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Author Topic: Anyone have full remission with Pristiq?  (Read 458 times)

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Offline 2sungo

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Anyone have full remission with Pristiq?
« on: February 01, 2014, 12:11:28 PM »
Well its been over a year, and I had a fairly long stretch of generally good days while working but still feel like I have not got full remission yet from my combination of Lexapro 15 mg, klonopin (1 mg, .5 at night, .25 on waking and .25 around 4), fish oil pills (2) and Deplin (15 mg), the latter of which I went off of for a week, but took one yesterday.  The last few days I have had a bit of a setback, I feel more anxious and depressed, and I know there are some triggers (week at work involved less interaction with people, it was quieter than usual) and my wife has to work this and next weekends, and I generally feel better when she is around.  My pdoc is thinking about switching me to Pristiq, she says it along with Lexapro seem to be the best tolerated for folks in her practice.  She said Cymbalta has too much trouble with insurance coverage when it needs to be raised to higher doses, and Pristiq has some advantages over its parent Effexor.  It does make me feel better thinking there might be an alternative out there, but then again I may feel better in a couple of days when work begins again.  I'm also afraid of doing a switchover for fear of a difficult adjustment, and also finding out that maybe it doesn't work.  Also I would hope that if I did this that it would not poop out on me for a long time if ever, and if it did, might the Lexapro work again after not taking it at all for a while.  I find that when I am having setbacks I get really tired again, some of the physical symptoms return, like mouth dryness, stomach jitters/gas/pain, reduced appetite (though I have recently gained back some weight) and I feel a bit short of breath when I am lying down at night, like my lungs feel dry inside or something.  Sometimes I will get a random twitch or jerk like I did in the beginning of this episode. Before the 4 oclock  klonopin dose I sometimes feel sort of a zap when I turn my head or walk. 
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Offline insights

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Re: Anyone have full remission with Pristiq?
« Reply #1 on: February 01, 2014, 05:23:59 PM »
Well its been over a year, and I had a fairly long stretch of generally good days while working but still feel like I have not got full remission yet from my combination of Lexapro 15 mg, klonopin (1 mg, .5 at night, .25 on waking and .25 around 4), fish oil pills (2) and Deplin (15 mg),

I'm a great believer in the K.I.S.S. principle so if you still need to take 2mg/day of Klonopin in addition to the antidepressant and still aren't getting adequate control of your anxiety then what is the point of taking the antidepressant at all, you might as well only take Klonopin. It sounds like it is doing most, if not all the heavy lifting.

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The last few days I have had a bit of a setback, I feel more anxious and depressed, and I know there are some triggers (week at work involved less interaction with people, it was quieter than usual) and my wife has to work this and next weekends, and I generally feel better when she is around....but then again I may feel better in a couple of days when work begins again.

Everyone has bad patches in their life. If you're expecting any combination of meds to keep you in a permanent state of bliss irrespective of what crappy thing are going on in your life then you're destined to be forever disappointed, or so doped up that life will mostly be a meaningless blur. Stuff happens which triggers anxiety, but it's not anxiety which needs medicating, it needs to be dealt with.

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My pdoc is thinking about switching me to Pristiq, she says it along with Lexapro seem to be the best tolerated for folks in her practice.  She said Cymbalta has too much trouble with insurance coverage when it needs to be raised to higher doses, and Pristiq has some advantages over its parent Effexor.

Is Lexapro your first SSRI, or have you been on others previously?

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I'm also afraid of doing a switchover for fear of a difficult adjustment, and also finding out that maybe it doesn't work.  Also I would hope that if I did this that it would not poop out on me for a long time if ever, and if it did, might the Lexapro work again after not taking it at all for a while.

Unfortunately, none of these can be guaranteed. Switching to another antidepressant is a lottery. But then the Lexapro is hardly a roaring success either.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline 2sungo

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Re: Anyone have full remission with Pristiq?
« Reply #2 on: February 01, 2014, 07:23:10 PM »
Hi Ian,
Thanks for your reply, I also think the klonopin has been doing most of the heavy lifting as you put it.  Perhaps the lex helps, but not like before when I was symptom free.  I have had longer periods of feeling better of late, so I was inevitably disappointed when the last couple of days seemed worse.  This morning was really bad, but has gotten better as the day progressed, I even went out to get prescriptions refilled and put air in my tires, despite feeling somewhat agoraphobic when the anxiety/depression acts up. Also took a little walk around the neighborhood, weather was finally decent enough to do so (its been horribly cold where I am for weeks).  I don't expect to be happy every day, but I certainly had more resilience when I have had 100% remission.   I have tried other SSRIs in the past, Prozac was definitely too agitating that didn't last long, Zoloft has worked twice but was difficult to get back on the second time, perhaps because I was crosstapering down off of serzone which seemed to work for years with no side effects that I recall until it just quit one day and I had a panic attack.  I had been on nortryptilene before that, but I think I took klonopin most of that time, then went to Zoloft, then to serzone, and after round 2 episode, back to Zoloft then to Lexapro which was wonderful for about a decade though I lowered the dose over time from 10 (felt a little tired and it had sexual effects though not as bad as zoloft) to 5 (that was good, should have stopped there, then to crumbs, big mistake.  I took klonopin very infrequently while on Lexapro, hardly at all.  It was an easy transition from Zoloft at the time, which was making my hands tremble among other things.  I did take a crumb more klonopin around one in the afternoon today, usually I stick to the l mg per day but if it gets that bad again I will take more.  I just hope it doesn't lose its potency, hasn't done that before.  I have not been on an SNRI yet, and my experience with nortriptylene wasn't great in the sense that it made my pulse rate go fast, get some heart skips,  and I was tired, though I did sleep well.   I read occasional reports of medications working again after one is off of them for a while, I also know of someone whose son had this response to Paxil after it quit on him and he returned to it some months later after taking something else.  Sometimes I wonder if just more time would help.  I did take a deplin today again, even though I was concerned about reading stuff about folic acid supplements slightly increasing cancer rates (though my pdoc called the deplin folks and they said it was not that it causes cancer, just that if it was already present folic acid could make it grow faster, and rarely at that). I figured that since I quit the deplin a week ago maybe that caused the slump?  Its expensive stuff, and I am heterozygous for the gene that converts folic acid to methylfoliate (which is what deplin is) so I don't know how much I really need the deplin, because while I don't convert folic acid as efficiently as a homozygous normal does, I am still able to convert something like 60 to 80 percent efficiency if I am reading correctly--plus half the population is either heterozygous or, worse, homozygous recessive, for this gene.  I would think the latter group would benefit the most from deplin.  My pdoc also recommended adding another fish oil capsule to get the omegas up to 2000 or so, but mostly I take 2 a day lately, they are also expensive (the better quality ones).  Thanks again.
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Re: Anyone have full remission with Pristiq?
« Reply #3 on: February 01, 2014, 10:20:02 PM »
Also took a little walk around the neighborhood, weather was finally decent enough to do so (its been horribly cold where I am for weeks)

I'll trade you some of the cold for some of the hot weather we've been having here recently, 10 days have been over 100 F out of the last 14, peaking at 115 and the forecast if for more of the same next week.

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serzone which seemed to work for years with no side effects that I recall until it just quit one day

Serzone was pulled off the market back in 2004 because a rare side-effect is severe liver damage, so you would have been taken off it anyway.

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then to Lexapro which was wonderful for about a decade though I lowered the dose over time from 10 (felt a little tired and it had sexual effects though not as bad as zoloft) to 5 (that was good, should have stopped there, then to crumbs, big mistake.

You probably set it up to fail as soon as you dropped the dose to 5mg which is a sub therapeutic for most. Not only did you begin to lose the therapeutic effect and thus potentially increased the severity of side-effects on restarting and the need for a higher subsequent maintenance dose, but taking small ineffective doses which don't sustain neurogenesis may 'teach' the brain to ignore the drug, increasing the poop-out potential.

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I have not been on an SNRI yet, and my experience with nortriptylene wasn't great in the sense that it made my pulse rate go fast, get some heart skips,  and I was tired, though I did sleep well.

Nortriptyline is at the more norepinephrinergic end of the range (about 1:10 SE:NE) so one with a more even serotonin-norepinephrinergic balance such as amitriptyline (~2.5:1 SE:NE) may solve that issue, as could desvenlafaxine (Pristiq) though its ~14:1 SE:NE ratio is a bit higher than might be ideal, though this is much better than its parent venlafaxine (Effexor) which is ~30:1, and then only at high doses. The duloxetine (Cymbalta) ratio is around 9:1 SE:NE.

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I figured that since I quit the deplin a week ago maybe that caused the slump?  Its expensive stuff, and I am heterozygous for the gene that converts folic acid to methylfoliate (which is what deplin is) so I don't know how much I really need the deplin, because while I don't convert folic acid as efficiently as a homozygous normal does, I am still able to convert something like 60 to 80 percent efficiency if I am reading correctly--plus half the population is either heterozygous or, worse, homozygous recessive, for this gene.

I'm not convinced it makes much difference except maybe where there is a definite folate deficiency. The few small scale studies done were for only short periods, no more than a month, which is of very limited usefulness given most people take longer to respond to antidepressants. Even studies conducted by the same researchers using the same methylfolate dose and similar methodology have produced mixed results. 

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline 2sungo

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Re: Anyone have full remission with Pristiq?
« Reply #4 on: February 02, 2014, 02:45:54 PM »
Hi Ian,
Wow seems the weather is crazy everywhere, we got the severe cold and sounds like Oz has the severe hot weather.  I remember a couple of years ago when they had to add a new color to the temperature map for some part of central Australia, it got so hot the regular colors didn't cover it. Hope you get some relief soon. 
I do regret going down on the Lexapro, though I did go off or down on it at least once and got back up to 10 without problems.  Maybe I let it go too far this time, or maybe it was its time to poop out, I got a decade out of it pretty much.  As for serzone, I know they had serious liver problems well after I was on it, I got on it when it first came out but luckily it did not bother my liver other than raising liver enzymes which all ADs seem to do to some extent, but it wasn't too high.  I do have a liver cyst though, one of a few "harmless" but disconcerting things I learned from a CAT scan with and without contrast near the end of last year, the other was a small patch of dead bone below my left shoulder, most likely an infarct according to the radiologist report--they sent me back to xray that area but the xrays showed even less detail than the cat scan-, with the note to follow up with MRI if clinically warrented, whatever that means.  I don't feel anything, so the regular doc didn't seem concerned.  Then they found some bilateral hypodensities on the kidneys, again, seems to be no big deal according to the doc, radiological report couldn't decide what they were either, they are too small I think.  I guess when one gets old enough, the dents and dings begin to show. 
I am back on the deplin for now, though I suspect you are absolutely right, and I have concerns with taking it long term, but for now I want to get out of the slump I am in, so since it was the only medical thing that changed, I figured I'd better stay on it till I can see my pdoc again, which will be at the end of the month.  I called today, naturally she is away for the next week, so no major changes happening anytime soon.  If I feel worse, I will up the klonopin, though I don't think that will help the depressive part of this but it could relieve anxiety and some/all of the physical symptoms.   I looked up more stuff on Pristiq and Amitryptilene, seems some folks have stomach issues on the pristiq which I have when my anxiety acts up (gurgles pain etc), and the tricyclics as a rule seem to make people tired and can speed up the heart, which I really don't need if I can avoid it.  Of course it is the internet so more unhappy folks will likely have something to say about any medicine than the satisfied folks who aren't needing to vent. But then again at some point I may have to bite the bullet and try something else anyway, and being pill phobic with HA doesn't help one make rational decisions.  In any case it helps to have this site to communicate with others that do understand, and I have to thank you again, you spend a lot of time trying to give informed advice on this site to folks in need of support and the wisdom of your experience.
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Re: Anyone have full remission with Pristiq?
« Reply #5 on: February 02, 2014, 06:05:01 PM »
I do have a liver cyst though, one of a few "harmless" but disconcerting things I learned from a CAT scan with and without contrast near the end of last year, the other was a small patch of dead bone below my left shoulder

I suspect that if they did a full medical including scans on everyone there would be few people who didn't have at least 2 minor things wrong with them. Most just never have such detailed medicals so remain in ignorant bliss. I used to have very detailed medicals twice a year because of my job and reading my files made for 'interesting' reading, but none of the things found ever caused me real concern.

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I looked up more stuff on Pristiq and Amitryptilene, seems some folks have stomach issues on the pristiq which I have when my anxiety acts up (gurgles pain etc)

The gut has a lot more to do with anxiety than most realise, which is why both it and antidepressants can sometimes cause upset.

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and the tricyclics as a rule seem to make people tired and can speed up the heart, which I really don't need if I can avoid it

They don't all have this affect as there is much more variation in their chemistry than there is between the different SSRIs, though they are all more cardio-toxic at very high doses. However, this isn't usually of much importance at typical therapeutic doses.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline 2sungo

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Re: Anyone have full remission with Pristiq?
« Reply #6 on: February 02, 2014, 07:17:42 PM »
Well one of the things the cat scan didn't pick up on is some sort of thing on my stomach, I had an endoscopy a few years ago and they took out a polyp and also biopsied a nodule that turned out to be nothing, the doc thought maybe a lipoma and it didn't change on a followup.  I will get it looked at again by a new doc closer to where I live, they have some kind of thing that can ultrasound it while they are looking at it which I don't think the other doc had.  Plus its probably close to time for a colonoscopy again, last one found nothing so that's great.  Interesting link on the digestive system nerves and connection with the vagal nerve, it makes sense that antidepressants would affect it as does anxiety.  I definitely get more gurgling and discomfort on days like today than on "good days".  Come to think of it, this episode really got going after I had severe stomach cramps the day before I stayed home and took Cipro, then drank tea, that's when the adrenaline waves started, though I had been stressed and sometimes down the preceding several months, but nothing I couldn't handle. Sometimes I wish I was born today so I would be able to reap all the benefits of what they will discover to better treat/fix this condition in the coming years, but then again its better than having been born in the 1800s I suppose. 
I remember when I was first sick at 31 they tried small doses of a couple of tricyclics (I think doxepin and desipramine) but they made me dizzy, more palps, and more anxious, but then again they were small doses and some of what I felt may have been my condition at the time too.  I also went thru my journals today and see that it did take a couple of years to really feel better the first time, even after I finally got put on the effective combination of nortriptylene and klonopin (at a higher dose than I had been taking) it still took months to really feel normalish (though I did notice better mood fairly soon, just appears I did have bad days too, but less of them).  The second time was much faster, it was summer and I was busier, so that helped, and once I got thru the transition from serzone back to Zoloft (which was not fun) I did feel better.  Still took a few months to feel really normal though, and I was on klonopin for at least half a year or so. I think its sort of like PTSD every time this happens so it takes a while even with effective treatment to really feel good.  Looking back I definitely should have not gone down on the Lexapro when I did, and even afterwards, when I was feeling the stress build up I should have sought help before it blew up, I think it responds better if caught before it becomes unmanageable, but it had been so long I kind of didn't believe I could get it again and if I did the lex would take care of it quickly. 
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