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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Laurie1041 on May 28, 2011, at 21:31:46
Hi,
I have been on various SNRI's/SSRI's for 11 years and have tried on various occasions to taper off. Now I am in a position where I have no choice and have to get off AD's due to severe mood instability.
Obviously, my pdoc has never tapered anyone off of Pristiq yet because he dropped my dose from 100 mg. to 50 mg. (Pristiq only is available in 50 mg. and 100 mg. time-release tablets). Within 72 hours I was in terrible withdrawal. I tried splitting a tablet (my pdoc said I could do that, even though I was skeptical) and I got terribly ill within 45 minutes of taking the split pill. I hate being the guinea pig, but that is another story.
So, my pdoc said to pick any SSRI, with the exception of Paxil, that is available in a liquid preparation for easy titration. I was advised to take Lexapro 10 mg. with the Pristiq to decrease my withdrawal and to get ready to dump the Pristiq. By the way, yes I acknowledge the inherent risks of Serotonin Syndrome, but have been on dual AD's when crossing over to another AD at least 5 times in the past without a problem. This is just my personal experience, always check with your pdoc.
I am now up to Lexapro 20 mg. + Pristiq 50 mg. and will be dropping the Pristiq tomorrow and I will undoubtedly go into withdrawal and end up increasing the Lexapro to 30 mg. Once I am stable (no withdrawal) the plan is to decrease the Lexapro by 5-10% every 3 weeks (no less than 3 weeks) as tolerated until I can taper off completely.
I wish I never ever started on AD's 11 years ago. They never did anything to help with my depression (nada) and withdrawal can become intolerable and a long drawn out process. I shall be acquiring a new skill - patience. If anyone has any better ideas to get me out of this predicament, please feel free to let me know. Thanks, Laurie
Posted by Phillipa on May 28, 2011, at 21:56:49
In reply to Pristiq - One Heck of a Taper Strategy, posted by Laurie1041 on May 28, 2011, at 21:31:46
Laurie only cause it's used by quite a few on this board what about prozac with the long half life? Or could you switch to regular effexor and taper that same med basically but not time release? I feel the same as you SSRI's SNRI's nada in 14 years taken low doses of but benzos worked fine until now. What will you do when off all ad's? Phillipa
Posted by Lou Pilder on May 28, 2011, at 22:25:06
In reply to Pristiq - One Heck of a Taper Strategy, posted by Laurie1041 on May 28, 2011, at 21:31:46
> Hi,
>
> I have been on various SNRI's/SSRI's for 11 years and have tried on various occasions to taper off. Now I am in a position where I have no choice and have to get off AD's due to severe mood instability.
>
> Obviously, my pdoc has never tapered anyone off of Pristiq yet because he dropped my dose from 100 mg. to 50 mg. (Pristiq only is available in 50 mg. and 100 mg. time-release tablets). Within 72 hours I was in terrible withdrawal. I tried splitting a tablet (my pdoc said I could do that, even though I was skeptical) and I got terribly ill within 45 minutes of taking the split pill. I hate being the guinea pig, but that is another story.
>
> So, my pdoc said to pick any SSRI, with the exception of Paxil, that is available in a liquid preparation for easy titration. I was advised to take Lexapro 10 mg. with the Pristiq to decrease my withdrawal and to get ready to dump the Pristiq. By the way, yes I acknowledge the inherent risks of Serotonin Syndrome, but have been on dual AD's when crossing over to another AD at least 5 times in the past without a problem. This is just my personal experience, always check with your pdoc.
>
> I am now up to Lexapro 20 mg. + Pristiq 50 mg. and will be dropping the Pristiq tomorrow and I will undoubtedly go into withdrawal and end up increasing the Lexapro to 30 mg. Once I am stable (no withdrawal) the plan is to decrease the Lexapro by 5-10% every 3 weeks (no less than 3 weeks) as tolerated until I can taper off completely.
>
> I wish I never ever started on AD's 11 years ago. They never did anything to help with my depression (nada) and withdrawal can become intolerable and a long drawn out process. I shall be acquiring a new skill - patience. If anyone has any better ideas to get me out of this predicament, please feel free to let me know. Thanks, LaurieLauri1041,
You wrote,[...have to get off ADS...I wish I never...I will go into withdrawal..if anyone has any better ideas to get me out of this predicament..let me know...].
I understand two ways that people withdrawal from mind-altering drugs. One is by human achievment, the other by divine accomplishment.
The withdrawal can be horrific, I know. But you see, it has been revealed to me that healing can come to one in this horrific state. Sadly, it is in the state of withdrawal that irrational thoughts can occupy the mind. Thoughts of suicide or murder. It has been revealed to me that one in this state is in The Heart Of The Earth. This is a state of great tribulation, a state of great fear.
You see, this state is not what we are intended to be in, a state of darkness and death. There is a state, or realm, that we can return to. The realm of light and life. A new life. A new heart. A new spirit...
Lou
Posted by Christ_empowered on May 29, 2011, at 6:17:15
In reply to Re: Pristiq - One Heck of a Taper Strategy » Laurie1041, posted by Phillipa on May 28, 2011, at 21:56:49
hey. I'm with Phillipa..I mean, I'm no expert or anything, but couldn't you try effexor? Those old school effexor tablets would make it easier to reduce the dose gradually. Even the xr caps I think come in a number of different strengths.
Tapering psychotropics sucks. I hope this is over for you soon.
Posted by 49er on May 30, 2011, at 11:09:44
In reply to Re: Pristiq - One Heck of a Taper Strategy, posted by Christ_empowered on May 29, 2011, at 6:17:15
> hey. I'm with Phillipa..I mean, I'm no expert or anything, but couldn't you try effexor? Those old school effexor tablets would make it easier to reduce the dose gradually. Even the xr caps I think come in a number of different strengths.
>
> Tapering psychotropics sucks. I hope this is over for you soon.Hi Laurie,
I am not a medical professional but I have successfully tapered off of a 4 psych meds by doing it very slowly over a near 4 year period.
With all due respect to Christ Empowered and Philipa, since you have already nearly crossed over to Lexapro, you should stick with that option since it sounds like you are tolerating it decently.
The only thing you might might want to change is tapering more slowly at 5 to 10% every 4 to 6 weeks vs. every 3 weeks. But you can certainly see how it goes trying it every 3 weeks.
Finally, if you feel you need more specific support in tapering, I would suggest you visit this board, http://survivingantidepressants.org/index.php?/index.
It depends on individual contributions and is not affiliated with any group. Posting commercial links is forbidden.
Hope this helps.
49er
Posted by floatingbridge on May 30, 2011, at 15:59:39
In reply to Pristiq - One Heck of a Taper Strategy, posted by Laurie1041 on May 28, 2011, at 21:31:46
Well, I tapered accidentally by what was an otherwise disaster. My experience no way is superior to any mentioned above. And 49er's tapers are one that are meant to reduce rebound thus create a real, lasting withdrawal.
So. I switched (emergency situation) from pristiq to cymbalta to lyrica. When I cross tapered from cymbalta to lyrics in a week, I had no head zaps. No doubled over naeusea (sp). I just went on to lyrica.
Go figure. Don't know if it was healthy or not, but I didn't suffer as previously.
Posted by jono_in_adelaide on May 30, 2011, at 20:02:28
In reply to Pristiq - One Heck of a Taper Strategy, posted by Laurie1041 on May 28, 2011, at 21:31:46
Ask your doc for a script for fluoxetine 20mg (Prozac)
Take 2 per day for 1 week, then one per day for 1 week, then one every other day for one week
It will supress the withdrawl symptoms from Pristique, but because it has a very long half life, it shouldnt cause any discintinuation effects of its own.
Also, ask the doc for a few tablets of a benzo - Ativan or Xanax or Valium..... you can take one of those when you feel particularly bad.... even 10 pills would be ahelp.
Posted by bleauberry on May 30, 2011, at 20:26:55
In reply to Pristiq - One Heck of a Taper Strategy, posted by Laurie1041 on May 28, 2011, at 21:31:46
I was on meds for about 15 years. My final stretch was with prozac+zyprexa. After ECt had failed and proz/zyp stopped working it was about a 3 month careful process in small steps to get to the final dose. Which was mere crumbs by then.
The reason you got sick on Pristiq was because when it was broken the time released characteristic was destroyed. So you got all of that dose at one time immediately, instead of spread out evenly and slowly over a long time. To try it again, use the flat side of a butter knife to smash it into powder. Then you can make whatever kind of custom doses you want and take them frequently throughout the day in a manner to try to duplicate a steady slow release in small amounts. Every dose is now immediate release, not time release.
Lex isn't any picnic to get off of either, but at least it isn't as bad as effexor/pristiq.
I wonder why those meds are so hard on withdrawal? I don't know. I've seen some science studies that theorized there was some as yet unknown link with the opioid system. That would make sense. I once thought maybe it was because it was a combination serotonin/norepinephrine thing. But then I remembered how easy my withdrawal was from milnacipran, so no, that wasn't it.
Anyway, all I can say is....tiny steps, be patient, don't rush it past the point of intolerance.
The more common way to get off those meds is with prozac, not lexapro. That's because of prozac's long halflife, it makes everything much easier to manage. A single dose once a week or multiple doses, whatever. It's still early into Lex so probably wouldn't be a big deal if you thought about doing that.
A long time ago in Dr Bobs Psychopharmacology Notes I remember comments that Benadryl is helpful for the withdrawal symptoms of Effexor. I don't know by what mechanism, but some doctors found it useful.
Totally off the subject, in the above paragraph I just saw another example of how memory loss in ECT is so random and selective. Total huge chunks of memory gone....but yet....I can recall fairly odd random things such as somehting I saw in Dr Bobs Tips a long time ago. Weird.
Anyway, I think you will do well. Just take it easy and slow. It took 11 years to get here, but it won't take that long to get off. My guess is 2 to 5 months, somewhere in there.
Posted by Ron Hill on June 2, 2011, at 13:25:06
In reply to Pristiq - One Heck of a Taper Strategy, posted by Laurie1041 on May 28, 2011, at 21:31:46
> Obviously, my pdoc has never tapered anyone off of Pristiq yet because he dropped my dose from 100 mg. to 50 mg. (Pristiq only is available in 50 mg. and 100 mg. time-release tablets). Within 72 hours I was in terrible withdrawal. I tried splitting a tablet (my pdoc said I could do that, even though I was skeptical) and I got terribly ill within 45 minutes of taking the split pill.
------------Laurie,
It's too late now, but perhaps you could have bought some enteric coated capsules, broke a 50 mg Pristiq time release tablet into the size you wanted, and put the tablet piece into an enteric coated capsule.
Buy the enteric coated capsules here:
http://capsules-online.co.uk/store/category.php?id_category=9
Just a thought.
-- Ron
Posted by floatingbridge on June 2, 2011, at 13:33:17
In reply to Re: Pristiq - One Heck of a Taper Strategy » Laurie1041, posted by Ron Hill on June 2, 2011, at 13:25:06
> > Obviously, my pdoc has never tapered anyone off of Pristiq yet because he dropped my dose from 100 mg. to 50 mg. (Pristiq only is available in 50 mg. and 100 mg. time-release tablets). Within 72 hours I was in terrible withdrawal. I tried splitting a tablet (my pdoc said I could do that, even though I was skeptical) and I got terribly ill within 45 minutes of taking the split pill.
> ------------
>
> Laurie,
>
> It's too late now, but perhaps you could have bought some enteric coated capsules, broke a 50 mg Pristiq time release tablet into the size you wanted, and put the tablet piece into
an enteric coated capsule.
>
> Buy the enteric coated capsules here:
>
> http://capsules-online.co.uk/store/category.php?id_category=9
>
> Just a thought.
>
> -- Ron
>A great thought. I didn't know they existed. Thanks!
This is the end of the thread.
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