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Author Topic: Going to try to switch from lexapro to pristiq  (Read 4336 times)

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Offline 2sungo

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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.
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Offline insights

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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
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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: 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.
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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
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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: 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.
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Offline 2sungo

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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.
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Offline comoso

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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.
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Offline 2sungo

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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.
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Offline 2sungo

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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. 
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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
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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.

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