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dteeger: finding a good taper psychiatrist/doctor


dteeger

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I'm sure this is a very common question, but I couldn't find an answer. I may have missed it. I live in San Francisco and I am wondering how I can find a psychiatrist or other doctor who specializes in tapering antidepressants.

 

Thank you.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
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  • ChessieCat changed the title to REAL NAME? Finding a good taper psychiatrist/doctor
  • 2 weeks later...
  • Moderator Emeritus

Hi and welcome to SA,

 

The reason this site and other similar sites exist is because there are not many medical professionals who know about psychiatric drugs (adverse effects, side effects, withdrawal symptoms, tapering, drug interactions) and how to get people off them.  There is a wealth of excellent information available on this site about how to taper a psychiatric drug. 

 

This is SA's topic about doctors:

 

recommended-doctors-therapists-and-clinics

 

It is possible to get off Pristiq by tapering it.  I was taking 100mg Pristiq and by following the tapering information here at SA I managed to get off last November 2021.  There is information in my signature below this post.

 

SA's suggested tapering protocol is to reduce by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  If the drug is reduced too quickly then withdrawal symptoms may be experienced.  I used to get brain zaps if I accidentally missed taking it for one day.

 

Why taper by 10% of my dosage?


Dr Joseph Glenmullen's WD Symptoms Checklist

 

Post #1 of this topic has information about how to get non standard doses:

 

Tips for tapering off desvenlafaxine (Pristiq)

 

I hope this information is helpful.  Please ask any questions you have here in your topic.

 

Please create your drug signature following these instructions:

 

Instructions:  Withdrawal History Signature

 

This is your own Introduction topic where you ask questions about your own situation and journal your progress.  This keeps your history in one place and means you do not have to repeat your story.

 

Edited by ChessieCat
removed mod note

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • ChessieCat changed the title to dteeger: Finding a good taper psychiatrist/doctor

Hi everyone,

 

I am currently having a somewhat unique issue with Pristiq. I am having digestive issues and I am not absorbing the ER tablets, which means I'm getting a wildly fluctuating dosage each day. I'm very sensitive to Pristiq changes and the fluctuations are making me sick. I've talked with my doctors and the only reliable solution we've come up with is to have a compounding pharmacy make me instant-release tablets. So for example, I'm taking 125mg (75mg in morning and 50mg at night). Instead, I would switch to taking five 25mg instant-release pills each day, spread out roughly 5 hours apart. 

 

However, I'm concerned that each pill will cause me to get too much medicine too quickly and spike my blood levels.


Has anyone out there ever crushed Pristiq tablets and made their own instant-release pills? How did it work out for you?

 

Thanks a lot.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Moderator Emeritus
2 hours ago, dteeger said:

I am having digestive issues and I am not absorbing the ER tablets

 

Q:  Are you making this assumption because you are experiencing diarrhea?

 

Please see the quote below about serotonin syndrome.  Please read about what happened to me (below).

 

As soon as a Pristiq tablet is crushed it becomes immediate release, with a half life of about 11 hours so the dose needs to be taken twice a day.  The slow release of Pristiq tablets is contained in the glue of the tablet, not the coating.  The coating sometimes does not dissolve at all and the patient information says that it might be seen in the stool when you have a bowel movement.

 

I had my Pristiq tablets compounded and the compounding pharmacist added slow released formula.

 

Q:  What symptoms are you getting? 

 

I'm wondering if you are experiencing mild serotonin syndrome.  About 95% of serotonin is in the gut.  The high dose you are taking may be causing your issues.

 

I experienced mild serotonin toxicity when I was taking 100mg Pristiq (no other serotonergic drug involved).  Once my dose got lower the symptoms of serotonin toxicity went.  My diastolic blood pressure went very high (doctor just prescribed higher dose of BP drug, he did not make the connection of the increased blood pressure with the change from 50mg to 100mg Pristiq), anxiety and unable to concentrate, tight calf muscles when walking a short distance, sweating even on a cold day.

 

From https://en.wikipedia.org/wiki/Serotonin_syndrome

 

Quote

 

Serotonin syndrome (SS) is a group of symptoms that may occur with the use of certain serotonergic medications or drugs.[1] The degree of symptoms can range from mild to severe, including a potentiality of death.[4][5][2] Symptoms in mild cases include high blood pressure and a fast heart rate; usually without a fever.[2] Symptoms in moderate cases include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.[1][2] In severe cases body temperature can increase to greater than 41.1 °C (106.0 °F).[2] Complications may include seizures and extensive muscle breakdown.[2]

 

 

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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Hi @ChessieCat thank you for your response. To answer your questions:

 

Q:  Are you making this assumption because you are experiencing diarrhea?

Yes, but it's more than that. At the risk of too much information, I have seen the pills pass out, and they are still largely undigested and full of medicine (not just shells).

 

Q:  What symptoms are you getting?

When I miss doses of Pristiq, I get electric shocking pain in the nerves and muscles of my torso and abdomen, as well as digestive problems. I do not think it is serotonin syndrome, because I have been taking the Pristiq for many years. The pain began when I missed a dose back in July. That event seems to have destabilized me, and I am now extremely sensitive to small changes in the Pristiq dose.

 

That is why I am considering going to compounded instant-release Pristiq tablets, to make sure I digest everything. It may be risky, but I also can't afford to keep having days where I pass out most of the medication and get severely under-dosed.

 

Thanks.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment

Not offering any advice but I can tell you what I did when I was having the same issue, passing whole Pristiq tablets in my stool.  After getting a bit of the runaround from my doctor and pharmacist, my doctor told me to break the 25mg in half and take both to make sure they were absorbed.  I did this and didn’t have any adverse reactions and no longer passed whole Pristiq.  I was only doing this for a few months before I started getting the Pristiq compounded to go to lower doses.  My recollection from researching back then is that when you break the Pristiq in half or quarters, but not crush them, they retain some amount (could be 90% or could be 5%) of the extended release capacity. 

Multiple drugs for my teen years.  ~10 years on Pristiq 100mg.  
January 2021: 50mg Pristiq to 43.75. Stopped Viibryd at 10mg

March 2021: holding at 37.5mg.
April 2021: 25mg.  May 2021: 18.75 to 12.5.  
June 2021: 12.5 to (accidentally) 4.29mg.  Updose to 6mg using compounded Pristiq

August 2020: Crashed at day 35 of 5mg. Updose to 6mg

September 2020: 5.5mg from 6 after 38 days

10/2021: 5mg, 11/2021: 4.5mg, 12/21:4mg, 3/22:3.75mg, Propranolol 10mg prn

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@Kevman2112 Thanks that's really helpful. When you got them compounded, did you have them made as instant release or extended release? How big was the dose?

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment

It’s essentially instant release, the pharmacist takes my 25mg tablets and crushes them into a solution to make 1mg/ml.  I believe I first got my dose compounded when I was at 6mg a day so 6ml per day.  I have read others getting a compounding pharmacist to make extended release versions but I never found anyone in my area to do that.  

Multiple drugs for my teen years.  ~10 years on Pristiq 100mg.  
January 2021: 50mg Pristiq to 43.75. Stopped Viibryd at 10mg

March 2021: holding at 37.5mg.
April 2021: 25mg.  May 2021: 18.75 to 12.5.  
June 2021: 12.5 to (accidentally) 4.29mg.  Updose to 6mg using compounded Pristiq

August 2020: Crashed at day 35 of 5mg. Updose to 6mg

September 2020: 5.5mg from 6 after 38 days

10/2021: 5mg, 11/2021: 4.5mg, 12/21:4mg, 3/22:3.75mg, Propranolol 10mg prn

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  • Administrator

Hello, @dteeger

 

6 hours ago, dteeger said:

Instead, I would switch to taking five 25mg instant-release pills each day, spread out roughly 5 hours apart. 

 

Why do you want to follow this unusual schedule? You'd need to take immediate-release Pristiq only twice a day, 12 hours apart.

 

38 minutes ago, Kevman2112 said:

My recollection from researching back then is that when you break the Pristiq in half or quarters, but not crush them, they retain some amount (could be 90% or could be 5%) of the extended release capacity. 

 

We have people here tapering Pristiq by cutting the tablets up. However, you cannot count on any extended-release quality being retained in a broken tablet. This is explained here Tips for tapering off desvenlafaxine (Pristiq)

 

59 minutes ago, dteeger said:

When I miss doses of Pristiq, I get electric shocking pain in the nerves and muscles of my torso and abdomen, as well as digestive problems. I do not think it is serotonin syndrome, because I have been taking the Pristiq for many years. The pain began when I missed a dose back in July. That event seems to have destabilized me, and I am now extremely sensitive to small changes in the Pristiq dose.

 

Correct, when you miss doses of Pristiq, you get those very typical withdrawal symptoms. We have a lot of people here who have been sensitized by such drug mishaps.

 

@dteeger are you also taking Klonopin and Neurontin? If I were you, I would taper only one drug at a time. If you change more than one, we don't know where adverse symptoms are coming from. 

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi @Altostrata the unusual schedule is to reduce "dose-dumping". I don't want to get too much of the medicine into my blood at once. I'm currently taking 125mg, which is a lot. So if I'm going to do instant-release, I'd feel much safer taking 25mg 5 times a day rather than taking 62.5mg twice a day. I'm very sensitive to changes in blood concentration of the drug. Does that make sense? That's why I wanted to hear people's experience with doing instant-release. So for example, if I hear from a lot of people that they did 50mg IR twice a day and didn't get sick, I'd feel a lot better. On the other hand, if someone tells me they had took a 25mg IR tablet and got sick, I'd be worried.


Interaction report attached. Yeah I'm on a lot of stuff. I've got to get off, but getting off the Pristiq is my priority. It's making me really sick.

Drug Interaction Report - Drugs.com.pdf

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Administrator

If you're taking 125mg Pristiq -- an amount that should set a record for overprescription -- you could take a 50mg tablet twice a day. You could split a 25mg to take twice a day as well.

 

However, 125mg is so very excessive, you could probably drop 25mg and not feel it. There's a limit to how much neuroreceptor saturation that dosage can attain.

 

If I were you, I might make a complaint about your prescriber to the state medical board. That is incompetent prescribing, putting you at high risk of serotonin syndrome.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
  • Administrator

No downloads, thank you. Please post the link to your drug interactions report.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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@Altostrata Agree, it's too much. My prescription was 100mg. One day I accidentally took too much (long story) and when I tried to get back down to 100, I had bad withdrawal symptoms. So I got stuck at 125mg. I take 75mg in the morning and 50 at night.  I now have 5mg compounded ER pills on hand and am going to try and get back down to 100, gradually.

 

However, this is all complicated by the fact that I'm passing pills due to digestive problems. So I have to solve that problem first, probably by going to compounded IR pills. But I need to make sure I don't spike my blood levels too much, which is why I would probably err on the side of caution and take five 25mg IR pills a day, instead of two 62.5mg IR pills. (Hopefully I'll get back down to 100 and can do 4 25mg pills, etc).

 

One silver lining of the dosing accident: Adding the extra 25mg at night helped reduce some chronic neurological problems that I believe are linked to the Pristiq. When I switched from 100/25 to 75/50, they reduced even more. My hypothesis is that taking all my Pristiq in the morning was causing me to have "mini-withdrawals" every night as my blood levels dropped (yes I think I'm that sensitive). By switching to twice a day, I think (I hope) I may be reducing that effect. One thing to note about ER capsules is that they release more at first, and less as time goes on. It's roughly an exponential drop. So even if an ER pill says it releases over 24 hours, I think you get a lot more medicine in the first 12 than in the last 12.

 

Here's the link: https://www.drugs.com/interactions-check.php?drug_list=2796-12488,703-357,1147-0,1956-0,896-1617,1684-0,1482-0

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Administrator
18 hours ago, dteeger said:

One day I accidentally took too much (long story) and when I tried to get back down to 100, I had bad withdrawal symptoms.

 

Taking too much Pristiq for ONE DAY would not cause withdrawal symptoms when you went back down to 100mg, but it might cause serotonin toxicity or sensitize you to Pristiq.

 

Over the last 6 years, has it repeatedly happened that you occasionally forgot to take a dose or took too much or less than customary?

 

I think it's very possible that many of your symptoms, particularly your digestive problems, are from TOO MUCH Pristiq and what you think are withdrawal symptoms are something else, maybe serotonin toxicity, which can be dangerous.

 

That you've tolerated at least 100mg Pristiq for so long suggests you are a fast metabolizer of Pristiq. Fast metabolizers are subject to excessive dosing and consequent drug-induced adverse effects such as liver damage.

 

Given your excessively high Pristiq intake and the fact that Pristiq is available in 25mg and 50mg tablets, your dosing and tapering plan makes no sense to me at all. All you're doing is arranging to take Pristiq all day long at an excessive daily dose.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi @Altostrata

 

Thank you again for your advice. I agree it sounds like serotonin syndrome may be an issue, and that my dose is excessive (I am trying to reduce asap). Let me give a (simplified) history and perhaps you and the others can help me understand what I may be experiencing. In general, I have been extremely careful with my dosing. However, as you will see, I made two mistakes that landed me in my current predicament.

 

1. I have been taking Pristiq 100mg every morning for about five years, except for a brief period last year where my doctor tapered me (slowly) down to 50mg to see if I could make do with less of the medication. My depressive symptoms worsened, so we went (slowly) back up to 100mg.
2. During this period I never missed a dose or overdosed. I was very careful. I also had no adverse effects from the drug that I could tell. I seemed to tolerate it well.
3. In July of 2021, due to unforeseen circumstances, I missed a dose (perhaps two). Before I realized what had happened, it had been somewhere between 48 and 72 hours since my last dose.
4. At the same time, I began to experience sharp neuropathic pain in my torso, including burning and “zapping” nerves, and severe digestive dysfunction. I cannot conclude that Pristiq withdrawal/discontinuation caused these symptoms, but it was certainly correlated.
5.The symptoms continued, even after I reinstated my normal Pristiq dose. In fact, they have been getting worse ever since, and are very incapacitating.
6. Two months ago, my doctor and I discussed whether missing the dose in July may have somehow caused me to become hyper-sensitive to changes in blood level of Pristiq. To try and level out my dosing, we switched from a single 100mg tablet in the morning to a 50mg in the morning and a 50mg at night. This seemed to improve things somewhat, although it didn’t solve the problem.
7. Last month, in a rare mistake, I accidentally took an additional 25mg tablet in the evening.
8. The next day, I took my normal 50mg/50mg doses. That night, at about midnight, I began to experience an extreme exacerbation of my nerve and gut pain. It felt like withdrawal all over again. To avoid any more persistent side effects, I took another 25mg. (This was a difficult decision, but I felt I needed to err on the side of avoiding having even more permanent, incapacitating symptoms from the sudden drop from 125 to 100mg)
9. Hence, today I am “stuck” at 125mg, specifically 75mg in the morning and 50mg at night. I am working to taper back down to 50/50, and then go lower from there.
10. All this is complicated by the fact that I am still having digestive problems and am unsure if I am absorbing my full dose daily.

 

I hope this clarifies things. I certainly understand my current situation is a problem, and I am trying to figure out how to fix it as quickly as possible. I know it seems unusual, but I do believe I have become hyper-sensitive to Pristiq dose changes, and hence ran into trouble when I dropped from 125mg down to 100mg too quickly.

 

Thanks again.


David

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Moderator Emeritus
19 minutes ago, dteeger said:

1. I have been taking Pristiq 100mg every morning for about five years, except for a brief period last year where my doctor tapered me (slowly) down to 50mg to see if I could make do with less of the medication. My depressive symptoms worsened, so we went (slowly) back up to 100mg.

 

Q:  What specifically was the tapering rate?  "Slow" means different things to different people.  If you cannot remember the rate, how many months did it take to get from 100mg to 50mg Pristiq?

 

Q:  Did you skip days to do this due to the limited doses available?

 

Q:  Did you experience withdrawals symptoms during the reduction and more importantly did you continue reducing whilst you still had the withdrawal symptoms?

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

22 minutes ago, dteeger said:

10. All this is complicated by the fact that I am still having digestive problems and am unsure if I am absorbing my full dose daily.

 

You could try what someone suggested (Alto or another member, I cannot remember which):  break/cut the tablet into 2 or 4.  This will "bypass" the coating on the Pristiq tablet.

 

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

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  • Administrator

@dteeger, I understand why you did what you did. But it looks to me that the upset after you missed doses in July 2021 was withdrawal (cold turkey from 100mg!), and your overdosing since then has made the dysregulation from withdrawal ongoing and worse. You might even have become allergic to Pristiq.

 

I'd take Pristiq with food, because it may be your digestive system is a sensitized area. 

 

If I were you, I'd reduce to 50mg in the morning and 50mg in the evening. If dropping the 25mg seems too precipitous to you, you might cut the 25mg tablet in half and take only 12.5mg of it for 2 weeks (a 10% reduction on 125mg), then drop the other 12.5mg. At your level of excessive dosing, it probably won't make much difference.

 

As an amateur peer counselor, I find your level of dosing alarming. Even if you experience odd symptoms while reducing to 112.5mg or 100mg, if I were you, I'd surf them, because taking the amount of serotonergic in 125mg is high risk.

 

I didn't see your drug-drug interactions, but they also may be causing some of your symptoms. Your doctor apparently thinks if a little bit of a drug is good, a lot of it is better.

 

 

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi @ChessieCat If I remember correctly, my doctor took me down to 75mg for a month, then 50mg. I did not notice any withdrawal symptoms. Apparently at that time I could tolerate a 25mg drop, which is no longer the case. After 1-2 months at 50mg, I noticed an increase in depressive symptoms, so we reversed the process and I went back up to 100mg. I never skipped a day or experienced any withdrawal symptoms during this whole process.

 

@Altostrata Thank you, I will try taking it with food, and I agree 125mg is too much and I am going to start dropping back to 50/50. I have 5mg ER compounded pills, so I can do it gradually (eg 120 for a few days, 115 for a few days, etc).  

 

This drug is such a toxic brew. Sigh...

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Moderator Emeritus
3 hours ago, Altostrata said:

I didn't see your drug-drug interactions, but they also may be causing some of your symptoms.

 

Q:  Has the same doctor put you on all of these drugs?

 

From https://reference.medscape.com/drug-interactionchecker

Monitor Closely

  • gabapentin + clonazepam

    gabapentin, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

  • gabapentin + desvenlafaxine

    gabapentin, desvenlafaxine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Link to comment

@ChessieCat Not originally, but my current PCP and psychiatrist are aware of everything I'm taking, as is my neurologist. I'm already tapering down the clonazepam, and I'm going to be starting with a new psychiatrist soon, who wants to taper the neurontin as well. My goal is to get off most or all of it. But the neurontin is treating incapacitating nerve pain, so none of this is simple or straightforward.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
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  • Moderator Emeritus

Q:  What is the timeline of your Pristiq dose increases?  That is, what dose were you started on, how long were you on that dose, when was the dose increased and to what dose etc.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Link to comment
  • Administrator

All 3 of your doctors have been negligent.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi @ChessieCat  My doctor started me on the Pristiq more than five years ago. I don't remember exactly what dose we started with, but I've been on 100mg as long as I can remember, except for that brief period last year where we tried dropping me to 50mg. So yeah, it's almost always been 100mg, without much change.

 

@Altostrata The psychiatrist who started me on the Pristiq and large doses of klonopin was negligent. I stopped seeing her. With my current doctors, I have maintained the Pristiq and reduced the klonopin. I have increased the neurontin, but as I mentioned my alternative was (and is) incapacitating nerve pain. So we're all doing the best we can under the circumstances. My goal is to continue to drop the klonopin, drop the Pristiq, and figure out what to do about the neurontin. I'm in a difficult situation, but I am sure I need to taper down and eliminate the Pristiq, which is making me sick.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Moderator Emeritus

Thank you for answering my question.

 

Q:  Do you know what caused/is causing the nerve pain?

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Link to comment
  • Administrator

I would not be a bit surprised if the nerve pain were caused by excessive Pristiq. I still haven't seen your drug-drug interactions, which could be elevating the amount of Pristiq in your bloodstream.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Hi @ChessieCat good question. I don't know. There are two mysteries: why did the pain *start*, and why is it still *continuing*. I am pretty sure the  pain started when I missed a dose of Pristiq back in July of 2021. I had never missed a dose before, and the next day I noticed the pain beginning. It continued to get worse, even though I reinstated the normal dose as soon as I realized. Also, my dosage didn't really change for years, it was basically always 100mg, including in July of 2021. So the only change was the missed dose. My guess is that the sudden withdrawal of the drug caused some kind of injury to my brain or CNS. I think it also left my body hypersensitive to Pristiq. What actually happened at the cellular or neurological level, I have no idea. This is only a guess on my part.
 

So, as to @Altostrata's comment on the pain being caused by excessive Pristiq, I would say it is certainly possible that I am now super-sensitive to the drug, and am taking too much of it. My hope is that as I reduce the amount, the pain will clear up. As for my drug-drug interactions, it does indicate that the gabapentin may be increasing the effect of the Pristiq. I do not know if this is having a practical effect on me. Again, I think my best bet is to reduce the Pristiq and see what happens. I know Neurontin is problematic, but it is helping with the pain and I don't seem to be that sensitive to changes in dose, so I think Pristiq is the main culprit here.

 

Thank you again for your questions and advice.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Administrator
12 minutes ago, dteeger said:

so I think Pristiq is the main culprit here.

 

The amount of Pristiq you're taking, followed by ever-increasing amounts of Neurontin as a chaser, is a giant flashing red warning sign.

 

Still looking for that link to your drug-drug interactions.

 

Also, it's not clear what's going on with the Klonopin. Do not change more than one drug at a time. What is your daily drug schedule, with dosages?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment

Hi @Altostrata Here is my drug interaction link: https://www.drugs.com/interactions-check.php?drug_list=2796-12488,703-357,1147-0,1956-0,896-1617,1684-0,1482-0

 

And here is my daily drug schedule:

 

 

Klonopin

Propranalol

Benadryl

Neurontin

Pristiq

Other

Morning

7am-9am

--

--

--

700mg

75mg (tapering down to 50)

Loperamide 2mg

Noon

11am-1pm

--

--

700mg

--

Loperamide 2mg

Evening

5pm-7pm

20mg

25mg

---

--

Loperamide 2mg

Bedtime

~10pm

1.25mg

60mg ER

50mg

800mg

50mg

Tamsulosin .4mg

Low-dose naltrexone 1.5 mg

 

I'm aware this is a lot of medication. I am working to reduce it. I have been reducing the Klonopin for the past six months, but I am now holding it steady while I reduce the Pristiq. Thanks.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • 2 weeks later...

Hi @Altostrata @ChessieCat and others. I'm trying to better understand one specific aspect of my struggles with Pristiq. Specifically, as I mentioned earlier, I missed a dose back in July of 2021, when I was at a steady 100mg. That missed dose seems to have set off a worsening neurological problem involving pain in my torso and digestive system. I do not think this is specifically a *withdrawal* issue anymore since I went right back on a steady dose of 100mg, and the pain continued to get worse in August, September, October, etc, and is still getting worse. Have you ever seen this kind of effect before? Do you have any suggestions?

 

I am afraid that the problem is now "permanent" and will continue even if I am able to taper off all Pristiq and stop the drug entirely. I understand I am currently on too much Pristiq and other meds, but again I think the neurological injury I suffered in July may now have a life of its own. I am looking for any experience with this kind of thing. 


Thanks all.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Administrator
40 minutes ago, dteeger said:

That missed dose seems to have set off a worsening neurological problem involving pain in my torso and digestive system.

 

It was withdrawal at that time. That set off an ongoing neurological dysfunction which probably was aggravated by any drug changes you made after you restored Pristiq. Your ridiculous drug cocktail was precariously balanced, skipping that one enormous dose of Pristiq caused your body's ability to cope with it to become unstable.

 

Most likely, after you go off all these drugs, you will be coping with the after-effects, withdrawal or not, for a good long while. But you are endangering your life by continuing this remarkable drug burden. You might end up with liver or kidney damage. 

 

However, you can continue it if you wish. It's up to you.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to comment
  • Moderator Emeritus

Here are the results from a different drug interaction checker https://reference.medscape.com/drug-interactionchecker:

 

Monitor Closely

diphenhydramine + propranolol

diphenhydramine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

gabapentin + clonazepam

gabapentin, clonazepam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

gabapentin + diphenhydramine

gabapentin, diphenhydramine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

gabapentin + desvenlafaxine

gabapentin, desvenlafaxine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

diphenhydramine + clonazepam

diphenhydramine and clonazepam both increase sedation. Use Caution/Monitor.

desvenlafaxine + propranolol

desvenlafaxine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Link to comment

Thank you @ChessieCat that's helpful

 

Thank you @Altostrata, I appreciate the advice. You have mentioned many times that I am on too many meds, and I agree. As I have mentioned, I am working on decreasing them as fast as possible. What I am looking for is advice on how to deal with this neurological issue, as it is the single biggest problem I face right now. I suppose my best chance is to taper the Pristiq and hope that helps reduce the issue. 

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Moderator Emeritus

Please include all the other drugs (current and previous) in your drug signature.  We need to be able to see your drug history at a glance and not have to read back through your posts to get the information.  Thank you.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Link to comment

@ChessieCat  Good point, done. Thank you.

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
Link to comment
  • Moderator Emeritus

Please bold the drug names that you are currently taking.

* NO LONGER ACTIVE on SA *

MISSION ACCOMPLISHED:  (6 year taper)      0mg Pristiq  on 13th November 2021

ADs since ~1992:  25+ years - 1 unknown, Prozac (muscle weakness), Zoloft; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after); Pristiq:  50mg 2012, 100mg beg 2013 (Serotonin Toxicity)  Tapering from Oct 2015 - 13 Nov 2021   LAST DOSE 0.0025mg

Post 0 updates start here    My tapering program     My Intro (goes to tapering graph)

 VIDEO:   Antidepressant Withdrawal Syndrome and its Management

Link to comment
  • 4 weeks later...

Relieved to report I am finally back down to 100mg Pristiq from 125mg, by reducing 5mg every 7-10 days. Now I need to figure out how to plan the taper down to 0. I want to go as quickly as possible because I think the drug is making me sick, but obviously don't want to go too fast and injure myself that way.

 

Does anyone have advice on how to titrate one's taper rate for maximum efficiency?

  • Pristiq 94mg  (down from 125mg. having adverse reaction, tapering down. 20mg am, 25mg noon, 24mg eve, 25mg bed)
  • Klonopin 1.25mg since 2010 (tapering. Down from 2.5mg. All taken at bedtime)
  • Neurontin 2200mg since 2021 (controlling pain, but need to taper. 500 am, 500 noon, 500 eve, 700 bed)
  • Propranalol 20mg (bed)
  • Tamusolin .4mg (for kidney stone, temporary)
  • Risperidone: low dose taken for 4 weeks in 2019 for anxiety. Discontinued due to extreme reaction of agitation and sleeplessness
  • Seroquel: low dose taken in 2021 for anxiety. Discontinued for same reason as risperidone. Persistent agitation led to prescription of benadryl and propranalol.
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