Neata Hi :)

[Neata]

Hi

 

I'm Neata and I'm a 34 years old. I was diagnosed with Major Depression, BPD and Anxiety after a suicide attempt in 2011. I was placed on Prisiq 50mg initially (now taking 100mg) and now's the time to come off it.

 

I've been finding recently that it's been losing it's effectiveness as the day wears on and I'm getting the "spaced out" feeling I get if I miss a dose. I'm to the point where I'm asking myself if I took the previous day's dose. I'm also trying to concieve and I'm not happy with the lack of information surrounding this drug and pregnancy (I'm a nurse and I've been looking through EVERYTHING).

 

I have a lovely and very supportive parnter who I have been with since 2008 and I also have a 7 year old son. I'm a crazy cat lady and I love to read. I also like Pina Colada's and getting caught in the rain...

 

This is a huge step for me as it was something I fought against going on initially and apart from the "space outs", brain zaps, headaches, tachycardia, nausea, dizzyness and irritability that I feal wien I miss a dose, I love me for the first time in my life.

 

I look forward to sharing my journey with you

[Altostrata]

Welcome, Neata.

 

I see you've seen our topic about tapering Pristiq. Which tapering method do you think would be best for you?

[Neata]

I'm going to see my Dr and see what she suggests. I'm thinking using Effexor would be best since as a nurse I wouldn't do something to myself that I wouldn't do to a patient. Getting sick of the brain zaps and heart palps that keep happening at this time of day

[bubble]

Hello Neata and welcome from me too!

 

Thank you for putting the information in your signature.

 

I apologise in advance for failing to completely understand what you mean by "I wouldn't do something to myself that I wouldn't do to a patient."

 

Are you familiar with the concept of withdrawal? When you are talking about brain zaps, they are one of the most common withdrawal symptoms and might be happening because you are skipping doses (if I understood correctly what you wrote in your initial post). 

 

I wouldn't be surprised if your doctor didn't know about withdrawal. Most of them don't but ascribe exacerbation in their patient's condition after abruptly discontinuing medication as a return of the "illness" and usually conclude patients have to be on drugs for life. Since you are yourself a medical professional this might be difficult for you to accept. We all struggled badly with the idea that our doctors might not know it all but we suffered too many times too badly not to be convinced otherwise ;( So basically we had to educate ourselves with our body being the main teacher.  

 

I will attach for you the link to the topic which explains what withdrawal is and why we advise tapering by 10 % of your current dose with much longer holds than most doctors understand to avoid withdrawal.

 

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Now I read about Pristiq and why it is especially tricky to taper and crossing over to Effexor is one option. It will be interesting to hear what your doctor thinks.

 

 http://survivingantidepressants.org/index.php?/topic/876-tips-for-tapering-off-pristiq-desvenlafaxine/

 

(PS I'm 37 and because of unsuccessful attempts to come off the medication, I haven't even tried to have a child ;( I'm very scared to get pregnant while on these medication. After I joined the forum I finally understood what went wrong when I tried to come off medication following my doctor's advice. So although it will take a long time I firmly believe this is the way. Now I started thinking that i might start considering getting pregnant while still on meds but will take some time to come off them a bit more... I hope you don't mind me sharing my story with you and I look forward to learning from you).

 

best,

 

bubble 

[Neata]

Hi Bubble,

 

What I mean by saying I wouldn't do something to myself that I wouldn't do to a patient, is that as a nurse, there's no way I'd recommend a person cutting medications in half if they are a sustained/extended release tablet. Also, I would never skip a dose on purpose but would occassionally forget to take it.

 

As it is, my dr is getting me to start on Sertraline as I've just found out I'm 7 weeks pregnant (which was why I began having issue with pristiq). I'll be going through a day or so of hell, but hopefully it'll be worth it in the end and the withdrawals for the baby at the end will be less. He was surprised that I'd been put on Pristiq in the first place without trying anything else.

[Petunia]

Congratulations on finding out you are pregnant  Neata, that's great news.

 

What dose of sertraline does your doctor want you to take?

[Altostrata]

Why sertraline? Does your doctor think sertraline is safer for pregnancy than any other antidepressant? Or easier to come off?

 

I would think fluoxetine myself.

[Neata]

Congratulations on finding out you are pregnant  Neata, that's great news.

 

What dose of sertraline does your doctor want you to take?

Thank you - he's put me on 100mg. Today hasn't been too bad.

 

Why sertraline? Does your doctor think sertraline is safer for pregnancy than any other antidepressant? Or easier to come off?

 

I would think fluoxetine myself.

The reason he chose sertraline is that the withdrawals for the baby post birt would only be 1 to 2 days instead of a week for the fluoxetine. The studies suggest that one isn't better than the other in pregnancy.

[bubble]

I'm cheering for you and I very much look forward to your updates.

 

Unfortunately I haven't had this experience but I believe pregnancy gives you an additional strength and floods you with all sorts of positive hormones and everything. So I think this will counter the withdrawal. Just my belief. You will make it. Very happy for you

[Altostrata]

Neata, your doctor has good intentions but planning a cold turkey from Zoloft for a baby -- his thinking is going in the wrong direction.

 

Prozac taking longer rather than shorter for withdrawal is an advantage -- it gives the nervous system longer to adapt to a gradual reduction. Not that I'm advocating cold turkey for a baby from Prozac, either.

 

Why didn't he start you on 50mg? That might do fine. How many days have you been taking the Zoloft? How are you feeling now?

[Altostrata]

Neata, I'm very concerned about your taking an extra-high amount of Zoloft.

If I were you, I'd consider the following:
- Switch to 20mg Prozac, I would overlap for a few days with 50mg Zoloft. Because of its long half-life, Prozac is easier to taper and will cause less withdrawal problems for the baby if it is born while you're still taking Prozac.

(There is no guarantee of zero problems with any of these drugs.)

20mg Prozac is a normal dosage but often works as a substitute. A lower dosage may have less effect on your developing baby.

- Once you're stable on Prozac, taper fairly quickly to a lowest effective dose by using Prozac liquid.

- Reduce to 50mg Zoloft.

- Taper fairly quickly to a lowest effective dose by using Zoloft liquid.

Please be aware your doctor does not know anything about prescribing psychiatric drugs, the effects on newborns, or how to go off psychiatric drugs. This is not unusual.

[bubble]

Dear Neata,

 

I need to underline, double underline and stress what Alto says. I know that for you being a medical professional it might be additionally hard to accept that most doctors are in the dark when it comes to psychiatric drugs. Alto spent, I think, over 9 years researching everything there is concerning these drugs and combined that with her own experience. So when she says something, we know it is our best bet.

 

Also doctors who know the true nature of these drugs are here on the list (there are few of them...)

 

I'm glad you are here with us.

[Neata]

Actually, I'm happy to follow my dr on this. Here in Australia our GP's generally have a fair bit of training in this stuff and as a medical professional myself, I've got access to the advice of those who make this their lifes work.

 

I'm on 100mg as it is equal to what I was on of Pristiq. As to how I'm feeling - I feel fantastic. Apart from a slight headache which is more than likely due to being pregnant, no issues what-so-ever. I apreaciate your advice and I'll take it on board

[dalsaan]

Hi Neata

 

I respect your right to make your own decisions. Unfortunately it's not been my experience that Australian Drs are well informed

 

Best wishes

 

Dalsaan

[Altostrata]

Nowhere in the world are GPs well-informed about the use of psychiatric drugs, and even fewer know anything about withdrawal.
 
Yours has already made a major error in thinking a neonate would do better with Zoloft withdrawal.
 
Please be aware that if you are on 100mg Zoloft when the baby is born, he or she will be cold-turkeying from an extra-high amount of Zoloft, which has a half-life of 24 hours, compared to Prozac's half-life of 4-6 days.
 
Please also look at this paper about neurotransmitter occupancy

Meyer, 2004 Serotonin transporter occupancy of five selective serotonin reuptake inhibitors at different doses: an %5B11C%5DDASB positron emission tomography study.
 
Higher doses of antidepressants often do little to increase receptor occupancy. In other words, there's a lot of excess capacity in higher doses.
 
Also see http://pro.psychcentral.com/2013/pristiq-an-update/004149.html by Daniel Carlat:

The bottom line pretty much remains the same as the last time we looked at Pristiq. At the recommended dose of 50 mg per day, Pristiq is marginally more effective than placebo but there is no data comparing this low dose with any other antidepressant. Very high doses of Pristiq appear to be less effective than therapeutic doses of Effexor XR. Pristiq’s documented lack of a dose-response relationship is probably the drug’s greatest liability, because it is common practice among psychiatrists to increase the dose of antidepressants when a patient is not responding. Therefore, starting a patient on a medication that yields no benefit at higher doses (but substantially more side effects) seems inadvisable given the plentiful array of other antidepressants available, many of them either in generic form or approaching patent expiration.

 
And http://primarypsychiatry.com/serotonin-norepinephrine-reuptake-inhibitors-similarities-and-differences/

Shelton, 2009 Serotonin Norepinephrine Reuptake Inhibitors: Similarities and Differences

Clinical studies have demonstrated efficacy of desvenla- faxine at doses of 50–400 mg/day.66-68 No additional ben- efits were observed at doses >50 mg/day, but AEs and dis- continuations were more frequent at higher doses.66-68 Thus, the recommended dose of desvenlafaxine is 50 mg/day.4

This paper, published in Primary Psychiatry, was sponsored by Wyeth, manufacturer of Effexor and Pristiq.

I agree with dalsaan, this is your decision. Please be aware that there's more to this than most doctors know.

[bubble]

How about you discuss all this with your GP? Present her/him with Alto's arguments and hear what he/she has to say?

 

(I have personally been brought into very bad states by well meaning medical professionals too many times until I realized it was my body, my health, my mind and it was me at the end of the day suffering. So I had to take a stand, inform myself and become a SENIOR partner in my treatment, the one who makes an informed choice, or gives free and informed consent (or declines it).