Ican03: switching AD - help needed

[Ican03]

Thank you everyone in advance . I’m am new here and come for some help. I was switched from 5mg paroxetine to 100mg generic Pristiq 5 days ago. Was on the paroxetine for almost 3 years. I’m having a very rough time with increased anxiety, tingling , inner shaking and bad panic attacks. My shrink says I should not be having withdrawal symptoms as I replaced the paroxetine for something better. I am not sure if it is withdrawal or the new medicine or a mixture and don’t know what to do if stick to the new med or go back to Paroxetine , anyone in a similar situation? Today is my 5th day on the new AD. Thank you !!! 

[Gridley]

Welcome to SA, Ican03.

 

Here is a link to Pristiq side effects.

 

https://www.drugs.com/sfx/pristiq-side-effects.html

 

100mg Prisiq is a very high dose.  Recommended maximum dose is 50mg.  It's difficult to ascertain equivalencies in dosage between SSRIs like Paxil and SNRIs like Pristiq, but it's clear you're taking a lot more drug now with 100mg Pristiq than when you were on 5mg Paxil.  I recommend you drop your dose to 50mg Pristiq.  This should minimize or eliminate side effects. 

 

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). Many people find these to be calming to the nervous system. 

 

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, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

[Ican03]

Thank you very much for your reply , my shrink insists that 100 mg is the correct dose for anxiety and panic attacks and I don’t think I can’t cut the pill in half. I am on day 6 today so will stick to the dose for a few more days , if it gets worse then I will insist on lowering the dose to 50mg. When in the day do you think it is best to take omega 3? 

[Gridley]

3 hours ago, Ican03 said:

When in the day do you think it is best to take omega 3?

I take it three times a days, after breakfast, lunch and after dinner.  The total EPA/DHA is around 1000mg.  You could start with that dose and if it works well, some members take more.

 

No, you can't cut Pristiq in half.  It does come in 50mg dosage.

Edited September 21, 2020 by Gridley

[ChessieCat]

Hi and welcome from me too,

 

If it was me I would be reducing to 50mg ASAP.  It takes about 4 days for a dose change to get to full level in the blood and a bit longer for it to register in the brain.

 

I had multiple issues whilst on 100mg Pristiq.  The most obvious one was my diastolic blood pressure increased a lot.  Unfortunately my doctor did not connect the increase in my dose from 50mg to 100mg Pristiq with the BP increase and just doubled my BP drug.  It wasn't until several years later when I started researching because I felt so rotten and found out the side effects that I realised that what I was experiencing was caused by the drug.

 

The slow release action of Pristiq is contained within the whole tablet (the glue), not the coating (like many other drugs).  It is okay to cut the tablets, but because of their shape it can be difficult to get an accurate dose.  If you cannot get Pristiq 50mg straight away and wish to reduce to 50mg then you could try cutting a 100mg tablet.  If the tablet breaks into a few different pieces you could eyeball 1/2 and take the broken pieces about 1 or 2 hours apart to try to overcome any dose dumping.

 

When changing from one psychiatric drug to another because of the different actions of the drugs you may still get withdrawal symptoms from the original drug, but you can also get start up, side effects and/or a bad reaction from the new drug.  Because of the changes made it can be hard to tell what is causing what.  However, 100mg Pristiq IS a high dose.

 

Please note that SA suggests only making one change at a time, otherwise you won't know if something helped/harmed.  It would be better to wait until after reducing your Pristiq before starting anything new.

 

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable

 

[Ican03]

Thank you all for your replies. I talked to my shrink and unfortunately she does not want to lower my dose to 50mg. She says that she will explain better in our next appointment ( which is in about 2 weeks).  I will have to stick with these side effects and on the 100mg dose until we speak again or until the symptoms become so unbearable that I try to cut the pill in half. I will try to stay calm and positive and hope for the best as tomorrow I hit a one week mark with the new medicine.  

 

[ChessieCat]

36 minutes ago, Ican03 said:

I talked to my shrink and unfortunately she does not want to lower my dose to 50mg. She says that she will explain better in our next appointment ( which is in about 2 weeks). 

 

This is not acceptable.  She's already put you on too high a dose of Pristiq.  And it may be that you are experiencing side effects caused by that and/or an adverse reaction.  Another 2 weeks (which would be 3 altogether) at 100mg Pristiq will mean that you will most likely have to taper it, but you might be able to reduce it quicker than a regular taper.   It can take as little as 4 weeks for the brain to become physiologically dependent on a drug.    And tapering Pristiq is difficult because of the only doses available are 25mg (in some countries, but not Australia), 50mg and 100mg.  I have to pay extra and get mine compounded.  Your regular doctor can write scripts.  I would be contacting them and requesting a script for 50mg Pristiq.

 

I would also be cancelling the appointment with this psychiatrist and if you feel that you still need to see one, I'd be finding a new one.  This is not the right way to be treating a patient who is experiencing the symptoms you are.

[ChessieCat]

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

[composter]

Hi there. I agree with Chessie wholeheartedly. You need to do what is best for you, not what is convenient for your doctor. Now is not the time to play “obedient patient” and follow orders. Now is the time to listen to your body and make an informed decision. 
 

I have several questions for you:

1) What was the reason for switching the paroxetine to the Pristiq? Were you not tolerating paroxetine well or was this a mostly arbitrary decision from your doctor?

 

2) When was your last dose of paroxetine? Or are you currently taking it? We don’t want you to go through withdrawal from paroxetine at the same time as having an adverse effect to a high dose of Pristiq. 
 

3) I see that you take Clonazepam 1 mg daily. When did you start this medication? We don’t want you to become dependent on benzos and have to taper from that too. 

[Ican03]

Thank you all very much. I think I can actually get the pristiq 50mg in 3-4 days and just lower the dose myself. I just though I should be a good patient and follow instructions. 
 

To answer Composter’s questions :

 

1. I starting having bad panic attacks and major anxiety all day. I had not had an appointment with a shrink in about 5 years  and though it will be a good idea , she suggested that pristiq was better than paroxetine and that I change will do good for me. 
 

2. My last dose of 0.5 mg paroxetine was last Wednesday and then started pristiq on Thursday. My main doctor explained that I’m probably going through both withdrawal and new side effects from Pristiq altogether but also said to trust the shrink. ( I’m so confused on what to do ).
 

3. I am for sure dependent on benzodiazepines already , I have Been taking 0.5 mg daily for about a year and a half now but with this AD change the new shrink upper my Dose  while I get “adjusted”. 
 

 

[composter]

Thanks for your reply. I’ve asked mods to weigh in on your situation further given the details you’ve just shared. 
 

The drugs act on your brain in different ways so an abrupt switch from one to another can really throw off the receptors and put you into a combo of withdrawal and adverse startup effects. 
 

If I were you I would focus on reducing the Pristiq to 0 over the next 1-2 weeks. As for the paroxetine did you taper at all from 5 mg to 0.5 mg? If so when did you start that taper and what was the schedule?

 

7 hours ago, Ican03 said:

I am for sure dependent on benzodiazepines already , I have Been taking 0.5 mg daily for about a year and a half now but with this AD change the new shrink upper my Dose  while I get “adjusted”. 

Your psychiatrist is clearly unaware of benzo dependence and appropriate dosing. I would focus on non-drug coping tools like mindfulness, acceptance, journaling, and soothing activities. I would recommend these any day over an upper dose of a benzo. I’ll have other mods weigh in on a plan for your benzo eventually but keep in mind our approach here is to only make one change at a time. This allows the brain to adjust and helps narrow down the culprit if something goes haywire.

 

Did you increase the benzo dose last Weds as well? 
 

We appreciate your cooperation. All the info you can provide will help us build a better picture of what you’re going through. 
 

IMHO your “shrink” is someone who prescribes drug changes only and subscribes fully to the medical management of mental health via psych drugs. I imagine you would benefit a great deal from therapy, and learning to manage panic and anxiety through mindfulness and CBT. 

[Ican03]

Hello composter,

 

I did not tapper the paroxetine, went from 5mg to the Pristiq, from one day to the other.  Also, yes, my clonazepam was also increased when starting the Pristiq to mitigate the side effects plus (what I now know) is withdrawal as well. As of today, I started tapering the clonazepam very slowly and using other techniques to cope.  I am waiting to see if I can get the 50mg dose of the Pristiq to also lower that down.  I am not sure if I can now be completely off meds because I was having major panic attacks ( main reason I consulted with this new psychiatrist).  I also agree that I need ASAP a therapist to help me out instead of relying on medication only.  

 

Thank you very much for your help. 

 

Are there any recommended mindfulness links, apps that focus on anxiety that you can recommend?  

[ChessieCat]

On 9/23/2020 at 1:00 AM, Ican03 said:

 

I just though I should be a good patient and follow instructions.

 

 

You might read this member's post about his experience of following his doctor's/doctors' advice.  Note that he states that the multiple back surgeries were unnecessary:

 

albert-preparing-to-get-off-paxil-paroxetine-for-good

[composter]

21 hours ago, Ican03 said:

As of today, I started tapering the clonazepam very slowly and using other techniques to cope.  I am waiting to see if I can get the 50mg dose of the Pristiq to also lower that down.

We strongly recommend making only one medication change at a time. This way you know which change is to blame if issues arise. That being said you made the Clonazepam increase relatively recently (1 week ago) so you may be ok with cutting back to the 0.5 mg relatively quickly and staying on that while you taper the Pristiq. 
 

As for the 50 mg dose you can likely prepare this yourself. I am not familiar with whether it comes in beads or a tablet form. But there are many ways to taper listed on our site which folks often use to great success. 
 

21 hours ago, Ican03 said:

Are there any recommended mindfulness links, apps that focus on anxiety that you can recommend? 

Glad you’re interested in all this. I recommend you review the threads in the Symptoms and Self-care section which share lots of ideas. Claire Weekes is an expert on managing anxiety and many people on here find her work to be helpful. As for apps I personally use the Calm app which does have some free meditations. I believe the app Insight Timer is mostly free for meditation. 
 

Sorry I’m on mobile right now so it’s harder for me to find all the links to various threads on managing anxiety. I trust you can peruse through these sections. 

Edited September 23, 2020 by composter

[ChessieCat]

20 minutes ago, composter said:

As for the 50 mg dose you can likely prepare this yourself. I am not familiar with whether it comes in beads or a tablet form. But there are many ways to taper listed on our site which folks often use to great success. 

 

tips-for-tapering-off-pristiq-desvenlafaxine

 

[Ican03]

I can’t thank you all enough for the suggestions. I am following the advise!! 

[Ican03]

Hi all again ,

 

I will be able to buy the pristiq 50mg dose next Monday. That will be 13 days on the 100mg dose , will it be ok to tapper / lower the dose at that point ? I’m now sure , after reading all of the stories here I don’t want to be on such a high dose. !!!

[ChessieCat]

It might be better to do some time, perhaps 1 or 2 weeks, on 75mg by cutting 50mg tablets in half, unless you can also get a script for 25mg tablets.  And then go to 50mg.

 

Hopefully the other mods might be able to weigh in on this.

[ChessieCat]

The mods are discussing your situation and what the options might be.

[Ican03]

I think it is important to mention that this generic Pristiq has a different oval large shape that looks very easy to cut. Wondering if I can upload a picture...?

[Altostrata]

On 9/21/2020 at 9:44 AM, Ican03 said:

Thank you very much for your reply , my shrink insists that 100 mg is the correct dose for anxiety and panic attacks and I don’t think I can’t cut the pill in half. I am on day 6 today so will stick to the dose for a few more days , if it gets worse then I will insist on lowering the dose to 50mg. When in the day do you think it is best to take omega 3? 

 

Hello, you were taking 5mg paroxetine? 100mg desvenlafaxine (Pristiq) is about 8 times as strong as your paroxetine dose.

 

Further, paroxetine is an antidepressant among the worst for withdrawal symptoms. You probably have paroxetine withdrawal as well as excessive stimulation from a too-high dose of desvenlafaxine.

 

If I were you, I would get another doctor and go back to paroxetine as soon as possible.

 

As this is a site for going off psychiatric drugs, ordinarily we don't assist in drug switches, that's what your doctor gets paid for. We will be happy to provide you support when you decide you want to reduce or go off your drugs.