Chat Now!   Member Gallery    Member Articles    Games   Member Groups   Member Blogs   Health News    Bored?

Author Topic: Going to try to switch from lexapro to pristiq  (Read 2790 times)

0 Members and 1 Guest are viewing this topic.

Offline 2sungo

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #45 on: April 27, 2014, 07:38:02 PM »
Today (Sunday) was definitely not good.  As I lie in bed my wife puts her head on my chest and notes that my pulse is rapid.  My eyes were open around 6 but we didn't get up till 830 or so, all that time I didn't feel like moving, I am sure others know that morning unease.  Of course I did deep breathing, meditation, prayer, etc, but its still was hard.  Got up and felt a bit angry about it all, then went to a store with my wife, felt bad cramps and had to tend to that, later on couldn't find my wife in the large store, cell phone service was not great in there, meanwhile she is looking for me, and concerned that maybe I passed out in the bathroom (memories of me passing out on Sapphris still haunt her) so she asked someone to look and see if I was in there.  Finally we found each other, and both of us weren't feeling too great.  Back home I just felt more anxious, reading stuff on the net about the meds and depression etc (a sure sign I am not doing well, if I feel well I do that much less or not at all except for an occasional check in at this site), then we went to go to a barber (who was closed) by that point I am shaking I am so upset/agitated/anxious.  I took a quarter extra of .5 klonopin when we got to the barbers, (I also had a quarter extra in the morning, usually I am pretty strict in sticking to my 1 mg max for the day but not today), got home and just lost it, crying, cursing this damn thing, breathing too fast, just really not feeling well and venting my considerable frustration.  On my wife's urging I went and worked out some of my anxiety on a stepper machine for a few minutes (very light, I am not in the shape I was in before this began), then I called my therapist, left a message.  She called back and I was calmer by then, then I called the pdoc cell phone just to ask if I should take 15 mg instead of half of that of the remeron, as it seems to have lost its initial calming effect.
Just got a call back as I was writing this, my pdoc says to go up to 15 mg on the remeron, expect that I might be foggy a couple of days  given my sensitivity to medicines but it should help.  I know it will probably stop the stomach/intestine discomfort, it did when I started it.
I feel calmer right now but not real happy.  I truly hope raising the remeron works and it works for a good long while, she said it might have to go to 22.5, but its quite possible the 15 will do the trick.  I'll keep updating this journey.  If anyone has experience with this combination (with or without klonopin, which I will take until I am well stabilized for long time) feel free to chime in. 
Bookmark and Share

Offline insights

  • Hero Member
  • *****
  • Posts: 4582
  • Country: au
  • Rec's: 105
  • Gender: Male
  • Mood: Curious
    Curious
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #46 on: April 27, 2014, 09:46:17 PM »
So to summarize your day as I understand it:

You woke up feeling a bit crappy, but only mildly anxious/uneasy, then you wife mentions your high heart rate which kicked the anxiety levels up considerably, you then lose contact with your wife at the store which sends anxiety levels into the stratosphere, but apparently not high enough because  on arriving home you then go on-line to find stuff with which to mentally self-flagellate yourself with boosting your anxiety levels into orbit, followed by the stress of the barber being closed at which point you're into melt down mode. CBT could teach you techniques to nip these escalations from unease to meltdown in the bud. If it's possible I urge you to consider doing a course.

Quote
Just got a call back as I was writing this, my pdoc says to go up to 15 mg on the remeron, expect that I might be foggy a couple of days  given my sensitivity to medicines but it should help.  I know it will probably stop the stomach/intestine discomfort, it did when I started it.

So are you thinking of using Remeron to do the heavy lifting instead of upping the Pristiq dose?

Ian
Bookmark and Share
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

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #47 on: April 28, 2014, 10:19:13 AM »
Hi Ian,
not exactly like that, I have been sliding backwards for several days.   First some out of nowhere depression feelings, pit in stomach stuff, then comes the anxiety, then the health ocd, etc.  I actually was scared to go to the barber, I was already feeling crappy, I didn't get worse b/c he was closed.  It was already stressful for me to even go.  I have done some CBT, and I have books on it, maybe I should practice more and I do spend a lot of time trying to reassure myself, but it can take on a life of its own.   I did do a meditation yesterday morning, but that seems not to do a whole lot for me, at least not yet.  There are some upcoming situations that can stress me out, but here's the thing, they would not stress me out before all of this, for example I have an endoscopy in a couple of weeks, I had it a couple of times before and even though they found something that is probably harmless, I could deal with it.  This time another doc who is closer and in the medical group I joined since moving here will be doing it and will use ultrasound to better characterize it, so I will have more reassurance than "its probably just a lipoma", but one of the things the new doc mentioned as a possibility was a carcinoid (of many things) which of course got my bells ringing--even though he said it would not cause my symptoms (I kind of wish it was something they could cut out, but realistically it is unlikely). 
The remeron and the pristiq are supposed to work as a combo, I guess with the remeron offsetting some of pristiq's agitational effects that I seem to experience at 100mg. It was plan B, plan A was Pristiq alone.  I did not sleep well last night, which was a surprise, but I did take a day off work with my wife and got up late, I do feel a bit out of it today but less anxious to a degree.  I'm not gonna lie, I am scared of too much at this point, but I also know somewhere deep in my brain that I can and will have good days again. 
BTW which CBT technique could nip one of those anxiety/depressive/frustrated attacks before it happens, they don't happen unless I am already feeling poorly and during them I often think of how could I try and get out of it other than letting it pass.  I tried some deep breathing without success and I did do some exercise when I got home to try and get the shaky angst out of my system with maybe partial success. 
Bookmark and Share

Offline insights

  • Hero Member
  • *****
  • Posts: 4582
  • Country: au
  • Rec's: 105
  • Gender: Male
  • Mood: Curious
    Curious
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #48 on: April 28, 2014, 06:30:55 PM »
BTW which CBT technique could nip one of those anxiety/depressive/frustrated attacks before it happens

There are several, but the main one would be reframing what is happening from the often default catastrophizing.

You also need to work hard at not monitoring your bp/heart rate. You're deciding how good you feel emotionally based on your bp and/or pulse rate, and often setting up your day by what they are first thing in the morning. This is nutz. It is not "part of the territory" as you wrote earlier, your letting it rule your "territory." How you feel should not be determined by how fast/slow your pulse is during a random 30 seconds.

Ian





Bookmark and Share
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

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #49 on: April 29, 2014, 06:20:57 PM »
Well today was better than yesterday.  As per pdoc instructions I took the whole remeron pill 15 mg on Sunday night, but I did not sleep well, had a very hungover feeling (expected), and unlike when I first took half a pill, I was very anxious and depressed.  So I took off from work, stomach was a mess, etc, went with my wife to the city and saw a family friend who is also a general doctor and got blood taken , among other stuff that my wife had to do, etc.  Its amazing I could drive that far considering how I felt, I have to give credit to myself for that.  I texted the pdoc and left a message that I was going to cut the remeron back to half a pill for now because I found the side effects (remember this is on top of 50 mg Pristiq) intolerable, even for one day.  She called back and basically will pull my chart and do a review, to see if we can work with the Pristiq or I need another option all together.  Last night I slept better than Sunday but still not great, sweated like crazy when I woke up in the middle of the night, before drifting off into dream sleep before having to get up and go to work.  In spite of stomach aches I went to work and that was a good decision, I almost always feel better at work when I am busy, despite it being a rather stressful time of year for my job. 
Ian I do know about the catastrophizing and I am certainly guilty of this at times, so I tried really hard to remember what my therapist has told me, that the worst outcome is very unlikely for any given situation.  So when I was sweating last night (gee, now I know what hot flashes must feel like for women), I put it down to a side effect rather than some lethal disease.  When my stomach was bothering me, I reminded myself of all the times ADs or anxiety have bothered my stomach, and in any case I am having my stomach checked out in a couple of weeks for something that I have known for  about 4 years is in there but now they can ultrasound it and give me a more definite description of what it is (I do know its not stomach cancer, its soft and below the surface layer where that happens).  Its most likely nothing of consequence.  As for bp/pulse, I try to remember that anxiety can increase both, but its more of a problem when I am on an AD that can also raise them, I was not checking bp/pulse for a long time while I was on Lexapro after an initial bout of too much of that, since I know it doesn't do much to them.  It will be harder to control, but at least for today I can rationalize that whatever it is it is either a reflection of my mind state or the Pristiq. 
So who knows what tomorrow brings, but at least today wasn't too bad. 
Bookmark and Share

Offline 2sungo

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #50 on: April 30, 2014, 06:44:19 PM »
Well despite pouring rain and a grey day that made even "normal" people feel down (heard exactly this from someone at work) I got through the day rather well.  I took a crumb less than half a remeron last night, and did sleep quite well, no sweats this time.  Getting up was hard, and naturally the stomach discomfort has been present most of the day, along with a bit of weird head stuff, including some zaps in the late afternoon and a minor headache.  I think the Pristiq makes ones eyeballs feel funny too, they feel sort of swollen, but actually look fine.  Got to speak with my pdoc, she had three courses of action, stay where we are on half the remeron pill and give it more time, add low dose Seroquel instead (both options with Pristiq at 50 mg) or switch to something else completely.  Naturally with my concerns about working, it seemed best to select the first option for now, I will have time off in a couple of months to play around with meds if needed, don't want to rock the boat if I can help it.  And I'm not keen on any antipsychotic at any dose as an AD add on after trying Sapphris once and passing out cold, nor did I like the orthostatic hypotension I seemed to have on a low dose of zyprexa way back last spring, let alone what else it could have done long term.  I'd actually like to not have to deal with the remeron at all, but I don't want to move too many things right now, I am trying to use my logic to get through this by reassuring myself that my crappy physical feelings are all anxiety/depression or med side effects, and that I need to be patient.  When I checked my journals it seems that the first time I went thru this several decades ago I had a long period of not feeling well, months if not more than a year, a time where I could (mostly) function but just felt unwell much of the time.  That slowly faded away, it was not  a quick process even on effective meds (which themselves had annoying side effects).  So far in my life there were two meds that were trouble free for me, serzone (but it gave out on me and I had a panic attack, thus beginning round 2 of this illness, which was mercifully of shorter duration than the first or this time) and Lexapro, but it didn't feel the same after this round hit.  Zoloft would be next on my list of acceptable drugs, but it wasn't great for sleep and it did bother my stomach sometimes, and I think the second time around it gave me a slight hand tremor and was much harder to get onto than the first time (but maybe that's b/c I was coming off of serzone onto the Zoloft, so some of that could have been coming off serzone).  I went from Zoloft to Lexapro, and that was an easy transition back then.  Oh well, tomorrow is another day.
Bookmark and Share

Offline insights

  • Hero Member
  • *****
  • Posts: 4582
  • Country: au
  • Rec's: 105
  • Gender: Male
  • Mood: Curious
    Curious
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #51 on: April 30, 2014, 08:29:13 PM »
Oh well, tomorrow is another day.

Yes, it is. I've found the best way of coping is to just take each new day as it comes without bringing yesterday's 'baggage' into it, though this is easier said then done.

Ian
Bookmark and Share
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

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #52 on: May 07, 2014, 09:37:00 PM »
Checking in again, it seems to be going well since the last report.  I am not anxious, stopped checking bp, and my mood is good most of the time, no real depression or anxiety to speak of thus far.  I'm not sure how much is the Pristiq alone or how much the half a 15 mg remeron is helping.  Plus the 1 mg of klonopin helps out I am sure, though I'd like to wean off it one day, but not now while I am working, I'll at least wait till summer break before even considering it.  The only real complaint I can think of is that I am often very tired, and there have been a few days where I have drunk green tea or black tea just because I am so tired.  I imagine all of the meds I am on could contribute to that, but hopefully it will lessen over time.  But I'll take a little tiredness over anxiety/depression any day. 
I will have an endoscopy on Monday with ultrasound to examine a submucosal structure in my stomach that hasn't changed in the last few years, but I did not know they can ultrasound it till I saw a new doc, and that will give a more definitive idea of what it is, though it is probably nothing to worry about.  Naturally that will be a test of my health anxiety, but I am not afraid of the exam and hope for the best, worrying wont affect the results anyway.
Bookmark and Share

Offline insights

  • Hero Member
  • *****
  • Posts: 4582
  • Country: au
  • Rec's: 105
  • Gender: Male
  • Mood: Curious
    Curious
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #53 on: May 08, 2014, 12:47:38 AM »
The only real complaint I can think of is that I am often very tired, and there have been a few days where I have drunk green tea or black tea just because I am so tired.  I imagine all of the meds I am on could contribute to that, but hopefully it will lessen over time.

Mirtazapine would probably be the main sedation driver. Tolerance to the sedating effects of the benzodiazepines tends to develop quickly when they are taken daily, but Klonopin can't be completely ruled out as a contributor, and while Pristiq is generally neutral there are some who find it either sedating or stimulating to various degrees. If you're not already doing so try taking the mirtazapine at night.

Ian
Bookmark and Share
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

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #54 on: May 08, 2014, 07:07:02 PM »
Thanks Ian, I do take the remeron at night with the .5 klonopin.  I had some black tea late morning today, and it helped greatly without making me anxious, kind of like what tea did before I got sick this time around, so maybe my brain is slowly returning to normal.  In any case, I will leave the meds as is until I see how long this good period lasts and if it does, then I'll deal with changes when I have some down time in summer, if I am still very tired.
Bookmark and Share

Offline 2sungo

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #55 on: May 11, 2014, 09:59:07 PM »
well today was a bit rough, after several days of not checking BP/pulse I did so b/c I felt so not well.  BP is basically fine, but pulse was over a 100 most of the day except when I got up and it was in the 80s.  I think its a combination of mothers day (w/o mom who died shortly after this nightmare began for me), my wife having to go to work all day on a weekend, and probably most important, I have a gastro exam tomorrow w/ultrasound checking of something that has been there for a while.  Probably nothing but when one feels so weird for so long its easy to get ideas about physical causes, though I do have to remember I have felt good most days of late and I certainly had many good years in between the other two attacks.  Despite how I felt, I spent a lot of time outside gardening, took a nap after lunch (I could feel the pulse still was revved up, which I find odd since it was quite good a week or so ago when I last bothered to check). Went back to work in the evening, actually got a lot done.  I am concerned about how the meds might interact with the stuff the docs give me for the exam, let alone the results of the exam, but I guess I have to remember I am not the first person they have seen taking these meds, and I didn't worry about it when I was on Lexapro and fine when I had the other two gastro checks and a colonoscopy.  Waking up last night may also have contributed to my anxiety today, I feel like I had bad dreams but don't remember them. 
Hoping tomorrow goes well and hoping today was a fluke, and I can at least say I was reasonably productive anyway.
Bookmark and Share

Offline comoso

  • Full Member
  • ***
  • Posts: 161
  • Rec's: 0
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #56 on: May 11, 2014, 10:04:59 PM »
Everything you just named was enough to give "normal" people quite a bit of anxiety.  I think you're getting better.  You were productive when you had lots of reasons to waller in your anxiety.  Pat yourself on the back and keep going.

I used to have the check bp and pulse thing.  I still do it every now and then, but nothing like when I first got sick.  I can promise you this, it's true the more you check your pulse the higher it goes.  Think of it as free easy cardio and your burning calories.  I know when I was in the height of my panic about 5 months ago I was the lightest I've been since 18.  I'm 41 now.

Keep chugging on.  There was nothing wrong with being anxious today.
Bookmark and Share

Offline 2sungo

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #57 on: May 12, 2014, 03:27:35 PM »
Thanks Comoso, I got thru it and the good news is the thing in my stomach is a lipoma, nothing to be afraid of, does not even require further followup, the ultrasound confirmed what the previous doc had said in past years.  So that's good.  I am still feeling anxious though, not about that but about being anxious, my pulse has been high but lower than yesterday (and was great when I came out of the grog from the endoscopy, though I noticed this time the propofol didn't make me feel happy when I woke up, but just calm and tired, I had slept poorly with fast pulse the night before).  I will see the pdoc later and see what to do, maybe I just need a bit more klonopin (I am reluctant to raise it unless I am in dire straights) or time.  I know she thought about Seroquel but that also scares me, and I need to be awake during the day.  It may just be so many things that came together this past weekend, and anything health related is pretty much guaranteed to raise my anxiety for reasons unknown.  I mean its not like I can change a lot of things, whatever happens will happen.  My last bloodwork was good except for low vit D (I take I every day, so that surprised me, so I took even more this past week, maybe that did something) and low blood creatinine (that seems to have been going down over the last year, but I have lost weight and muscle mass for sure).  I do know that when I am feeling better I wont be checking my bp/pulse so much, it is some kind of an anxiety loop that is easy to slip into when not feeling well.
Bookmark and Share

Offline 2sungo

  • Sr. Member
  • ****
  • Posts: 329
  • Rec's: 2
  • Gender: Male
  • Personal text
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #58 on: May 12, 2014, 08:39:24 PM »
well the rest of the day wasn't so great, my wife drove to the pdoc since the gastro folks told me not to drive, she drives quite slowly and we were running slightly late and I don't like to be late for anything, so I got anxious, then upset when she got annoyed.  It was a tearful kind of anxiety where I just start letting my arm shake and try and take deep breaths to bring it under control.  Its not a panic attack, that is a different and even worse beast from the past, instead this is more a feeling of extreme frustration/anxiety/sadness over a lack of control over what is happening to me.  I was able to even say, though, that I knew this would pass, but I have yet to find a way to stop it in its tracks.  So we get to the pdoc , who when she last saw me said I was doing very well, and after some thought she laid out what she thought were the options at this point.  She mentioned Seroquel because of my sleep and anxiety problems but I was not keen on that, she also said that I should try and inch up on the remeron with a view towards eventually replacing the pristiq.  I was a bit surprised I thought maybe the pristiq might need more time, but she said probably not.  I also told her how I read how its so difficult to get off of, but she said if I can get to a higher level of remeron that would negate the withdrawal effects to at least some degree.  The thing is, though, I don't like the fact that the stupid pristiq is a pill that is not supposed to be broken, though she said folks do it anyway, and I have read such, but it seems like the company has never come out with a recommendation on how to go down on it other than every other day which sounds like a recipe for disaster to me.  She didn't think going back to Lexapro was an option either.  Since I had a bad reaction when I did a whole 15 mg of remeron (didn't sleep so great that night had anxiety and brain fog the next day), she thought that going more slowly up from the 7.5 that I am on would possibly work better, helping with sleep and anxiety.  I did sleep great on the 7.5 the first night and did have brain fog the next day but that went away.  She also gave me a prescription for propranolol, a beta blocker, she said I can take half a 10 mg tablet if I feel one of those agitation states coming on, her reasoning being that I worry so much about the pulse and blood pressure that if I could control that it wouldn't develop into a anxiety feedback loop.  So if I feel my pulse going fast at 2 in the morning tonight, I will try it, but chances are I might have a decent night, as she figured there were triggers that worsened this weekend for me.  When I compared it to past episodes she said its different this time in that my parents are dead, I am married, and I am a different person than when it struck twice before.   It still is a matter of finding the right med for me she said.  She had also mentioned the new one fetzima, but I want to go slow on whatever we do especially while I am working, and I am not keen to be a guinea pig for another new one unless there is some overwhelming reason to try it, like it works great and is actually healthy to take, unlike so many of them. 
Bookmark and Share

Offline insights

  • Hero Member
  • *****
  • Posts: 4582
  • Country: au
  • Rec's: 105
  • Gender: Male
  • Mood: Curious
    Curious
    • Poke This Member
Re: Going to try to switch from lexapro to pristiq
« Reply #59 on: May 12, 2014, 09:27:15 PM »
Well, if I were your doctor I'd stick you in a hospital bed for several weeks and take you off everything,  replacing the Pristiq with imipramine which is the TCA closest to Pristiq in its inhibition of serotonin (5-HT) and norepinephrine (NE), aka noradrenaline transporters which should limit any withdrawal effects. Then depending on how you reacted either keep you on imipramine or switch you to its main metabolite desipramine. Imipramine is biased towards blocking serotonin reuptake, desipramine towards norepinephrine reuptake inhibition (if it works desipramine is the better med as it usually produces less ongoing side-effects).

But given none of that is likely to happen, easing you onto Remeron is probably the best of the likely available options.

Ian
Bookmark and Share
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.

Tags:
 

Related Topics

  Subject / Started by Replies Last post
1 Replies
400 Views
Last post April 15, 2012, 10:09:32 PM
by Soccer_Dude
5 Replies
1033 Views
Last post August 25, 2012, 08:58:07 PM
by insights
1 Replies
1298 Views
Last post February 21, 2013, 01:57:57 PM
by camel
8 Replies
253 Views
Last post August 05, 2013, 01:26:22 PM
by vardnas
14 Replies
529 Views
Last post January 10, 2014, 10:57:19 AM
by BusuB