Pristiq: side effects, and staying sane whilst getting off it.
November 12, 2014 3:06 PM   Subscribe

Does anyone else have experience with Pristiq, night sweats, and successfully weaning themselves off the drug?

I'll try to keep this as brief as possible while including all relevant info. I apologise in advance for any vagueness; I haven't kept the records I probably should have.

I've been taking 200mg of Pristiq daily for...12 to 18 months (?) Before that, I was on a lower dose of Pristiq for about 12 months. And before that, I was on Effexor XR for a couple of years. I can't remember exactly why my prescribing psychiatrist (who I no longer see) switched me over from Effexor to Pristiq, nor why he gradually increased my dose from 100mg to 200mg daily over a couple of years.

I've been on and off anti-depressants, of many different types, since I was about 19. I am now 41. I'm sick of the side effects, I've probably tried everything at this point, and I just want to be anti-dep-free. Over the past 12 months, I've suffered increasingly severe and frequent night sweats and nightmares. I wake up 4-5 nights a week in a soaking wet bed, with rivulets of sweat rolling down my body. This is accompanied by nightmares that are like horror movies; my last partner said I used to cry and whimper in my sleep, which was mortifying. I have had a full physical workup and my doctor has excluded any other possible causes (e.g. peri-menopause): it's definitely the Pristiq, and I need it to stop.

As anyone on Pristiq probably knows, the problem is that it only comes in 50 and 100mg tablets. The tablets can't be chopped in half because of the slow-release coating. I am frankly terrified of going straight from 200mg to 150mg, and so on, because I've experienced Effexor withdrawals and I know what to expect.

The questions: has anyone else experienced these side-effects whilst taking Pristiq? Did you decide to go off the meds? Which method did you use? Any experience or advice is hugely appreciated. I am quite scared about this.

Additional info: I'm not in the US. Am currently not in therapy, but my new GP has given me referrals to several psychologists, and am in the process of finding one who has space to take me on. I will not be doing this unsupervised, but at the same time, my GP does not have much experience in this area, and changing doctors is not an option right now.
posted by anonymous to Health & Fitness (10 answers total) 1 user marked this as a favorite
Not a direct answer but have you spoken with a pharmacist? It's a long shot but maybe, since deslafaxine (Pristiq) is the synthetic primary metabolite of venlafaxine (Effexor), you could step down the Pristiq with Effexor support? I'm sorry, SNRI withdrawal is no fun. Good luck.
posted by gingerest at 3:26 PM on November 12, 2014

I have gone down from 100 mg to 50 mg of Pristiq without experiencing the withdrawal symptoms. Tapering down from 50 mg to nothing is generally done by skipping a day between doses for a while, then two days, and so on. Good luck!
posted by Ruki at 3:57 PM on November 12, 2014 [1 favorite]

My doctor told me I could in fact cut the slow release pristiq in half. I did and had few problems. I was on the 100 dose though, so definitely check before trying it with a higher one. I did halves and then quarters. He also said an alternative would be not to cut them, but to transition to taking them every second day before stopping completely.

The other time I went off I did it cold turkey, which was awful. The main side effects were dizziness and nausea and extreme tiredness. I did it over the Christmas break and it lasted pretty much the whole time from Christmas to new year's. I can't imagine having to go to work on that condition. My husband was on pristiq for a while too at the 200 dose and his side effects coming off were different. Mainly a buzzing sound like mosquitoes that he said sounded like it was inside his brain.
posted by lollusc at 4:01 PM on November 12, 2014

I didn't think it was possible to get off of Pristiq. However, first my doc took me down to 50mg Pristiq. Then she had me take 50 mg Prozac with the Pristiq for I believe one week. Then I continued to take the prozac for two weeks, while taking Pristiq every other day. Then I took Prozac only for a week (every day) and then was to ween off of it for about 15 days, taking it only every other day. I forgot to do this last step after a while. I had barely any dizziness (just a few days scattered over about 3 weeks--maybe 5 days total) and no brain zaps. I was amazed!
posted by bluespark25 at 6:21 PM on November 12, 2014

I had to go off of Pristiq cold turkey and I DO NOT recommend it. Really nasty. And I had experienced going off Cymbalta cold turkey before, so I knew what to expect. I was all over every forum and help line when I had to stop, and though I had health concerns that meant cold turkey was my only choice, I can tell you what I found and what I personally would counsel a friend who was considering going off the drug.

First off, the half-life of Pristiq is such that taking a pill every other day as a method of tapering off is NOT recommended. That's just a really, really bad idea, sorry. Even psychiatrists will recommend this because they don't really know what to do, either, as Pristiq needs to be tapered off of and the lowest dose is 50mg, as you noted. As far as splitting the pills go, the time-release coating IS an issue and people have reported mixed results; sometimes all goes well, but sometimes there is a surge of super pill followed by a day of nasty withdrawal side effects. It is a bit of a crap shoot but you can try that route.

Many people have reported good results by, surprisingly, adding Prozac to the mix right when you start tapering off the Pristiq. If I had been able to take the time, that is the way I would have preferred to go. I recommend, if you have the time to taper slowly and your psychiatrist will work with you, that you spend a couple weeks going from 200 to 150, and then a couple weeks tapering down to 100. Prozac has a long half-life and takes a while to "boot up", but usually kicks in by the four week date, and apparently levels off the worst effects of tapering down from the Pristiq. So you will be able to taper from the 100 to 50 to 0 in the final few weeks much more easily.

Then, when you are about a month free of any Pristiq whatsoever--and yes, sorry, but the side effects can actually last that long; though I was on Pristiq for years, I never took higher than 50mg and noticeable withdrawal side effects (nausea, mood swings, brain zaps, headaches and dizziness, etc.) lasted about three weeks after I took my final pill--you can quit taking the Prozac. Prozac is remarkably easy to quit and usually you will have no side effects at all, so it really isn't more of a hardship to overlap and I think it would be really helpful for you.

So that would mean you would need to take the Prozac for only a total of three months, which may seem like a while but you have been on Pristiq, in very high doses, for years! The bright side is you will be completely clear of the Pristiq by Spring.

Good luck! It is NOT easy, but you CAN do it and you will feel MUCH better once the withdrawal is behind you! Feel free to Mefimail me if you want for moral support or whatever along the way.
posted by misha at 6:32 PM on November 12, 2014 [1 favorite]

I would substitute Effexor sr once you get to the lowest dose of the pristiq, and then cut the Effexor with a pillcutter as you taper off.
posted by persona au gratin at 2:04 AM on November 13, 2014

Also, mentioned here, Prozac 10mg 2-3x/week can help with withdrawal from at least SSRIs. It may help with Pristiq.
posted by persona au gratin at 2:05 AM on November 13, 2014

There is some good information here, under section "4". Here's an excerpt:
Breaking the coating will cause the drug to be absorbed all at once by your system – which may be extremely potent and is not recommended. Instead what most knowledgeable doctors will do to help ease withdrawal symptoms from the 50 mg dose is prescribe another drug. Some doctors will prescribe a medication like Prozac due to its longer half life.

A common alternative though is to prescribe Effexor – the parent-drug of Pristiq. These drugs are molecularly similar and many people have had success by transitioning to Effexor and simply lowering the dosage over time. It is never recommended to quit Pristiq “cold turkey” as this may result in prolonged withdrawal symptoms that are more severe than necessary.

Some people have had success taking the 50 mg of Pristiq “every other day.” However, some have argued that this is an ill-advised strategy akin to playing “ping pong” with your brain. Work closely with a trained professional while tapering off of this medication.
posted by alex1965 at 4:18 AM on November 13, 2014

I was on 100 mg of Pristiq for a couple of years, then had to quit cold turkey due to insurance shenanigans. It...actually wasn't bad. I only had a couple of brain zaps, which were tolerable, and I was in this sort of odd spacey/wired head space for a few days, but that was it, and everything had cleared up within 2-3 weeks. I was honestly expecting it to be much worse. That said, a lot of people have had terrible experiences, so I wouldn't *recommend* this course. But it might work out OK for you, if you have no other choice.

Ultimately going off medication didn't work out for me, so now I'm on Effexor, which so far I like better than the Pristiq--it seems more effective on my moods and has the same (minimal) side effects. (I never got the sweats or nightmares that you have.)
posted by velvet_n_purrs at 2:23 PM on November 13, 2014

I found that when I was on Pristiq I seemed to metabolize it more quickly than I was supposed to, so the withdrawal effects would kick in at the 22-23 hour mark, so taking it every day really sucked; they manifested as brain fuzziness and dizziness for me. I ended up just switching straight back to Effexor, which cleared up the weird Pristiq effects and brought back the Effexor dreams, which are awesome. (I've had similar nightmares to what you're having on Pristiq on Lexapro, though-- I called them "the Quentin Tarantino Dreams"-- so I can totally sympathize.)

I'm still on the Effexor, which doesn't have those weird withdrawals for me even if I forget and take it a few hours late. Note that cutting the Effexor in half might not work, since it's a capsule, but it's full of tiny thingies and you might be able to measure half/half of those (or count them out if you're worried/persnickety).

I highly recommend making sure you have people who will take care of you or keep an eye on you in case your mood gets really low and suicidal ideation takes hold. Also if you get the dizziness thing you might wanna try something OTC for it. Good luck.
posted by NoraReed at 3:42 PM on November 13, 2014

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