Huggy's Pristiq taper

[Huggy]

Hi all,

 

The time has come for me to discontinue Pristiq. This site has been an excellent source of information whilst I've been researching way's to come off of Pristiq safely/possible hiccoughs. I thought it was only fair that I would contribute my experience as well

 

Some pertinent information:

• I'm a 24 y.o Male, prescribed 50mg Pristiq in late 2011 to help control anxiety/variable mood. Prior to this I was occasionally using Benzos (10mg Diazepam) to help control heightened anxiety - on reflection the Benzos were probably causing/contributing to variable mood, at the time however my doctor didn't mention this and prescribed Pristiq. I saw excellent results once the Pristiq started to kick in, boundless energy (mental functioning above average with only 5-6 hours sleep), significant weight loss and a stable mood. These effects started to wear off after 6 or so months.
• Increased my dose to 100mg on suggestion of doctor in mid 2012 in an attempt to control resurging anxiety coupled with some depression - most likely related to juggling 5 challenging univeristy courses with some tough personal circumstances. I saw an improvement in mood/functioning and didn't notice an increase in side effects at the time aside from it becoming nearly impossible to orgasm from intercourse alone (apologies if this is too much information). Unfortunately I didn't see anything like the weightloss or stimulant effects I had when starting on 50mg. 
• Since being on the 100mg dose I've noticed I get brain zaps much sooner after missing a dose than I had on 50mg. Slowly but surely putting weight back on - currently back to where I was prior ot starting Pristiq in 2011.
• Successfuly completed university at the end of 2013. Spent a month travelling before starting a job in February 2014. Began relationship with my current partner in April 2014.

The fourth dot point is there to qualify my choice to discontinue medication - things have a changed a lot for me over the past 12 months. I feel like I am in a much safer, more stable place than I have been for the past few years. For completeness I should also mention that the sexual side effects of Pristiq (Delayed orgasm) are also becoming problematic now I'm in a long term relationship and providing a bit of an extra push to go through the withdrawal process, though they are by no means the only reason I'm choosing to do so.

My taper plan:

Having read through tips for tapering off of Pristiq along with a suite of posts on this site and others I've decided to taper by cutting tablets. I considered a switch to a more easily tapered drug like prozac or effexor but ultimately decided against it, mostly because I didn't want to risk new and exciting side effects from those drugs in addition to Pristiq discontinuation syndrome. I still have reservations about cutting tablets given the warnings on the packet about it but I feel like I don't have a choice in the matter given that 50mg is the next and only lower dose.
 

I intend to taper by 12.5mg (1/4 of a 50mg tablet) at a time, though I might look for ways to slow this down towards the end of the taper. I have been on an 87.5mg dose for 6 days now and intend to maintain this for another 3 weeks before dropping to 75mg. If I'm still relatively side effect free after 3 weeks on 75mg I'll drop down to 62.5mg, if that is succesful then I will try and maintain a 2 week interval between drops from 62.5mg to 0. Really depends on how I'm feeling after each taper though.

 

My discontinuation effects have been reasonably mild so far. I'm taking 3/4 of a tablet with breakfast and a whole 50mg tablet at 3pm. My rationale is that if I am seeing dose dumping due to split tablets it's better that I get a big desvenfelaxine kick in the morning, by taking 50mg in the afternoon I know I will have some slow release Pristiq in my system to get me throught the evening/night before I take my next dose. Once I get down to 37.5mg I will try and spread the three quarter tablets across the day - one quarter morning afternoon and night.

I would like to taper by 10% at a time as suggested by this site but it just isn't feasible with this particular medication.

 

How to succesfully cut tablets into quarters:

 

*Please note that this goes directly against explicit advise from the manufacturer of Pristiq - attempt to divide tablets at your own risk.*

Pristiq tablets are notoriously difficult to divide accurately. The best way I've found so far is to cut a groove through the coating and 1/3 of the way into the tablet with an exacto knife before completing the split with a butter knife (I suspect a pill cutter would be a better option than a butter knife but I don't currently have one). I do this on a nylon cutting board while holding the tablet on either side with my fingers. Though still not a perfect split it is usually very close, certainly close enough to not make a difference at the high dose I'm taking - this might become more problematic at the end of my taper.

 

Side effects/discontinuation effects:

On the couple of days that I've been late with the afternoon dose I've noticed mild brain zaps and what feels like slightly delayed inertia when moving. It's difficult to fully describe but I liken it to my brain and balance lagging half a second behind the physical movement of my body. For the most part this has abated after taking the 50mg tablet .

Today (6th day of my taper) is the first day I've had noticeable discontinuation effects all day. After consulting dr. google I've self diagnosed mild Mania (whether this is accurate or not I'm not qualified to say). I had a restless sleep and woke up at 3am full of energy. After an hour I crashed and went back to sleep. When I awoke again at 7am I was in a black mood - extremely irritable but not lacking motivation. This continued for a couple of hours before I was hit with Euphoria. It felt like switching on a light, within the space of 30 seconds I went from being pissed off at everyone and everyone to randomly singing and dancing around the house as I was doing housework. It's now 3pm and I've felt relatively normal for the last couple of hours, aside from some mild dizziness and brain zaps despite having already taken my afternoon dose of Pristiq.

General Comments:

 

It is probably worth noting that I think on balance Pristiq was the right medication for me. It did what it said on the packet with acceptable levels of negative side effects (and the added bonus of some beneficial ones). That said, I find it incredibly frustrating that pfizer don't offer a 25mg tablet or liquid dose that would allow me to taper my dose easily and safely.

Thanks for reading if you've managed to get this far, I tried to make it as logical and easy to read as possible but it's still ended up ebing a lot of text.

I'll post progress updates as I go

Cheers,

Huggy

 

[ang]

hello Huggy, and welcome.

 

If you do need to bridge with meds, my recommendation is AVOID EFFEXOR, at all costs.  It is the worst of all of them, in my opinion, and I have been on quite a few.  Withdrawals are horrific, and it changes your personaily while on it.   

I (unintentionally, but tahnk goodness in hindsight), went from effexor to zoloft (was a very bumpy ride)......

 

I also gave up Zoloft over 4 months (I think), and WD took 4 months after no drugs, to raise their ugly head.

 

So, go slow, slow, and even slower, with your taper, and good luck!

 

sounds you have a wonderful future ahead............

[Huggy]

Cheers for the reply and advice Ang

I really want to avoid bridging if I can but if I need to go slower once I get down to lower doses I won't have much choice, I have a while to think about it and put a strategy together if I do though!
 

[Huggy]

Laundry list of supplements I'm trying to support my taper:
 

• 5g Fish Oil
• 650mg Magnesium
• 12mg Manganese
• 2000IU Vitamin D3
• 1100mg Vitamin C
• 25mg Vitamin B2, 50mg B1,B3 and B5, 170mg B6, 50mcg B12

 

Efficacy is debatable but I want to give myself the best chance to succeed, a little bit of placebo effect isn't going to hurt either.

I did consider trying some L-Tyrosine/ 5-HTP but in the end thought better of it. Not clear what dose I should be trying and would rather not risk nasty interactions or a new dependancy on a supplement.

[Petunia]

Welcome Huggy,

Thank you for posting an introduction and filling in your signature.  I have to say I'm impressed with how informed and organized you are and I can't think of anything to offer in the way of advice or suggestions, it sounds like you have it all covered

 

If you are already taking all those supplements and feel fine taking them, I don't see any harm in continuing.  But if you haven't yet started, I suggest you add them one at a time, that way if you have any adverse effects, you will know which one is causing it.

 

I look forward to reading your progress updates, I'm glad you are here, feel free to write whenever you like and ask any questions you may have.

 

Petu.

[mammaP]

Hi Huggy, welcome from me too. Pristiq is notoriously difficult to taper and well done for doing your

homework before starting. One of our members, Mogfish had success with tapering and has posted a success story,

if you want to take a look how it was done here is the thread. Very similar to your own plans with a little ingenuity thrown

in!   http://survivingantidepressants.org/index.php?/topic/6695-mogfish-successful-taper-directly-off-pristiq-using-cutting-up-method/

[Huggy]

Cheers for the replys guys!

I count myself incredibly lucky to have done my research and found this site before I started trying to taper (or following my prescribing doctors advice to alternate doses). I have read a lot of posts from people in a world of hurt that have gone cold turkey, alternated tablets or tapered too fast.

I'll take a look at Mogfish's thread now thanks mammaP

Short update:

No 'mania' or black mood so far today. I don't quite feel like myself and was a little more tired than usual this morning - something is a little off but it's nothing I can readily put my finger on and describe i.e. a general feeling of unease. In addition to the off feeling I have very mild brain zaps but no nausea/'delayed inertia', certainily nothing unbearable in the grand scheme of things.

Cheers,

 

Huggy

[Huggy]

Taper schedule update:

Having read Mogfish's thread re: desvenfelaxine taper success, along with numerous other SSRI/SNRI threads, I think I need to be tapering more slowly once I drop below 50mg and especially once I get down to below the 10mg mark. This will probably look like tapering down to 62.5mg by 12.5mg drops each month (assuming I am tolerating drops that size well) then tapering by 1/8th of a pill or ~6mg drops a month down to 10mg. The drop to zero is something I will flesh out once I get closer in a few months time. 

I'm considering buying some empty gel capsules, a porcelain (relatively non porous) mortar and pestle with which to grind tablets and then using a jewelers scale to make up capsules with an accurate powdered dose. I will probably give it a go in a couple of weeks when I next fill a script for Pristiq and have plenty of pills.

 

Supplement update:

In light of reading the Magnesium and Omega 3 threads, along with the tolerable upper limit for vitamins page, I am going to make some adjustments to my supplement regimen. Dropping Magnesium, Manganese and Vitamin B6 by half to get below the recommended UL. I will also try to find a stronger fish oil tablet, currently only taking combined 1500mg EPA/DHA. I think a dose closer to 3000mg is more likely to show benefits, doing that with my current fish oil caps is impractical though (i.e. I would be taking 10 fish oil capsules a day). I will also add 400mg of Vitamin E to help with absorption.

There is some anecdotal evidence that the Vitamin B's can exacerbate withdrawal symptoms. Since I am already taking it (and all the other supplements I've chosen for that matter) without side effects I will leave it for now and consider stopping it if I start to get some off symptoms.

 

I'll be sure to update my sig with the latest supplement info when I get home from work

 

Cheers,

 

Huggy

[Huggy]

Update:

16 days in to my taper and things are going relatively smoothly. I've had 2-3 nonconsecutive days of obvious heightened anxiety - tightness in my chest, general feeling of impending doom. I am also sleeping less, going to bed an hour or two later than normal and waking during the night. I'm not sure if this is medication related or  because I have had a head cold for a week or so now. I know that I went back to bed and slept an extra 6 hours last Saturday morning which helped my anxiety and general feeling of wellbeing immensely.

I'll keep on keeping on for now - once my cold goes away I'll have a better idea if I need to actively do something to rebalance my sleeping pattern. Planning to stay on my current 87.5mg dose for another fortnight or so before dropping to 75mg assuming everything is still going well.

[cymbaltawithdrawal5600]

Seeing as how drops of more than 10% may not be felt for months into the future and cause very uncomfortable symptoms of destabilization not easily reversed or stopped, you may want to take a look at the 3KIS topic.

 

Your first drop, from 100mg to 87.5mg, was more than 10%. You are now contemplating another more than 10mg drop in a relatively short time. The drops are usually calculated on 10% of the CURRENT DOSE as it says in mammaP's sig. So all told you would be making a 25% drop from 100 to 75 mg in (how long is a fortnight?) lets just say, it too short a time.

 

Of course, ymmv. We just don't recommend fast tapers.