momorin: Pristiq taper

[momorin]

Hello everyone!

 

I discovered this forum two years ago in 2019, but I never really thought of making a thread until now. I noticed there aren't too many Pristiq reports that discuss cross-tapering so I think my experience could be valuable. It's a bit long, apologies for that.

 

I started taking medication (Zoloft 50 mg and Haloperidol, can't remember how much) in 2015, after which my doctor switched me to Pristiq 50 mg and got me off the Haloperidol a year later. I decided to taper off the Pristiq in early 2019 after discussing it with my psychiatrist, who concluded I was stable enough to go on without it. I read the threads on this forum and followed the advice, I started the taper in March 2019, tapering down to 25 mg and cross-tapering with Zoloft in June 2019, which then I tapered off fully by the time October rolled.

I don't remember suffering from major withdrawal effects, I only had a bit of fatigue and the usual waterlogged feeling that comes when you skip a Pristiq dose, but those went away quickly. In that sense, I was lucky to not suffer from any withdrawal effects and kept living my life as usual.

 

Unfortunately during June 2020 I developed an inner ear disorder which caused near permanent vertigo and swaying. I initially thought this could be a withdrawal effect but I have had very short and random vertigo episodes years before starting medication and all the MRI scans came out well. The ear exams showed I did have an imbalance in my right inner ear*.

 

One year later, I have managed to get used to it since the swaying feeling only happens while I'm still, so I'm able to move around and walk, drive etc. without issues and I'm currently on vestibular therapy, but back then when it started I got really bad medical anxiety about it, so my GP prescribed Prozac 40 mg (divided on two 20 mg doses throughout the day) and Trazadone 50 mg (to be able to sleep at night). I actually felt pretty good with the Prozac, way better than when I used Zoloft and Pristiq, but it interacted badly with the Trazodone and caused me constant tremors. After googling I found out you're not supposed to take these two medications, I regretted trusting my GP blindly but it was too late for that, so I decided to quit the Prozac cold turkey only 5 days after starting (a risky choice I know, but I wanted the tremors to stop asap). I took the Trazodone for a month and by December I had tapered it off fully.

 

I had no withdrawal effects from the Trazodone, but I did have an anxiety crisis (I didn't have anxiety attacks but I did have near constant anguish about several events currently going on in my life, combined with a stressful job that I had to quit) that started in October 2020. I don't know if this was caused by the Prozac or not because I didn't have any physical effects, but I didn't want to go back on meds again so I tried my best to keep it controlled and focus on the new job I got until I began having actual panic attacks in early January 2021. I was let go from the job due to anxiety/panic affecting my performance so I decided to begrudgingly go back to the psychiatrist and rest until I could have my anxiety fully controlled and be emotionally stable. He prescribed Pristiq 50 mg once again, along with Levomepromazine (3 drops, only to be taken if the intense panic attacks returned) and Seroquel 12 mg (only if I had insomnia).

 

6 months later the anxiety and panic is finally under control, I have developed better coping strategies (going to the gym everyday has helped me a lot), have found online support groups with other people who have also taken all types of medication but I really really hate the physical side-effects of Pristiq, I have to take laxatives because it makes me very constipated, and I hate how it basically ruins your day if you forget to take even a single dose, so after discussing it with my psychiatrist he allowed me to cross-taper to Prozac 20 mg and stay on it until the end of the year or more because my nervous system has been through a lot these two years lol. Another main reason I want to get off the meds is that my therapist suspects that I have autism and ADHD and that's what's causing my depression in the first place, in which case I would need a completely different treatment less focused on meds anyways.

 

I'm currently on day 90 since I started tapering and I'm now down to 25 mg. At first I'd cut the pill in four squares, take two at the morning and one at the evening, then I took only half of the pill at the morning. Contrary to the first time I tapered off Pristiq two years ago, this time has been tough emotionally, but the only effects I've had so far was slight fatigue and waterlogged feeling during the first two weeks along with sporadic episodes of insomnia. No brain zaps.

 

Yesterday I attempted the first day of the Prozac cross-taper, I took my final Pristiq 25 mg dose at 8 am and took Prozac 4 mg before sleep at 10 pm, but it stimulated me too much (it felt like taking 3 cups of coffee) and couldn't sleep until 4 am, in retrospective I shouldn't have taken it so late. I still have the Seroquel but I didn't know if taking it would interfere with this process and backfire so I had to endure. Today I took 20 mg of Pristiq at the morning and 1 mg of Prozac at 6 pm and felt a lot better, no shaking, no anxiety. I plan to speak with my psychiatrist and ask him to allow me to adjust the Prozac dose to 10 mg max since it seems even 20 mg might be too much for the moment despite doing well with 40 mg last year.

I will keep updating this post until I'm finally off the Pristiq.

 

Thanks for reading.

[momorin]

I wanted to add this following tidbit that could be useful to the researchers on this forum but I don't know how to put it under a spoiler so I have to make a new reply:

 

While researching about vertigo related disorders, I came across a person who told me they suffered from a similar condition to mine that is only now starting to be studied, called New Daily Persistent Headache. Some people get the persistent headache but others get the persistent vertigo like this person. They didn't have any inner ear issues like me and had no idea what to do until a neurologist told them of this condition. The only way to treat it is as if it were a case of chronic migraine and tricyclic antidepressants are really good for that, the vertigo completely went away after they started taking Amitryptiline (!!!) I thought that was really interesting since it's usually going off the med what causes vertigo, not the opposite.

[momorin]

Update:

Yesterday I slept well, it did take me a while to fall asleep (1:30 am) but it was earlier than the first day. I hope today I can fall asleep at 11-12 pm at least.

Today I took a quarter of a Pristiq pill (12.7 mg) at 9 am and I'll take 1-3 mg of Prozac at 6 pm (I only have the 20 mg pill so I can only estimate by eye). So far I'm feeling good except for cramps/stomach aches caused by gas and constipation, took a 30 minute nap.

[arbor]

Hello @momorin,

Welcome to SA and thank you for listing your signature.  You've been going through a lot.  I look forward to these symptoms resolving for you, and for your tapers to go smoothly.  To address some of your questions, I'm including links that may give you a little more information:

 

Important Topics in Tapering

 

Tips for tapering off Pristiq (desvenlafaxine)

 

Why taper by 10% of my dosage?

The Prozac switch or "bridging" with fluoxetine - Tapering  (Be sure to see page 3)

Good for you for recognizing that your Prozac dose was too high.  Doctors aren't always aware of the risks of too high a dose during reinstatements, which in your case, Prozac is.

Tips for tapering off Prozac (fluoxetine)

On 9/8/2021 at 7:27 PM, momorin said:

June 2020 I developed an inner ear disorder

As your system stabilizes and ultimately you are able to withdraw and recover, they will likely--though slowly--disappear.  

Dizziness, vertigo, light-headedness, rocking or swaying

On 9/8/2021 at 7:27 PM, momorin said:

6 months later the anxiety and panic is finally under control, I have developed better coping strategies

I'm glad to hear this.  It's truly helpful during withdrawal to develop such skills.  I consider it a true accomplishment.

 

On 9/8/2021 at 7:27 PM, momorin said:

I still have the Seroquel but I didn't know if taking it would interfere with this process and backfire so I had to endure.

I recommend, if you can, to stay away from it as it will add further complication, especially when your system has already been exposed to a number of psycho-drugs.  Here is a link that may be helpful:

Tips to help sleep: so many of us have that awful withdrawal ...

Early-morning waking - managing the morning cortisol spike ...

 

This is your Introduction site where you can ask questions, update your progress, and connect with other members.

I'm glad you've found us. 

Arbor

[Altostrata]

Hello, @momorin

 

From your account, it appears you have had intermittent withdrawal symptoms every time you've missed a dose of one of your drugs.

 

It's very important to take a psychiatric drug consistently. You may start out not feeling a skipped dose much, but over time that neurobiological upset can cause your nervous system to become sensitized to all kinds of things (including an inner ear condition). Once your nervous system is sensitized, small variations in dosage can cause odd and distressing symptoms, sometimes hours or days later.

 

Please be aware you are manipulating powerful drugs. You can take a more precise, consistent dose of fluoxetine by using the liquid form of the drug. This is available by prescription or you can make your own. See Tips for tapering off fluoxetine (Prozac)

 

I urge you to settle on one measured dosage of fluoxetine and take that at the same time each day. Fluoxetine takes about 2 weeks of consistent dosing to ramp up to full strength. If you take 3mg now, it may not feel like much, but it will get stronger over time.

 

Pristiq is a difficult drug to go off because it does not come in a dosage range and people have to cut up tablets to taper, as you have, but sometimes they do not tolerate the immediate release of the drug as you have. It will take about 3-4 days for the last Pristiq dose to leave your body.

 

So you will have overlapping drug effects as the Pristiq diminishes and Prozac ramps up. Please do not be surprised if you get odd symptoms. Adding in Seroquel will throw in another uncontrolled factor. We urge people to change only one drug at a time, or you won't know where odd symptoms are coming from.

 

Please let us know how you are feeling over the next 2 weeks.

[momorin]

Hello @arbor
@Altostrata
 and thank you for the warm welcome and advice. The dizziness topic was very interesting (I had no idea serotonin levels had an influence in the inner ear) and I'm still going through the rest.

 

Last sunday, a week ago, I took the last Pristiq dose and have remained only on 5mg Prozac at 5:00 pm every day. It has to be 5mg because the pill won't cut well and crumble below thay amount. So far it's been good. I feel a bit sleepy during the afternoon (and sometime even after taking it) but otherwise I'm functioning normally.

 

I also feel a weird tension/stiffness on my legs which I can't explain well, it doesn't hurt and it's not a tremor, it just feels like it's tensioned even if I try to relax my legs. This is only noticeable when I'm lying down though. Everything else has been fine.

 

Currently I just had a sleepless night due to forgetting to take the dose (I was convinced I had taken it until I discovered the Prozac chip in my pill box). I'm putting an alarm in my phone to avoid this happening again. It's different from the insomnia that I'd get when I forgot to take the Pristiq, that waterlogged/general hungover feeling is gone but it's replaced with the aforementioned tension and somehow a lot of energy. Thankfully it's sunday so I can try to relax. I will try to maintain a consistent routine next week to offset any possible side effects

 

@Altostrata
thanks again for the advice regarding dosage and consistency 👍 I will try to get liquid Prozac today and start with it, I don't know why I didn't think of that before orz

[arbor]

Good to hear from you @momorin

3 hours ago, momorin said:

it's replaced with the aforementioned tension and somehow a lot of energy.

I remember these feelings in the early stage of w/d from Prozac.

Hang in there.  I'm glad you can rest today.

Thinking of you,

Arbor

[Altostrata]

Please clarify -- you are taking a small amount of Pristiq with fluoxetine daily?

[momorin]

Update: Some things have happened since my last post. Sorry for the wall of text but I think it's important to be detailed so others can compare and learn what to do/what not to do.

I was almost institutionalized due to an emergency room visit (A family member said something very hurtful to me in late June and my self-esteem got worse until called a suicide hotline to vent, and they told me to go to a clinic). I stayed on the clinic two days and they only gave me one pill of Seroquel the first night and nothing else afterwards because I was very calm. I signed a voluntary release and the next week after that I had an urgent appointment with my psychiatrist who evaluated me and said I was stable but I had "reactive depression" due to my dysfunctional family and that I would recover if I continued therapy and learned new coping strategies. He also recommended leaving the country and work overseas and change environments, meet new people, a new culture etc. so I will start the process and paperwork next year when I'm done with my masters thesis. I'm currently on therapy with two specialists (one is provided by my insurance, the other is provided by the hotline), so I will be fine and I will get through this. I'm also thankful that the doctors I've seen believe more in the environmental theory of mental illness rather than the chemical imbalance theory and so they're willing to consider all the social factors instead of medicating me lol

 

About the suicidal thoughts: I'm truly not capable of hurting myself and I have been dealing with these thoughts for several years, so it's not like the medication suddenly caused this. But I am aware that the process of cross-tapering and getting off Pristiq could have worsened my state of mind, so there's that. I think it's important for me to tell the whole story so people who are still on Pristiq can learn from my experience. I also have "lean type" PCOS (I forgot to mention it in my intro! I was diagnosed at 16) and the hormonal imbalance it causes is another factor that complicates my emotions. But I have been on treatment for that too and I'm doing the best I can.

 

My psychiatrist prescribed me Venlafaxine (to "stabilize my emotions") but I really really do not want to go back to that orz so I'm still on the Prozac 10mg and I'm waiting for an appointment with the insurance psychiatrist in two weeks to see what can be made. But according to every therapist that has seen me since I started treatment in 2015 90% of my mental health issues are caused by a difficult environment and very probably autism so medication is just not the solution. My brother received a diagnosis of Autism level 1 these past months too, but he's younger than me and there's literally zero treatment or even a diagnosis available in my region for autistic adults so I'm just following a lot of autistic creators on instagram and feeling very identified with everything.

 

In summary, these past months I've been on:

• Prozac 10mg everyday

• Spironolactone 50mg (A testosterone blocker. I take this for my PCOS) everyday

• Magnesium 400mg supplement

• A drop of CBD oil with warm milk to feel calm. I'm an extremely anxious and irritable person so I drink this when I want to relax and watch a movie and I find it helps me reflect on my emotions and the way I react to things.

I don't smoke and the one time I tried a weed edible years ago I had an incredibly bad trip so I don't plan on doing any drugs for the rest of my life.

 

Physical effects:

• A month ago I had a strange skin rash in some parts of my body and I had to start washing my hair with a medicated shampoo every second day because my scalp was getting extremely dry and greasy at once.

• I no longer feel the tension from last time but I do feel like my legs get stiff at night sometimes. I go to the gym 4-5 days a week during the evening and that helps a lot seriously exercise has kept me stable when I have a bad day. I do grind my teeth when I sleep so I use a mouth guard at night.

• My sleep pattern is fine, I don't have insomnia and I use yellow lights in my room and yellow filters in my screens to make it easier to fall asleep. Last week I was feeling particularly sleepy which is an improvement over what I felt one year ago (I feel like I had some type of mild akathisia back then because I wanted to rip off my skin and let my skeleton run away as far as possible) when I was being restless on my bed from side to side like a rotisserie chicken.

• My libido returned 🥴 it's not on the level I had during early 2020 when I was unmedicated and at "my prime" but I don't think I will get back to that level until the day I leave all psychiatric medications again.

• I haven't had any uncontrollable panic attacks. As the time goes by, anxiety flare ups become milder and easier to manage.

[momorin]

On 9/19/2021 at 9:59 AM, arbor said:

Good to hear from you @momorin

I remember these feelings in the early stage of w/d from Prozac.

Hang in there.  I'm glad you can rest today.

Thinking of you,

Arbor

Thank you for your kind message!

 

On 9/19/2021 at 3:44 PM, Altostrata said:

Please clarify -- you are taking a small amount of Pristiq with fluoxetine daily?

My original plan was to decrease the Pristiq from 25mg to 0mg while increasing the Prozac from 0mg to 20mg at the same time over the course of 5 days, but because I reacted so badly the first time I took the Prozac I just went from 0 to 10mg Prozac and stayed there instead of going all the way to 20mg. I decreased the Pristiq in 5mg intervals everyday. I consulted with someone else who also cross-tapered like this (in another website) and they did it over two weeks. But they struggled a lot and told me it was better to do it over the course of one week instead of two so I followed their advice and the cross-taper thread's tips.

[Altostrata]

You are no longer taking Pristiq? When did you stop it? How did your symptom pattern change after that?

 

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