Tinnitus begins
• 2:30pm. Omeprazole 20mgn back ache, bit of anxiety
• 3. Anxiety increases
• 5pm tinnitus increases and louder than usual, high bp
• 9pm. Increased anxiety, crying, sadness, high bp, left arm aching, weakness, hopelessness, fear
• 11:30pm  Ambien 10mg, Cetirizine 10mg, clonazepam .125mg, miralax.   Bed

Saturday, Jan 25, 2020

• 12:30am. Ears ringing, tinnitus bad, numbness and aching of both arms, small cramp in right foot, pounding heartbeat, high bp
• 10:30am. Pristiq 25mg, Synthroid 125mcg; woke up with stiff neck and still there, tinnitus, some anxiety
• 11am. Premarin .625mg, d3 25mcg, probiotic; Tinnitus, anxiety, stiff neck
• 2:00  Famotidine 20mg
• 5:30pm. This has been the worse day emotionally in a long time. Anxiety, anger, impatient and on edge..stiff neck and tinnitus continue. Heartburn.

I’ll be very interested to read your insights. Thank you.

[Andie]

Hi There

 

I really empathise with you. I had high blood pressure with a higher rise of Pristiq too. It got better and I felt s lot better as the dose was reduced. 

 

I am currently doing a bridge to Prozac as I couldn’t reduce my dosage any lower than 12mg. 

 

Take care 

[FindRest]

@Andie  I too have thought about doing the Prozac bridge, as I’m not sure I can stay on this much longer.  It just hurts my body so much. I’m scared about the Prozac, however, as that is what they tried me on for a month or so before the Pristiq. It made me so anxious and I kept having to shake my legs up and down when seated. Thankful it didn’t affect me like that when trying to sleep. Maybe I just couldn’t handle the dose, even though it was a baby dose of only 10mg. I am following your progress to see how you do with it. Hope it all goes very well for you.

[Andie]

I had the shaking legs and felt I had to move them about,  I had it at night and couldn’t sleep but that seems to be settling down now. I’m still a bit sore in my legs though. 

 

 I came up slowly on the Prozac to avoid the agitation. Looking back I probably should have done it even slower. 10mg is a lot for me too. I think if I had started at 10 I would have stopped the Prozac. 

 

I really empathise with you. It took my a year to decide to switch, but things got so bad that I had to take the risk. 

 

 

 

 

[Andie]

I think it’s definitely a good idea to try and hold at 25mg for a few months if can manage it. 

 

. 

 

 

[FindRest]

@Andie I’m just afraid that the longer I’m on it, the worse the tinnitus will be and the more my body/brain will be getting used to the norepinephrine. When I was on Effexor, my dose was so low that the “N” wasn’t kicking in yet. I think that’s why I’m having so many more side effects on the Pristiq...but, these could also be wd side effects. I can get so upset when I think about all of this and how difficult it is. I understand your thinking, though, about staying on the 25mg for awhile. 

[FindRest]

I did contact several pharmacies and found one (300miles round trip) that said they could compound Pristiq, although they have never done it before. It would be very expensive. I’m assuming they can mail it, although I forgot to ask them. All of the other pharmacies said they wouldn’t recommend compounding because of unpredictable results. 

 

If I did end up going the compounding direction, I wouldn’t be able to afford it for more than 2-3 months. It’s just way too expensive.  The reaction I had to cutting the tablets was not good. 

[Andie]

I understand why you are worried. I’ve been there too. It’s like every option could be the wrong one and the worry that comes along with that just exacerbates everything. 

 

the one thing that has got me through every time my symptoms were really bad was stability and holding. 

 

I was having really unpredictable results with the compounded Pristiq after I got to about 20mg. I needed to come off hence the switch to Prozac. 

 

We can’t get the store bought 25mg here in Australia so 50mg is the lowest available and I started compounding from there. 

 

Chessiecat has reduced her dosage down using compounded Pristiq and I don’t think she hasn’t had any problems. Even if you did go the Compunding route you would still need to taper slowly. 

 

I wish I could give you some better advice. 

 

[FindRest]

4 minutes ago, Andie said:

It’s like every option could be the wrong one and the worry that comes along with that just exacerbates everything. . 

Exactly!

 

Thank you for reaching out to me, @Andie, and for your valuable advice. ❤️

[Andie]

 

 

Sending you a virtual hug.  Try not to panic  (my BP would then in turn skyrocket) as I absolutely believe you can heal from this. 

 

Keep in touch. 

[FindRest]

1 minute ago, Andie said:

 

 

Sending you a virtual hug.  Try not to panic  (my BP would then in turn skyrocket) as I absolutely believe you can heal from this. 

 

Keep in touch. 

Back atcha! ❤️

[FindRest]

On 1/25/2020 at 9:30 PM, Andie said:

 

 

Sending you a virtual hug.  Try not to panic  (my BP would then in turn skyrocket) as I absolutely believe you can heal from this. 

 

Keep in touch. 

Back atcha! ❤️

[FindRest]

@manymoretodays  I’m getting scared. My blood pressure has been skyrocketing lately and my heart cannot take it! I’m lying here in tears, thinking of all the things I went through to survive heart surgery, only to have it being compromised by this stupid pill. I’m going to be forced to call my pdr tomorrow because my bp has never ever been this high.  Unbelievable.  
 

Before talking to him, I’d like to have a “plan” in place and would value your opinion or the opinions of others here. To me, it’s clear that I can no longer stay on Pristiq. The norepinephrine is too much for my heart...and ears (tinnitus is also through the roof).  I’m trying to decide what is best....switching back to effexor, or  Prozac bridge, Or zoloft bridge, or even a lexapro bridge. I don’t have a lot of options. It’s become real clear to me these past few days that there will be no way my heart could withstand a lengthy Pristiq taper.  Effexor would only be a bit better since the norepinephrine wouldn’t kick in at the lower dose.

 

Please, can any of the mods give me some direction, ideas, et.c? I’ve been reading a ton here to try and learn as much as I can. I just don’t think my body can continue at this pace.  Thanks for taking the time to read this and I’m anxious to hear your insight.

 

[LarryS]

Hello FindRest,  Welcome to Surviving Antidepressants.  Thanks for letting me know you got some inspiration from my thoughts which just flowed out of my mind.

I sympathize regarding how difficult it must be for you to look back on so many years of taking various doctor recommended psychotic drugs, only to come to the realization that their long term side effects may be worse than their initial promoted good.  It can make us downright angry. 

And then to realize that their recommended way to get off them is a disaster waiting to happen to our central nervous systems, ouch!

You rightly have a lot of questions, and concerns.  There is plenty of good information on this web site to help you get a sense of what might work for you.  Keep reading and follow the many links.

You can do this.

[FindRest]

I hope it is ok to tag @Altostrata @Shep to get your opinions. I feel bad tagging any of the mods as I know you give so much of your time helping others.  I’m just torn on what to do. Thank you.

[Andie]

I am wondering whether you are really feeling the effects of Pristiq because per milligram,  it is stronger than Effexor. When I tried to change to Effexor 75mg from Pristiq 50mg I had withdrawal symptoms. 

 

In my own experience, I think a doubling of the Pristiq dosage should have been used to find the equivalency. I’ve also seen this mentioned in a journal article. 

 

Hopefully a Mod will pop by to advise you. 

 

 

 

 

 

 

 

 

 

 

[Shep]

 

On 1/27/2020 at 3:41 AM, FindRest said:

To me, it’s clear that I can no longer stay on Pristiq. The norepinephrine is too much for my heart...and ears (tinnitus is also through the roof).  I’m trying to decide what is best....switching back to effexor, or  Prozac bridge, Or zoloft bridge, or even a lexapro bridge.

 

FindRest, I'm not sure about bridging off Pristiq to another AD is the right thing to do or not. So I've asked the other mods for feedback. 

 

On 1/27/2020 at 3:41 AM, FindRest said:

I’m getting scared. My blood pressure has been skyrocketing lately and my heart cannot take it!

 

What time(s) of the day does your blood pressure increase? 

 

Please continue posting your drug and symptoms journal, making note of this symptom within the context of when you take each of your drugs. 

 

 

[FindRest]

@Andie I agree with you that this dose of 25mg Pristiq is too much compared to my 37.5 mg Effexor. But, I can’t tolerate cutting it, so what’s a person to do? I could call my dr and ask him to send a script to the one compounding pharmacy I found that said they could do it (but have never done so before). This is a possibility. Just wish it wasn’t 300 miles round-trip. I still have to call them and ask if they can mail them. I’m assuming so. I don’t know what mg would be best. I also don’t know how we would afford this option. From their quote, it is very expensive as our insurance won’t cover a lot of it. 
 

@Shep Thank you for responding. My blood pressure, according to the device I use to record my daily blood pressure,  was “normal” (ex: 119/74)  before Pristiq with an occasional “elevated BP” (ex: 124/78). Now, with no other medication or schedule changes it averages:

 

First thing in morning:  “normal” to “elevated bp”

Between noon and 5pm:  “Stage 1” (ex: 138/75) with a recent reading at 1pm being “Stage 2” of 144/76

Between 7pm and 11pm: mostly “Stage 2” (ex: 156/82, 149/84,152/83)

Between 1am and 3am: readings have been Stage 2, 158/91, 153/81

 

Then, by morning, they are back to “normal” or slightly “elevated”. It follows this pattern like clockwork. These may not seem too worrisome, but with my heart condition and 2018 heart surgery, I cannot afford it to be this high.

 

The other really troublesome symptom is the tinnitus...which also gets worse as the bp raises, but is there first thing in the morning as well. Usually, it’s all day every day. Driving me batty.

 

I continue to keep a journal on paper and will upload those as I have time today. Basically, it’s about the exact same as the other days. 
 

Thanks again. ❤️

[manymoretodays]

Hi FindRest,

I'm sorry, I got up to the mountains for some ski-ing and busy with some committee work lately, as well as other.......household and all.

 

Good job on the notes.  Keep those coming, with all your meds and symptoms included.

And that's a lot of medications too, all 11 of them.

2020 Jan 3-present: Pristiq 25mg

Current meds: Ambien 10mg nightly, clonazepam .125mg nightly, omeprazol 20mg (alt every other day w famotidine 20mg), Synthroid 125 mcg, Premarin .625mg, Miralax capful daily, fluticasone nasal spray once per day, cetirizine 10mg nightly.  Supplements: D3 25mcg, probiotic

 

Can you add some start dates to the Ambien and clonazepam and the rest, as best you recall?  Account settings/Signature

And then note if you have made any recent changes to any of your other medications and dates as well.

 

And I get it FR, your worries now around the flucuating BP, more especially after having had major heart surgery for your congenital heart defect, just a year and 1/2 ago.  It might be from the recent changes in the Pristiq.   WD can and is responsible for transient changes in our autonomic nervous systems.  Fingers crossed, that your BP resolves without further drug additions.   As bridges.... and switches now,  could be complicated, and you've done so many changes in the past year.  I'm just looking at your signature.

 

How did you do on the Prozac, back when you were briefly on it?

 

And okay, that's all I've got for now.  (((((FindRest)))))  Oh, do you have any calming techniques that help to decrease your BP?  That are tried and true?

.......and more input should be coming for you too, on if better to change from the Pristiq now or not. 

 

As far as the higher BP goes.....worth mentioning here is that there are also some more natural alternatives to meds that people use.  That might be something you could begin to research too, for your BP. 

 

L, P, H, and G,

mmt

 

A little more on sympathetic/parasympathetic nervous system and autonomic dys regulation here:

Dysautonomia(autonomic dysregulation) POTS, syncope, etc

^ I think this might apply

 

And here:  charts depicting, I'm trying to figure out how to share without any copyright infringement.

https://www.google.com/search?q=chart+or+picture+depicting+sympathetic+and+parasympathetic+nervous+systems&tbm=isch&source

 

 

 

Edited January 28, 2020 by manymoretodays
added links

[Altostrata]

Hello, FindRest.

 

On 1/18/2020 at 9:05 PM, FindRest said:

December 26, 2019: Saw new psychiatrist. He wanted me to stop Pristiq (because of the side effects) by skipping it every other day for a week then switch to Cymbalta. I declined, knowing that my cns was already in an uproar. He then lowered my Pristiq down to 25mg. Without him knowing, I thought maybe cutting my pills to gradually lower to 25mg would be better. I took 25mg + 1/8th of a 50 (6.25) in the morning then another 6.25 12 hours later. I did this for 3 or 4 days but couldn’t take the side effects (stomach pain, tremors, flu, headache, etc). Decided cutting the tabs wasn’t going to work. Began just taking the 25mg tablet after those 3 or 4 days. Symptoms improved immediately. Have been on this dose since.

 

First, you need to remove that psychiatrist from your payroll, he doesn't know what he's doing. Same with the psychiatric nurse practitioner. Your PCP can prescribe Pristiq or whatever for you.

 

Next, put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

 

It appears your problems started with this incredibly dumb instruction from another psychiatrist, causing withdrawal syndrome from Effexor:

 

On 1/18/2020 at 9:05 PM, FindRest said:

July 24, 2019: New psych had me CT off Effexor. When I brought up the idea of tapering it slower, she laughed, saying I was on almost 0 already.  I should have trusted my gut, but didn’t. Within two weeks, I was in a crippling depression with lots of anxiety/panic and suicidal to an extreme. I can’t recall ever being this depressed, or that it was even possible to feel this bad.

 

Effexor (venlafaxine) is Pristiq's chemical sibling. What I might do is tell your PCP you want to go back to Effexor, get a prescription for 37.5mg Effexor XR, and substitute 10 beads from the capsule for that 25mg Pristiq tablet. This is a lower dose of Effexor, but you're having such a bad reaction to Pristiq, I would balance the risk of getting withdrawal from a lower dosage against the serious adverse effect of high blood pressure with a heart condition.

 

Then, you need to sit down with each of your remaining doctors and have a good talk about why you're on so many drugs and the high risk of adverse reactions with polypharmacy. You must demand minimization of your drug burden. They need to figure it out. If they can't, you need new doctors.

 

This is a volunteer peer support forum for helping people taper off psychiatric drugs. We do this because people can't find help from their doctors. It's really your doctors' responsibility to watch out for polypharmacy and drug adverse reactions. If they're not doing this, perhaps you should fire the lot of them and find new doctors who will. Web peer support sites should not be doing the work of your doctors.

 

You also need to file complaints with your state medical board against any prescriber who tells you to quit a psychiatric drug abruptly.

[manymoretodays]

Alto,

Here you go......

On 1/20/2020 at 5:57 PM, FindRest said:

Here is the link for my drug interactions. I’m relieved I didn’t have any in the red considering all the drugs I’m taking. Reading through the “moderate” interactions, however, makes me realize that perhaps my memory and laziness/lack of motivation isn’t entirely withdrawal/depression related. It was eye-opening seeing how many of my medications promote drowsiness/confusion/etc.. I’ve been on them so long that I don’t notice much effect except with my nightly cocktail. As I’m reading many of the posts here, I also realize how some of the things these medications were diagnosed for are probably a side-effect of the AD’s...especially my severe rhinitis/Eustachian tube dysfunction. If I didn’t have that, I could take away many of the antihistamines. Yes, sadly, I did read here about the antihistamine issues and AD’s, acid reducers, etc.. I’m trying not to get my anxiety revved up thinking about all the things I need to change. I will do it, one step at a time.

 

https://www.drugs.com/interactions-check.php?drug_list=2796-12488,2333-1544,1463-869,2360-381,703-0,1750-0,1066-0,1893-1224,2418-0,569-0,646-5790

 

Sorry, it was up a ways there.

[Altostrata]

Okay, that's an insane list of drugs. You need to print that out and take it to your doctors and have a good heart-to-heart about unnecessary polypharmacy.

 

Why are you taking

 

omeprazole

famotidine

MiraLAX (polyethylene glycol 3350)

 

What's your gut problem? Omeprazole and famotidine are outright drug duplication. You need to taper either. Maybe you need to replace your PCP, too.

 

Please read up on every drug you take on drugs.com.

 

You're taking 3 psychiatric drugs that require tapering:

 

Pristiq (desvenlafaxine)

Ambien (zolpidem)

clonazepam

 

Why are you taking BOTH Ambien and clonazepam?

[FindRest]

Thank you all for your responses. I will respond to each of them later on this evening when I get back home. I’m in tears right now for several reasons: 1) people I don’t even know are taking time out of their day to reach out and help me...this really has me emotional. 2) realizing the polypharmacy aspect of this. I feel so dumb for blindly trusting my doctors. I just did what I was told. Living in a small community doesn’t help. There aren’t many local doctors. I’m just so disappointed in myself, as I am the one ultimately responsible.

 

Thanks again for your responses. I will respond later this evening. ❤️

[Gridley]

50 minutes ago, FindRest said:

Living in a small community doesn’t help. There aren’t many local doctors. I’m just so disappointed in myself, as I am the one ultimately responsible.

FindRest,

 

Please don't  blame yourself.  We trustted in the doctors who knew nothing.  The big city doctors know no more than the small town doctors that you had.  That is the state of the art, unfortunately.  I'm a polypharmacy victim too.  You will recover just fine.

 

Gridley

[Andie]

Don’t be too hard on yourself. We all put our trust in our Doctors when we first started on Psych meds. 

 

I still struggle with bitterness over the actions of my first GP and Psychiatrist. I consider myself to be a fairly intelligent, cautious and responsible  person  but I’ve felt like to stupidest person on the planet for being duped so terribly. I have to remind myself not To waste my precious energy, when its Needed for healing and other activities that will set me back on track to wellness. 

 

When you you know better, you do better right ? 

 

 

[FindRest]

8 hours ago, manymoretodays said:

Hi FindRest,

I'm sorry, I got up to the mountains for some ski-ing and busy with some committee work lately, as well as other.......household and all.

 

Glad you got some skiing in!! No need at all to apologize! I feel fortunate to have your help! 😊

 

8 hours ago, manymoretodays said:

 

And that's a lot of medications too, all 11 of them.

Can you add some start dates to the Ambien and clonazepam and the rest, as best you recall? 
 

Added the dates. So sad looking them. I’m amazed that I’ve never considered myself as being on a lot of meds. Where was my head? I’m so thankful all of you are making me aware of this. I used to think I was somewhat intelligent. I now wonder. Very thankful my eyes have been opened, though.

 

8 hours ago, manymoretodays said:

 

How did you do on the Prozac, back when you were briefly on it?

 

 

I was on Prozac for several years back in the early 90’s and did well on it until it pooped out. When I went on it in September, 2019, it lifted the severe depression from all the drug switches the months immediately prior, but I’d get periods off and on throughout the day when I had to shake my legs up and down rapidly while seated. I would also get this inner anxiety that would be relieved if I hit my fist from one hand into the palm of the other repeatedly. Happened once or twice a day. Strange, I know.  I was so afraid it was the beginning of akathisia, but the dr said it was just anxiety or “too low of dose”. 

8 hours ago, manymoretodays said:

Oh, do you have any calming techniques that help to decrease your BP?  That are tried and true?

Ironically, riding my stationary bicycle would end up decreasing it after awhile.  I need to get back on it. Am afraid of revving my system up, though. (Haha, if you could only envision this old lady here worried about “revving” her system up! 😅)

 

I will look up the natural alternatives to high bp. I also read the links you sent. Thanks for pointing me to them. 
@manymoretodays, ❤️

[FindRest]

8 hours ago, Altostrata said:

First, you need to remove that psychiatrist from your payroll, he doesn't know what he's doing. Same with the psychiatric nurse practitioner. Your PCP can prescribe Pristiq or whatever for you.

 

Thanks, @Altostrata, for your time and help.

 

Ironically, my PCP was the one who suggested I go to the others, as he wasn’t sure what the next best option was after the Effexor stopped working. He’s the one who put me on Effexor originally and had been overseeing it since that time.

8 hours ago, Altostrata said:

 

What I might do is tell your PCP you want to go back to Effexor, get a prescription for 37.5mg Effexor XR, and substitute 10 beads from the capsule for that 25mg Pristiq tablet. This is a lower dose of Effexor, but you're having such a bad reaction to Pristiq, I would balance the risk of getting withdrawal from a lower dosage against the serious adverse effect of high blood pressure with a heart condition.

I think it’s amazing the Effexor didn’t give me high BP like the Pristiq.  
I see your point about going the Effexor route. One reason I was thinking about Prozac was because I read somewhere here that the theory was the low dose Effexor didn’t affect norepinephrine, and was essentially an SSRI. That coupled with Prozac’s long half-life appealed to me. I took Prozac in the early 90’s with no problem until it pooped out. Then, when I tried it during withdrawals in September 2019, it was quite activating, but at least helped the depression.

 

IF going the Effexor route, I do get some comfort in knowing that I at least tolerated it well in the past. I know that could all change this time, however. 
 

Would you suggest taking a cutting of the Pristiq in addition to the Effexor beads? I know the cuttings got me sick when trying them a few days in December (when going down from 50 to 25mg), but would the benefits of having some of the norepinephrine from the Pristiq outweigh the sickness? 

 

8 hours ago, Altostrata said:

 

Then, you need to sit down with each of your remaining doctors and have a good talk about why you're on so many drugs and the high risk of adverse reactions with polypharmacy. You must demand minimization of your drug burden. They need to figure it out. If they can't, you need new doctors.

 

Thank you for being candid and pointing this out to me. I respect that. You are so right.  

[FindRest]

8 hours ago, Altostrata said:

Okay, that's an insane list of drugs. You need to print that out and take it to your doctors and have a good heart-to-heart about unnecessary polypharmacy.

I will do that. 

 

8 hours ago, Altostrata said:

Why are you taking

omeprazole

famotidine

MiraLAX (polyethylene glycol 3350)

 

What's your gut problem? Omeprazole and famotidine are outright drug duplication. You need to taper either. Maybe you need to replace your PCP, too.

 

In 2002, I had catastrophic bleeding during a hysterectomy. Barely survived. This left me with an abdomen full of adhesions, resulting in a small bowel obstruction in 2012. After emergency surgery to repair the SBO, my intestines would not start back up for 11-12 days. (Note that during this time I had been on Effexor for many years. I had to go ct for these 11-12 days as I couldn’t have anything at all by mouth. Ugh.) I ended up being sent to Mayo Clinic. My intestines work now, but not like before. I’m still full of adhesions, have slow motility, and my intestines don’t contract correctly. Mayo recommended I take the Miralax indefinitely, until a likely future sbo occurs. After many tests and many experts, it was decided that a surgery to correct anything before that time would be too risky.

 

I started on omeprazole 40mg in Oct 2019 after all the a/d switches months prior tore my gut up. I went down to 20mg in December. PCP had me alternate with famotidine beginning January, with the goal being to just be on famotidine by itself by my next appointment Feb 5th. I have a hiatal hernia resulting from the sbo, and two siblings with Barrett’s disease.

 

8 hours ago, Altostrata said:

Why are you taking BOTH Ambien and clonazepam?

I’ve been prescribed both for a long time, but rarely took clonazepam until May 2019 when all the med switches took place. “Rarely” as in maybe .125mg every couple of months or longer. After the Latina induced panic attacks began in May, my now-fired NP prescribed .5mg 3xday and said to take .5mg with the Ambien at night because the night panic attacks were awful. I did NOT take 3/day as prescribed and only took the .5 a few times. I did take .125mg at night though and continue to do so now. I’m afraid to stop it now as I don’t want those withdrawals on top of this. 
 

I was prescribed Ambien by my PCP at least 8 years ago after dealing with a trauma and the resulting insomnia and night terrors. I’ve been on it ever since. Started w 5mg, now 10. Yes, I know I’m addicted and plan to tackle this after I taper off the a/d and stabilize somewhat. Maybe I need to start sooner with this one but I think I read here to wait until after the a/d taper (or maybe this is just wishful thinking).

 

@Altostrata

[FindRest]

Oops....should say “Latuda induced” not “Latina induced”. Auto-correct got me. 🥴

[FindRest]

Thank you, @Gridley and @Andie. ❤️

[FindRest]

@Altostrata Do you think I would be wise getting the liquid Effexor instead of doing the10 beads, or would it make that much difference accuracy-wise? If I did the beads I could stop the Pristiq sooner as the compounding pharmacy is 300 miles away.