Ever been on Pristiq? What's it like?
August 26, 2016 7:39 AM   Subscribe

I'm about to start Pristiq, an SNRI antidepressant, as part of my treatment plan for depression/anxiety/ADHD. I've been on antidepressants before, but would like to hear what people's experiences have been with this one.

OK, so I'm trying medication again for my cluster of depression/anxiety/ADHD stuff, and the doctor prescribed me Pristiq. His line of reasoning was that the side-effect profile is lower than with most similar drugs and that weight gain in particular is not really a problem with this medication, which was a particular concern of mine.

I've been on SSRIs (Lexapro), and Wellbutrin before, but SNRIs are new to me. I'd like to get some sense of what I might expect from this drug, so if it's something you take or have taken, I'd be very interested to hear how it went for you. I've done a bit of research but like most antidepressants the impression I get from the statistics is that it's a total crapshoot and it might cause anything from a total side-effect-free cure to dissociative hallucinations and cyclic vomiting (only slightly exaggerating) as well as pretty much anything in between. I'd be particularly interested to hear if Pristiq had any effect on anxiety for you, either positive or negative.

I will also be taking Modafinil (Provigil), so if you've been on Pristiq in combination with Modafinil I'd be especially interested to hear from you. My understanding is that Modafinil is a pretty well-tolerated drug so I'm less concerned about that, but if you have anything to share then that would be great.

Finally, as a sort of follow-up question I'd be curious to hear your suggestions for what I might ask my doctor about if Pristiq doesn't do it for me for some reason, or if I like it OK but want to do something more about the anxiety aspect of my mental health situation, which is a significant component of my psychopathology and which I don't know if my combination of Pristiq and Modafinil is likely to address. I'm resistant to the idea of benzos due to tolerance and dependency issues, though the doctor has suggested them as an as-needed rather than a chronic use option and I may go that route later after I've had a chance to evaluate my reaction to these first two medications. Additional suggestions in that area would be welcome; my doctor seems pretty receptive to me bringing up options for myself, and is willing to entertain ideas and give me his professional opinion on their worthiness, so that's good.

Thanks in advance for your replies, I really appreciate it.
posted by Anticipation Of A New Lover's Arrival, The to Health & Fitness (7 answers total) 1 user marked this as a favorite
I took Pristiq for a while. I was put on it because Effexor had worked well for me previously (I stopped taking Effexor when I got pregnant, and went to an SSRI after that). Pristiq seems to be regarded as Effexor with fewer side effects. I only really experienced "brain zap" side effects with Effexor when I forgot to take my meds for a day or two. I found them manageable -- more of a reminder to take my meds than anything. It also let me know that tapering off of it (good practice anyway with these meds) would be particularly important. With Pristiq, the "hey take your meds lol" zaps happened even less often. And it worked for a while, until it stopped working -- as happens sometimes. I had hair loss, which is a listed side effect, but in retrospect there were other things going on that were probably causing that. As for anxiety, I don't recall substantial changes in either direction.

What I've found that is helpful with the crapshoot: Knowing what has worked for people with whom I have genetic connections. Identifying what works with a "failed" med, along with what doesn't. Realizing that people who are happy with their meds are far less likely to talk about that on the Internet. Having a friend who is a pharma scientist, and can explain how meds actually (or theoretically) work. And Crazymeds, with a grain of salt.

(What came after Pristiq is my current configuration of meds. I'm not super comfortable with putting a current health profile in public view, so feel free to MeMail if you think that info would be useful.)
posted by gnomeloaf at 8:49 AM on August 26, 2016

I've taken Pristiq for the last 8 months. I've had a noticeable reduction in my anxiety and very few side effects. The only possible side effect I can point to is that I tend to get tired in the middle of the day regardless of how well-rested I am. I'm tapering off it now because the circumstances that were spiking my anxiety have gotten under control, so I think I can manage without it. But you're correct, it's supposed to be pretty well-tolerated by most people.
posted by torridly at 9:05 AM on August 26, 2016

I've been on Pristiq for years. I had two weeks of intense nausea when I first started. I did have an as needed script for Ativan for the occasional panic attack, but Pristiq kept my general anxiety under control. It has greatly improved the quality of my life.
posted by Ruki at 10:06 AM on August 26, 2016

SNRIs should be better for energy and pain compared to SSRIs. Desvenlaxine (Pristiq) has a more predictable metabolism then venlafaxine. It still has a short half-life, though, and people can get some strange (electrical) nerve sensations (a mild form of withdrawal) when they stop or miss a dose. They aren't harmful, but they can disturb people, especially if they're already anxious and unprepared for it. It doesn't necessarily work better than SSRIs for anxiety, but since it works on different receptors, I think of it working for a group of people that overlaps with, but isn't exactly the same as, the group that SSRIs work for.

There are other options for anxiety. I think of pharmacologic treatment of anxiety mostly in the same terms as the distinction between SSRIs and SNRIs above - each mechanism seems to be helpful for a slightly different group of people. As far as I can tell, there's no good way of predicting in advance which mechanism is more likely to work.

With that being said, here are other options:
Sertraline: an SSRI that also affects the sigma receptor - some people seem to respond specifically to this rather than other SSRIs
Paroxetine: has significant side effects for many, but there are a few people who find it works really well without side effects. I don't know why.
Buspirone: Works at one of the serotonin receptors, rather than at the reuptake transporter, so it's more specific. Seems to work well, combines well with SSRIs and SNRIs if you're getting incomplete relief or relief of some symptoms but not others. Counteracts some SSRI side effects. Some people start taking it and get a clear sensation that something's wrong. It seems hard for them to describe, though.
Alpha2delta ligands (gabapentin and pregabalin): usually fairly benign and help for some. I think pregabalin is approved for anxiety in Europe. AFAIK, there won't be similar attempts at getting labelling in other countries because it won't be profitable.
Some anticonvulsants and antipsychotics, if you're really needing further help. They're usually more prone to serious side effects and therefore used only if others aren't helping.
Propranolol: blocks adrenaline and can be very helpful for some, especially for people who get tremor or heart palpitations first and the adrenaline surge makes them anxious afterwards.
Cannabinoids: reportedly helpful, possibility of dependence, not legally available everywhere.
Benzodiazepines: likely to cause tolerance and dose escalation, but a few people go along for years with small doses and no problems.
Ashwagandha: works on South Asians, seems to be useful for some midwesterners (USA). May work by reducing the effects of stress/cortisol. Cheap, OTC.
posted by Emmy Noether at 10:33 AM on August 26, 2016 [8 favorites]

I took pristiq twice. It worked really well for my depression and anxiety but I had two weeks of nausea going on, both times, and weird light-headedness/vertigo spells for a few weeks coming off. Also muscle tensing and bruxism throughout.

My husband was also on it a couple of times and did not have those symptoms, but did have the brain zaps coming off it.
posted by lollusc at 11:59 AM on August 26, 2016

Finally, as a sort of follow-up question I'd be curious to hear your suggestions for what I might ask my doctor about if Pristiq doesn't do it for me for some reason, or if I like it OK but want to do something more about the anxiety aspect of my mental health situation, which is a significant component of my psychopathology and which I don't know if my combination of Pristiq and Modafinil is likely to address.

An SNRI (for me, Cymbalta) was a godsend for my anxiety. SSRIs had worked on my depression and a bit on my anxiety, but apparently I needed the extra norepinephrine to get the extra anxiety under control. (Seriously, it was like someone just turned the volume off the constant worried interior monologue that I hadn't even realized was running.) If Pristiq has side effects you don't like, it still may be worth trying other SNRIs before giving up. I will say, however, that my anxiety tended to manifest in paralysis and lack of ability to act; norepinephrine helps with that. If your anxiety is manifesting differently, it may be worth detailing that to your prescriber.
posted by lazuli at 6:54 PM on August 26, 2016

I looooved being on Pristiq. Best med I'd ever taken. Being on it was the most "normal" I've felt since being diagnosed with depression. I don't remember having too many side effects, besides restlessness- I cleaned my house every day and did a lot of extra credit work for my summer classes that semester. Unfortunately, it turned out that I am very allergic to it. Stopping taking it cold turkey was pretty rough, with brain zaps and just a general feeling of malaise, I guess.

I'm currently taking nortriptyline/pamelor (tried both the generic and the brand name and the only difference was for me was their copays), since it's the single medication I don't seem to be allergic to. I've lost a lot of weight while taking it but according to my doctor most people gain weight? YMMV. My doctor also prescribed me brintellix, but I had an allergic reaction to that too quickly to know if it had any effect or not.
posted by mollywas at 12:46 AM on August 28, 2016

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