Weaning off Pristiq...but using Zoloft?

March 14, 2018 7:06 PM

In 2014 I weaned off Pristiq using Prozac. My doctor is out of the country and I want to get off Pristiq...again. I have left over Zoloft. YNMD, etc., but are they similar enough that Zoloft might work?

I wrote this in 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!"

I've got myself in the same Pristiq situation again. I'd like to get off b/c of side effects, and I don't want to wait or go through the horrible brain zaps. I wonder if Zoloft might be a good substitute since it's also an SSRI. Thoughts?

posted by bluespark25 to Health & Fitness (8 answers total)

If there’s some reason you don’t want to talk to your regular pharmacist, try asking at a different pharmacy. You could even try over the phone if you don’t want to go in.
posted by delezzo at 8:09 PM on March 14, 2018 [2 favorites]

Thoughts? Don't change these meds except under an MD's guidance. Toooo sketchy. See his backup guy. Brain zaps are tough, but not as tough as 24/7 suicidal ideation that feels real.
posted by j_curiouser at 8:09 PM on March 14, 2018 [6 favorites]

Off the cuff: no, because Prozac is famous for being able to bridge going off effexor, but I couldn't find support for zoloft working the same.
posted by thesockpuppet at 9:09 PM on March 14, 2018

From an anonymous commenter:

Switching any medications has risk, especially medications for your mental health. I suggest making changes with a doctor.

Each of these are antidepressants but they work differently. Specifically, they last for different amounts of time in your body. They are not one-to-one substitutes.

This sounds uncomfortable - hopefully you're able to see a doctor soon and feel better.

(IANYD. This is friendly encouragement, not medical advice.)

posted by restless_nomad at 10:29 PM on March 14, 2018

People often react differently to different SSRIs, and the differences differ among different people, if you get me. Even if what you're proposing is something that could work, you should have a doctor's supervision while you do it in case you start having suicidal ideation or something like that. How long is your doctor out of the country for? Is there a reason this can't wait until she gets back? I have stopped SSRIs on my own in the past, but that doesn't make it a good idea.

If you're dead set on doing this, I'd suggest not adding an additional medication and instead just very gradually reducing your dosage. This involves fewer variables. Take three quarters of your usual dose for two weeks, then half a dose for two weeks, then a quarter, then a quarter every other day, and then stop. Make sure you have enough pills to finish the process, before you begin. It's still not a good idea but that's what I did and it worked for me. I can give you no guarantees that it would work for you. You really should just wait and talk to your doctor when she gets back, or talk to another doctor in your regular doctor's practice if you can't wait.
posted by Anticipation Of A New Lover's Arrival, The at 4:32 AM on March 15, 2018

Hey I just checked up on Pristiq and discovered that it's an SNRI, not an SSRI. I have used the above procedure to stop both SNRIs (Effexor) and SSRIs (Lexapro). All the same caveats apply though.
posted by Anticipation Of A New Lover's Arrival, The at 4:39 AM on March 15, 2018

Best answer: IANAD but: The reason this works with fluoxetine (Prozac) is that it has an exceptionally long half-life of 96-144 hours against desvenlafaxine (Pristiq)'s 7 hours. This allows the fluoxetine to mask some of the withdrawal symptoms, and coming off the fluoxetine gives you a much less steep taper. Sertraline (Zoloft) has a half life of 36 hours - longer than the desvenlafaxine, but quite probably not enough to do what you need it to. Coming off antidepressants is hard and tricky for any number of reasons, and I don't think it's a great idea to do it without medical supervision. I especially wouldn't do it with anything in the venlafaxine family, that's a load of misery you don't want to put yourself through. Does your doctor really not have any kind of cover arranged for while they're not in the country?

(Probably doesn't apply to you, but I'll just note for the record that a lot of the time when I feel like Something Has To Change Immediately, No I Can't Wait For A Doctor's Appointment, it's because I'm getting depressed/anxious and that's generating a sense of extreme urgency and a feeling that my current state is intolerable. Feel free to disregard this if it's not a pattern you have.)
posted by Acheman at 6:13 AM on March 15, 2018 [1 favorite]

Response by poster: Thank you for the info! To be clear, my doctor prescribed the Prozac in 2014 to wean off the Pristiq. Thank you to Acheman—you’ve given me the medical info I needed to understand why Prozac is the preferred Rx. And you are correct. It’s not a great sign that I want to do this Right Now. The side effects are bad again and I want off yesterday!!
posted by bluespark25 at 7:53 AM on March 15, 2018