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dteeger: finding a good taper psychiatrist/doctor


dteeger

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  • Moderator Emeritus

Another mod wrote this to another member:

 

7 hours ago, getofflex said:

the trick is to try and balance the adverse reaction symptoms with the withdrawal symptoms. So we don’t want to taper off so fast that the withdrawal becomes worse than he symptoms of the adverse reaction.

 

I can understand you wanting to reduce your drug as quickly as possible.  I needed to do the same thing.

 

Please note that what I have written below are only suggestions, not advice.  It will be up to you to listen to your body/symptoms and taper according to those.  You might find keeping a symptom diary will help.  This topic has links to symptom lists (monthly printable and computer versions) and there is a key to rating your symptoms.

 

Please check out this post which gives a fairly simple explanation of SERT occupancy.  Once you have read that post you might find it helpful to read from the start of that topic.

 

Q:  Do you think you are currently experiencing any withdrawal symptoms that can be attributed to the Pristiq dose reduction from 125mg to 100mg?

 

If yes, then it would possibly be better to hold for a while until they subside. But this is something that you will have to decide on.

 

If no, then you might find that you can continue reducing by the same method until your dose gets a bit lower.  Once you get to 75mg my suggestion would be to hold there for a while before switching to the standard ~10%/~4 week taper.  I suggest this dose because I think you can get 25mg tablets where you are so it would be a convenient dose to hold on for a while (I'm thinking a 3 month hold, but again this is your decision) assuming that your adverse symptoms have reduced to a bearable level by this time.  You might find that you will have to reduce less and/or hold for longer the lower the dose gets. 

 

Dr Joseph Glenmullen's Withdrawal Symptoms

 

Edited by ChessieCat

* NO LONGER ACTIVE on SA *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 @Altostrata I am having a huge amount of trouble with my latest taper, from 105mg to 100mg. All the others were fairly smooth, but for this one I've been in agony since I dropped 3 days ago. How do I know if I should stick it out, or go back up to 105 and hold there for a while longer? 

 

Thanks alot

  • 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

It takes about 4 days for a dose to get to full level/steady state in the blood and a bit longer for it to register in the brain.  If your symptoms are bearable then you might try holding on this dose for a bit longer.  If the symptoms are unbearable then you could try increasing by a small amount.  You could try taking 1mg-2mg more so 101mg or 102mg.  It is better to increase by a small amount because your brain is already trying to adapt to the lower dose.

 

Please be careful that you don't panic and end up taking too high a dose.  The brain likes consistency and the more you bounce your dose up and down the more you risk destabilising (causing trauma to) your nervous system and the bigger the dose change the more work the brain has to do trying to balance things out / regain homeostasis.

 

When I had to decide whether to updose I asked myself:  If this continues for a while am I going to be able to live with the current symptoms?  If no, then I updosed a little bit, but not back to the previous dose.  If the answer was yes, then I held until I felt stabilised.

 

Please also consider whether these are from withdrawal symptoms or are adverse reaction/drug interaction.

 

Q:  Did anything else change in the previous week, eg alcohol, caffeine beverages, other supplements/medication, MSG, aspartame/phenylalanine, major stressor?

 

If it is from withdrawal symptoms then I think your fast tapering has caught up and it would be a good idea to hold at your chosen dose for at least 2 months before even considering reducing again.

 

But the choice is yours.  All I am doing is providing information and suggestions.  Only you can assess your ability to cope with the symptoms using non drug methods whilst your brain does what it needs to do.

* 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

Hello, @dteeger, please add approximate dates of starting for each drug in your signature. What are you taking now, at what times o'clock and dosages? 

 

On 5/15/2022 at 12:22 AM, dteeger said:

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. ....

 

In what ways do you think Pristiq is making you sick? Because of its form, it can be difficult to slowly taper it.

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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Thanks @ChessieCat that was helpful. I talked to my doctor and we agreed I would updose by 2.5mg for a few days.  It seems to be helping. 

  • 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

That's good that you have a doctor who seems willing to go carefully.  Please remember what I wrote about the time it takes.  You will need to be patient.  The aim is to improve the symptoms to a bearable level, not to get back to how you felt at your best or how you want to feel.  Some members have tried to find "the right dose" and have ended up making things worse.

 

Please remember to answer Alto's question.

* 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

How are you removing 5mg from a 100mg Pristiq tablet??? Or any Pristiq tablet? Did you read Tips for tapering off desvenlafaxine (Pristiq)

 

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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  • 1 month later...

Help! Was able to drop down to 95mg of Pristiq, but the last drop, from 100 to 95, was extremely difficult and I feel has left me with additional persistent pain. So now I am trying to drop by 1mg (I have 1mg compounded capsules). I have been at 94mg for 4 days and I feel like I am experiencing withdrawal symptoms. Is this possible? How can my body possibly notice a drop of 1mg? I've read that the amount of Pristiq your body absorbs can vary by 10% day to day based on your diet! So how can I be this sensitive? Have other people experiencing this kind of sensitivity?

 

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.
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  • Moderator Emeritus

Q:  Have you made any other changes; added/stopped any supplements?

 

Q:  Have you been sick or had a vaccination/booster?

* 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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  • Moderator Emeritus
21 minutes ago, dteeger said:

Was able to drop down to 95mg of Pristiq, but the last drop, from 100 to 95, was extremely difficult and I feel has left me with additional persistent pain.

 

SA recommends not making another reduction if you are experiencing withdrawal symptoms.  Do you think the pain was a withdrawal symptom?

 

Q:  How long you were taking 95mg for after reducing from 100mg?

 

Q:  Did the pain start to reduce as you held on 95mg?

* 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

No other changes

No sickness, vaccines or boosters

Was at 95 for 1 month. I held for a while since the drop to 95 was difficult.

Pain seemed mostly stable at 95, though hard to tell since I normally have day-day fluctuations.

Overall, I can't be 100% sure but the drop to 94mg did seem to activate some significant withdrawal symptoms. I am really shocked.

 

@Altostrata Would love to get your input as well.

 

Thank you both.

  • 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

Because you had a difficult time after reducing to 95mg then you probably should have held for longer.  Even it is wasn't the reduction itself that caused the issues, the additional stress on your system from the pain can lengthen the recovery time.  This is because your brain and nervous system is busy dealing with the stress (which it perceives as a threat to your safety and reacts accordingly, putting "unnecessary" processes on hold whilst dealing with the perceived threat).

 

If you are able to tolerate the current symptoms then I think holding for at least 2 months, and possibly three might be a good idea. 

 

It takes about 4 days for a dose to get to a steady level in the blood and a bit longer for it to register in the brain.  It is not unusual to experience a worsening of symptoms during the first week after a reduction;  the fact that you noticed a definite worsening may indicate that you did not hold for long enough on 95mg.  As time goes on then the symptoms generally ease.

 

If the symptoms are unbearable then you might consider returning to 95mg if you aren't able to measure 94.5mg which I think would be a better option if you were to updose.  To get 0.5mg you could put the contents of a 1mg capsule in water and take half of it and the half the next day.  I was using the contents of my capsules to get small doses.

 

Q:  Are you taking your dose twice a day?

 

Once a Pristiq tablet is crushed you lose the 24 hour extended release and the half life is about 11 hours, so to stop interdose withdrawal you divide your dose into two and take 12 hours apart.  You can tell if you have interdose withdrawal if your systems worsen and increase after about the 12 hours mark and you notice them improving a few hours after taking your next dose.  This will be a repeated pattern.

* 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 I am actually taking the Pristiq 4 times a day to avoid interdose issues. My current regime is 20mg am, 25mg noon, 24mg eve, 25mg bed. I use commercial tablets when I take 25mg, and compounded tablets when I take less.


The pain became unbearable, and in my experience when that happens I risk it becoming permanent. So today I aborted the taper and went back up to 95mg.

 

Sounds like your advice would be to wait a few months at 95mg and see if things settle down?

Have you heard of others who reacted like this to a 1% reduction? I 'm trying to figure out if this reaction is real, or possibly psychosomatic and/or just a random fluctuation in my pain levels.

 

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.
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  • Moderator Emeritus
7 minutes ago, dteeger said:

I am actually taking the Pristiq 4 times a day to avoid interdose issues.

 

That's good.  Thank you for clarifying that.  I didn't think to dose 2x a day until I got to 10mg and I think it would have made a different to my mornings if I had split dosed.  Hindsight is 20/20.

 

8 minutes ago, dteeger said:

So today I aborted the taper and went back up to 95mg.

 

I don't blame you.  I probably would have done that too.

 

8 minutes ago, dteeger said:

Sounds like your advice would be to wait a few months at 95mg and see if things settle down?

 

I think it would be a good idea.

 

9 minutes ago, dteeger said:

I 'm trying to figure out if this reaction is real, or possibly psychosomatic and/or just a random fluctuation in my pain levels.

 

Holding for several months might give you a better overview of what might have been the cause or at least if the reduction wasn't the cause.  If you are taking other drugs/supplements you might also research side effects and possible drug interactions to see if it something else that is causing/contributing.

 

You might also keep a diary of symptoms and FOOD because some people find that certain foods increase their issues.  Even people who aren't taking/tapering psychiatric drug/s.  I've recently started low carb and one of the YT channel guys notices a difference in how sore his knees are when he consumes things containing seed oils.  Other YT commenters mention that they notice general aches and pains improve when they limit their carbs.

 

If you drink alcohol, caffeinated beverages, diet beverages containing aspartame/phenylalanine*, or foods containing MSG* (monosodium glutamate) or other flavour enhancers then you might consider reducing or cutting them out.  You could also look into low histamine.  Please note that these are just general suggestions that I am making from my own life experience and what I have heard from others both on SA and elsewhere.

 

* These are both neurotoxins.

 

 

* 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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  • Moderator Emeritus

And if you don't know what is causing the pain you might consider getting it investigated just in case it is new and can be treated/needs treatment.  But of course be cautious if any drugs are suggested.

* 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

Where is the pain?

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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  • 4 weeks later...

Hi @Altostrata Sorry for the delayed response, been trying to stabilize and work my job (part time, but still hard to keep up). The pain is all over my body. Torso and limbs. Not head, thankfully. It's burning, aching, stabbing. If I try to reduce the Pristiq it becomes much worse in a very distinct way. As I mentioned above, now even reducing by 1mg caused terrible withdrawal symptoms.

 

Do you have any advice? Should I try to reduce by .5mg? I can get .5mg compounded pills. 

 

My doctor is also suggesting adding Prozac or Cymbalta, but I'm terrified of adding another SSRI or SSNRI. I'm afraid I'll get stuck on them too.


Thanks to you and @ChessieCat. I'm totally, completely stuck at this point and any advice is appreciated. I've got to get off this poison. If you know of any other forum members who got like this and can connect me to them that would be great as well.

 

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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  • Administrator

You're taking 5 drugs, and your doctor wants to add Prozac?

 

Is the pain worse at any particular times of day? When did the burning etc. pain start? How's your sleep?

 

How are you taking doses of 20mg and 24mg Pristiq? Are the 25mg doses whole Pristiq tablets? When did you change to this schedule:  20mg am, 25mg noon, 24mg eve, 25mg bed

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 Yes on the prozac, he's not thrilled about it but wants to help me taper the Pristiq

 

Pain tends to be worse in the morning, get a bit better, then worse again at night. The burning pain started a year ago, in my chest, when I missed a dose of Pristiq, and has continued to spread to my entire body and worsen since then. My sleep is about the same as it was, which is to say bad, but that's another story. The neurological pain makes it somewhat worse but I am still able to sleep, thankfully.

 

I have compounded 20mg Pristiq tablets. My current schedule is 20, 25, 25, 25 (ie 95mg). I was not able to stay at 94. I've been on that schedule for two months now. Before that, I was on 100mg. I was able to taper down to 95mg, but then got stuck and have been stuck ever since.

 

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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  • Administrator

Your compounded 20mg Pristiq tablet is, in effect, immediate-release. This may be causing problems.

 

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.

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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  • ChessieCat changed the title to dteeger: finding a good taper psychiatrist/doctor
  • 1 month later...

Hi @Altostrata Thank you for your response, sorry for my delay. The 20mg Pristiq tablet was actually compounded to be sustained release.

 

However, I recently re-developed chronic, severe stomach problems that are causing me to pass all my extended-release Pristiq tablets. Since I can't afford to constantly underdose, I have had no choice to but to switch over to all instant-release capsules from a compounding pharmacy. So I am now taking: 20mg IR @ 7am, 25mg IR  @ 2pm, 25mg IR @ 7pm, 25mg IR  @11pm. It seems to be working ok, but I can't really tell for sure.

 

I have no choice. I can't get off the Pristiq, and I can't stop passing ER tablets. My question for you is, what are the kinds of problems that taking Pristiq as IR can cause? I'm not sure what my options are, but I thought I'd ask.

 

I did re-read the first 8 pages of this post, so I know that cutting/crushing works for some. But I was hoping to get your perspective.


Thank you again for your help.

 

David

 

@ChessieCat FYI thank you.

 

P.S. I did start to keep a daily log as you suggested, but I found there were absolutely no patterns as to how I felt, especially regarding when I take meds. Some days I'd feel sick in the morning, and fine in the evening, and vice-versa. There was no discernible relationship between taking my meds (which I do 4 times a day) and how I felt. So I stopped. Didn't seem to be providing any useful information.
 

  • 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
3 hours ago, dteeger said:

The 20mg Pristiq tablet was actually compounded to be sustained release.

 

The compounded Pristiq tablets which contain a sustained release formula generally do not cover a 24 hour period, so you may experience interdose withdrawal; you get symptoms leading up to the time when your next dose is due and then they starting easing as the dose starts to take effect.

* 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

Please post daily logs as requested.

 

How long have you been on your new dosing regimen? As @ChessieCat noted, the compounded sustained-release capsules do not adequate substitute for extended-release tablets.

 

4 hours ago, dteeger said:

My question for you is, what are the kinds of problems that taking Pristiq as IR can cause?

 

The same as taking immediate-release venlafaxine, Pristiq's very close cousin. Substituting venlafaxine, extended-release or immediate-release, is one way to go off Pristiq, see Tips for tapering off venlafaxine (Effexor)

 

However, in my amateur opinion, your problems may be from excessive Pristiq and low-grade serotonin toxicity for a long time. See 

 

 

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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  • Mentor
11 hours ago, dteeger said:

severe stomach problems that are causing me to pass all my extended-release Pristiq tablets. Since I can't afford to constantly underdose, I have had no choice to but to switch over to all instant-release capsules


Are you aware that it is normal to pass what looks like a whole tablet of Pristiq in your stool? This is very common and is due to how the tablet is designed. According to Pfizer, the medication is still released even though the shell remains. 
 

The following is copied from the Pristiq Medication Guide that should be distributed with your medication:


When you take PRISTIQ, you may see something in your stool that looks like a tablet. This is the empty shell from the tablet after the medicine has been absorbed by your body.”


https://www.pfizermedicalinformation.com/en-us/pristiq/medguide

 

1988-1996  Various AD’s, all classifications.  1996-2019  Effexor XR 37.5mg to 150mg. Jan 2017 onward, 37.5 mg.

2019  Apr 11 - July 24: Trials of Latuda then Rexulti. CT'd off per dr.  Jul 24: CT Effexor (per dr)  Sep 9-19: Viibryd, CT (per dr).  Sep 23-27: Trintellix. CT (per dr).  Sep 28 - Oct 24:  Prozac 10mg.  Oct 24:  Stop Prozac, began Pristiq 25mg->50->25mg.

2020  Feb 1: CT Pristiq. Feb 1: Reinstated Effexor XR (10 large beads) gradually increasing to 22 beads (15L+7M) or 9.072mgai on Mar, 2020.

2021  Started Jan w 21 beads (13L+8M) or 8.47mgai ended Dec: 17 beads (7L+9M+1S) or 6.19mgai. Severe COVID + TIA.

2022  Ended yr w 14 beads (3L+5M+5S+1XS) or 4.5mgai. Major jaw injury during year + family tragedy.

2023  Jan: 13 beads (2L+5M+5S+1XS) or 4.2mgai; Feb: 12 beads (2L+4M+5S+1XS) or 3.9mgai; Mar: 11 beads (2L+4M+4S+1XS) or 3.6mgai, Apr: 10 beads (2L+3M+4S+1XS) or 3.3mgai; Jun: 9 beads (2L+3M+3S+1XS) or 3mgai,

 

Current: July, 2023: Effexor XR -  9 beads (2L+3M+3S+1XS) or 2.7 mgai

Other current meds: Ambien 10mg 3.935mg , clonazepam .125mg .107mg, omeprazoleSynthroid, Premarin.  Supplements: D3, C, probiotic, K2-MK7, Mg Glycinate

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  • 1 month later...

My doctor started me on Prozac as bridge to taper off Pristiq, but I'm not tolerating the Prozac well. So I'm trying to find the "next-best" SSRI to use to taper off Pristiq. Does anyone have any suggestions? 


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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Prozac.  Next best ssri for tapering from pristiq?

 

I, too, took the "prozac bridge" and didn't like it either; in my not so humble OPINION (just experience) it's just a bridge TO prozac and once the prozac kicks in you still need to taper the venlafaxine and then you're stuck on Prozac.  ("easier wean"? well maybe.  I finally finished the switch Back to venlafaxine after my prozac experience.)  

 

To wean from from 50mg Pristiq (desVenlafaxine XR), i would not mess with prozac at all, just taper the pristiq.  how?

Switch to  75mg Effexor XR (Venlafaxine).  same drug about 1/2 as potent, just switch.  stay on that for a month before considering any reductions, and carefully follow the SurvivingADRules re reductions: max 10%/month.   

if you can get TEVA-manufactured caps of effexorXR, do so, as you'll find you can conveniently count beads at ~1mg each. 

if you can't find TEVA, LIQUID is probably the best way to make smaller doses.  

JUST MY TWO CENTS, I"M NOT YOUR DOCTOR just some guy on the interwebs.  Talk to your doctor, of course!!, and get the blessing of the experienced advisors here at SurvivingAntidepressants.org

 good luck!  

20090810 Dx GeneralAnxietyDisorder & PanicDisorder.  Rx Pristiq (desvenlafaxine) 50mg.  stable, side effects minor but blurry vision, impotence, others. http://survivingantidepressants.org/index.php?/topic/5418-ktp-weaning-from-4yrs-50mg-pristiq/ for more details.  

20140210 switch Pristiq50mg (can't cut them!) to Effexor (venlafaxine, V) same drug but easier dose reduction (and mfr TEVA's beads are handily ~= 1mg ea).  20140218 125mgV  0309 112mg 0401:100mg, 410:75, 0506:70, 0512:65, 0525:56, 0614:37.5, 0620:30, 0624:27, 0630:26, 0706:24, 0724:22, 0801:20, 0804:19, 0808:18, 0813:17, 0818:16, 0819:15, 0821:13, 0903:12, 0911:11, 0918:10, 0921:9, 0927:8, 1001:6, 1021:5, missed a day?, darn, it was going so well, or so I thought.  SEVERE ANXIETY, INSOMNIA. WAY TOO QUICK REDUCTIONS! hindsight: 0813:5%/5days, 0818:6%/5days, 0819:6%/1day, 0821:13%/2days, 0903: 7%/14days, 0911:8%/8days, 0918:9%/7days; 0921:10%/3days, 0927:11%/6days, 1001:25%/3days (still okay!) 1021:16%20days.  guideline is 10%/30days =  i am a self-diagnosed idiot

20141103 back to 6mgV, xanax next several days. 1111 insomnia bad, 10mgAmbien slept well. 1112 8mgV no Ambien; miserable. 1113 Ambien+xanax, tough night. 1114 Very Tired. 0.125Xanax, 25mgV at 10, better 10min later. 20141115 37.5mg V +Ambien. miserable month, still insomnia & anxiety. 1214 upped to 75mg V, ate .125Xanax. 1215 37.5mg mornings; force sleep for one week and come back". 20150115 lots of appts lots of chat but we never get to MY agenda = meds discussion.  Upping to 47.5mg mornings (no more xanax-, lunesta-forced sleep) but still anxious.  PAYING BIGTIME FOR TOO-FAST WEANING in OCTOBER 2014!  20150220 50mg V. 20150330 still anxy each am let's try reducing: 45mg V 1/day mornings. 20150511:42mg, 0611:40, 0626:39, 0710:38, 0717:37, 0731:33, 0813:32, 0915:29, 0927:28, 1004:27, 1015:26, 1101:25, 1116:22mg/day.  Still anxiety every morning, this sucks.  20151124 found a shrink who seems to get weaning: 20151125 add 10mg/day Prozac aka fluoxetine F, continue taper V to zero, then taper the F, "easier".  20151203:10mg Prozac=P 19mg V, 1213:10mgP17mgV, daily anx quieter but lurking. 1227:10mgP15mgV, 20160108:10mgP14mgV, 0124:10P13V, 0131:P10,V12. 0215 P10,V11.  0223:P10V10.  0314:P10V9. enjoying relatively quiet brain.  0407 P10V8, 0427P10V7, 0517P10V6, 0611P10V5, 0706P10V4, 0818P10V3, 0921P10V2,  1021P10V1, 20161128Prozac10mgVenlafaxine ZERO, 20170115 still anxious upped Prozac to 20mg/day, better anxiety control... 

20190301 finally stable enough to consider weaning again, started skipping one day / week.

20190501 started skipping every 3rd day so 13.3mg/day average.  several days long 1/2life must be why the docs think of prozac as 'self-tapering' i think it just means longer time between upsetting the cart and seeing apples all over the road.  skipping is bad practice, even with longlife prozac: let's do liquid: 20190902 first day of 13mg via 5ml liquid made from 13 20mg caps in 100ml water.  20190921 12mg same way(7.7%/20days).  20191010 11mg (8.3%/20days) 20191031 10mg (9.1%/20days) 20191124 9mg (10.0%/24 days) 20191213 8.5mg (5.6%/20 days) 20191231 8mg (5.9%/20days) 20200120 hit a wall?  going another 20 days at 8mg, just started Lisinopril for hypertension (caused by prozac withdrawal creating less-than-panic-grade anxiety??) and doubled atorvastatin to 40mg.  Minimizing changes in general and had a semi-panic 4am 1/20... BP still wild. 20200208 back to 9mg daily anxiety starting about 1/18.  

20200212 increase to 10mg prozac cap daily.  anxiety still there but clears within hour of drugs.  20200222 still anxy 2 hrs after 10mg, added another 1mg and mucho better.  20200223 11mg early.  anxious enough to be glad i can actually sit.  will wait another 5 days before adding another milligram. 20200229 12mg prozac still anxious.  20200317 13mgProzac still anxious.  20200610 15mgProzac.  bp under control with Losartan50mg (lisinopril cough dictates change)  

20201028 10am met w Dr S.  to switch back to Venlafaxine XR, "take 10mg prozac + 37mg VenlafaxineXR for a monththen quit prozac." i think i'll taper thanx... 
20201116 9am start 10mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.  20201230 5mgProzac,37Venlafaxine,40Statin,25Losartan,81Aspirin.
20210124 4mgP,37V,40S,25L,81A.  20210213 3.5mgP,37V,40S,25L,81A;  20210306 3mgP,37V,40S,25L,81A  20210328 2.5mgP,37V,40S,25L,81A; 20210501 2.0mgP,37V,40S,25L,81A;20210519 1.5mgP,37V,40S,25L,81A; 20210607 1.5mgP,37V,40S,50L,81A. 
20210614 1.0mgP,37V,40S, 50L,81A. 20210702 0.5mgP,37V,40S,50L,81A; 20210728; 0.0mgProzac,37.5Venlafaxine,40Atorvastatin50Losartan,81Aspirin; 20210917 0915am anxiety started about a week after dropping the last 0.5mg of prozac.  just took 0.10mg xanax.  20210929 1:28 PM I'm anxious after so carefully weaning off prozac - the last 0.5mg may need to come back??  instead, trying an extra cap of 37.5mg venlafaxine, let's see if there's sudden relief?  it seems possible.  fingers x'd.  not sure but 5 minutes later i think i feel better gawd i hope.  20210930 7am anxious out of bed, took drugs early and oops chewed them.  no more drugs 2day.  11:41 AM 10/1/2021 very jagged today, avoiding the shower.   took <1/6 of a .5mg xanax and still anxy at noon.  6:59 PM 10/4/2021 2nd or 3rd day of 75mg Venlafaxine  met w/ shrink 2day he says i'm doing  it right so  20210728 75.0mgVenlafaxine,40Atorvastatin,50Losartan,81Aspirin;10mgCarbidopa-Levodopa; 12/18/2021  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 3x 25/100mgSinemet aka Carbidopa/Levodopa.    20220308 new neurologist, raising CL:  112.5mgVenlafaxine, 40Atorvastatin, 50Losartan, 81Aspirin; 0.4mgFlowmax; 4x 25/100mgSinemet aka Carbidopa/Levodopa.  possibly need to reduce losartan to avoid fainting.

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  • Administrator
3 hours ago, dteeger said:

My doctor started me on Prozac as bridge to taper off Pristiq, but I'm not tolerating the Prozac well. So I'm trying to find the "next-best" SSRI to use to taper off Pristiq. Does anyone have any suggestions? 


Thank you.

 

Hello, @dteeger Have you discussed your problems with your prescriber? This was not our recommendation.

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 I was completely unable to taper the Pristiq in any amount. This thread mentioned bridging with Prozac a number of times, as did several of my doctors. So I attempted it. I have discussed this with my provider but I wanted to get a "second opinion" from the forum. 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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  • Administrator
On 11/12/2022 at 7:37 PM, dteeger said:

My doctor started me on Prozac as bridge to taper off Pristiq, but I'm not tolerating the Prozac well. So I'm trying to find the "next-best" SSRI to use to taper off Pristiq.

....

 

You're already taking Prozac?

 

On 4/2/2022 at 12:16 AM, ChessieCat said:

 

The above topic carefully explains that one may substitute brand-name Effexor XR for Pristiq and taper by counting the beads in the Effexor capsule.

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 Yes, however, I am not capable of taking any ER medication. I have a digestive condition that causes me to pass the tablets too quickly. (I am currently taking compounded IR Pristiq).

 

Thus I had to substitute an IR medication. So I'm looking for the "best" other option besides Prozac (or Effexor) to use as a bridge for Pristiq. I know it's a bit complicated, unfortunately I'm stuck in a not-great situation.


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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  • Administrator
On 11/22/2022 at 8:39 PM, dteeger said:

I have a digestive condition that causes me to pass the tablets too quickly. (I am currently taking compounded IR Pristiq).

 

Is this a digestive condition different from that described here:

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110830/

Quote

 

When the shell housing the active drug does not disintegrate or does not get digested, it is passed out in the stool intact as a ‘ghost pill’. This can be a source of anxiety provoking experience and paranoia to patients, carers and professionals alike if the phenomenon is not known and the issue not handled sensitively as the following two cases illustrate.

....

Wyeth also produced extended-release tablets of desvenlafaxine, an active metabolite of venlafaxine under the brand name Pristiq available in the USA and Canada. The patient information leaflet states the following under the heading ‘How should I take Pristiq®?’: ‘When you take Pristiq®, you may see something in your stool that looks like a tablet. This is the empty shell from the tablet after the medicine has been absorbed by your body’ [Pfizer, 2011c]. 

 

 

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 yes, it is different. I have extremely high motility of the gut. I have confirmed that I am passing almost-whole ER pills, with the medicine still in them. Not just shells. My doctor agreed, and prescribed the instant-release compounded pills. 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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  • 2 weeks later...
  • Administrator
On 11/22/2022 at 11:39 PM, dteeger said:

So I'm looking for the "best" other option besides Prozac (or Effexor) to use as a bridge for Pristiq.

 

The best option would be immediate-release venlafaxine, taken at least twice a day.

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 thank you, I will discuss with my doctor. 

  • 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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