Managing side effects of med swap
April 26, 2015 5:19 PM   Subscribe

Swapping head drugs from escitalopram (Lexapro) to desvenlafexine (Pristiq). Side effects are not being kind, but from my research so far it seems the medical opinion is: totes normal, suck it up sunshine. I would like to be able to cope with daily life during the adjustment period a bit better than I am at the moment and am hoping you guys might have some practical suggestions. Details within. And yes, I completely know you are not my doctor or other mental health professional.

Last dose of Lexapro (30mg) was a week ago (Monday). Then had two days with no drugs, started taking the Pristiq (50mg, standard starting dose) on Thursday, which makes it 5 doses as of this morning. It is early days, I know this.

Side effects have been varied but consistently involve mild to extreme dizziness. Change in altitude (ie bending over, standing up from sitting/lying position) is not required - all I need to do is turn my head. Sometimes I don't even need to do that. Moods have been all over the place as well, from increased energy and ability to do things on Fri/Sat (this was part of the point of switching) to huge crying jags (yesterday). I seem to be particularly labile - pretty much anything can set me off at the moment. Physical activity also seems to be really difficult - obviously dizziness doesn't help, but I seem to be slower, more easily exhausted, break a sweat from trivial exertion, etc. I am not positive this is related, but it is annoying.

I am trying all the normal self-care routines. I have been living with depression for a good while now so I am pretty skilled with the making myself drink water, eat even if I don't want to, patting the kitty, reminding myself this too shall pass, distracting myself, etc.

Although in some ways it's tempting to use this as an excuse to take time off work (and I could), too much time on my own is really not good for my emotional health overall. So trying to keep it together and go about things as normally as possible seems like a desirable thing right now.

tl;dr: I need to level-up my self-care routine, and could also use any techniques for managing the physical side effects. Any hope/advice/experience you can offer about how long I can expect this to go on for (beyond the carefully neutral official advice) would also be reassuring.
posted by Athanassiel to Health & Fitness (7 answers total) 1 user marked this as a favorite
Did you get any Xanax* to tide you through the cross-tapering?

*Assuming you're in the US. In the UK it's diazepam (valium).
posted by ambrosen at 5:26 PM on April 26, 2015

I also had super-bad orthostatic hypotension and fast exercise fatigue/dizziness when I first went on Pristiq. After the first couple of weeks the dizziness and fatigue settled down, but orthostatic hypotension was basically the new normal; the whole time I was on it I had to be kind of careful not to sit up or stand up too fast.

Other possibilities: How's your appetite? Mine tanked when I started Pristiq and I wonder in retrospect if there might have been some low-blood-sugar chaos contributing to the dizziness. I also was abruptly really caffeine-sensitive; a single espresso could send me off the rails into sobbing-anxiety-land. I had to quit caffeine for about two months and reintroduce it gradually. Is that a factor for you?
posted by dorque at 5:36 PM on April 26, 2015

I know absolutely nothing about Pristiq but Benadryl has been recommended to dampen the side effects of ssri/snri withdrawals. I'd probably take a small dose in during the day and a larger one at night,
posted by MadMadam at 5:39 PM on April 26, 2015 [1 favorite]

Pristiq messed me up physically in similar ways in the early days of taking it; it's a side effect I seem to get a lot. At that point I was along the lines of "Unless this makes me throw up every hour I'll stick with it because I need a solution", but that's not really expandable to others.

Mentally what helped is the idea that for a while you're not obligated to keep yourself on a full exercise/diet routine, even if it would make you feel better - there is simply not enough willpower. I tried to eat slightly healthier takeout meals and otherwise didn't beat myself up about it. I don't know what you're taking Pristiq for - it was anxiety in my case so this was trying to counter that.

Physically what helped was a lot of low-impact exercise. Long, long walks. Casually cycling to go shopping. Time consuming, but once I actually got out of the house it was easy to continue, and the length helped use up some of the energy and agitation. It also helps to be in a public environment. Even if I'm not talking to anyone beyond transactions it's very grounding to see people going about their business.

This stage lasted about two and a half months. It was not consistent. Early days had the effects of anxiety still happening. Mid-period was the worst of the physical side effects. Toward the end, although not quite gone away, both had dampened down measurably and things were much better.

Summary: Self-care? Do more low-impact stuff. Compensate for the extra time against other things in your life if you can. It's unpleasant and not instant but relatively quick in the scheme of things.
posted by solarion at 5:49 PM on April 26, 2015 [3 favorites]

benadryl has helped me as well - though i'd be careful taking it during the day if you are already experiencing things like dizziness, etc. it WILL help with brain zaps and muscle stuff, though. and tons of water, like you are doing.

if your doctor is willing to prescribe a short course of klonipin, that would be awesome.

my biggest self care during withdrawals is long, hot baths. over and over again.
posted by megan_magnolia at 7:28 PM on April 26, 2015

Med changes suck. You have my sympathies.

I suggest treating yourself like you're mildly ill. You sound like you feel ill. Why not go to bed early, take a day off work, binge watch Netflix and drink tea. Eat chicken soup and crackers (I bet your GI tract will join the misery parade any time). You might feel better in the morning.

I don't suggest you let yourself wallow in it but if you feel sick, stay home.
posted by crazycanuck at 8:39 PM on April 26, 2015 [1 favorite]

Wait, they cross-tapered you from 30 mg to 0mg in one go? And had you do two days of no meds at all? That is a recipe for horrible discontinuation syndrome. You should call your psychiatrist (or whoever has been prescribing this for you) and ask if you can do the switch in steps: escitalopram comes in 30, 20, or 10mg doses, and you can usually (I am not a doctor, but I have done this a few times) drop the dose by 10mg a week without feeling awful. Even that might not be enough: I had so much trouble getting off of it that I started breaking my 10mg pills in half for a few days before tapering to zero, and it still sucked.
posted by Mayor West at 8:27 AM on April 27, 2015

« Older Un-solicited original music   |   Movie identification: sheep balloons? Newer »
This thread is closed to new comments.