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Offline 2sungo

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Rough patch right now, still on pristiq and a bit more
« on: June 10, 2014, 07:31:10 PM »
Rather than add to the long pristiq thread I started earlier, I wanted to say that I have been doing much better in general since I last wrote, but the last couple of days have unnerved me.  Started when I was in bed, waking up and had a dizzy spell lying down, possibly a flutter in my chest, and felt like I couldn't move till it was over.  Tapped my wife and told her what happened, she checked my pulse, it was fine.  Nonetheless that started the wheels going, I had a couple of similar experiences in the past few months where I lay down and got a dizzy feeling, flutter, whatever.  Once when my eyes were open I thought it looked like the ceiling was moving so I reasoned that must be an ear thing, not heart.  This time I didn't open my eyes, but it felt unpleasant, that's for sure and its not something I have a lot of experience with.  Now I have not had many of the usual palps that come with anxiety this time around and even without it, the kind that you feel after the fact when you get an extra bit of blood in the next "normal" pump, the one where it feels sort of like something flipped once in your chest.  These ones worry me more b/c they seem longer, and only seem to happen if I am laying down or maybe once sitting.  So my anxiety ratcheted up yesterday and today, today it was sufficiently bad that I went to the nurse at where I work, she called a bunch of my docs and the urgent care centers for the medical group in the area, naturally no one can see me right away.  She did get me an appt with the cardiologist next week so I will hopefully get an answer that puts my mind at ease.  I am still taking 50 mg of pristiq, a bit more than half a 15 mg remeron pill, and 1 mg of klonopin in three doses, half at night with the remeron and .25 each on waking and around 4.  Also take some fish oil and vit d, for whatever that might be worth.  I did take a quarter or a bit less extra klonopin in the morning today and a bit of a 10 mg beta blocker that my pdoc prescribed for when my heart rate is up in the afternoon shortly before seeing the nurse, but when I saw her my pulse was 100 and bp was 150/84.    Not horrible, but more than I am used to and I definitely felt uncomfortable.  Luckily this time I did not get teary over the anxiety, I slowly calmed down and went home and kind of curled up on the couch letting my thoughts just flow by.  Its such a contrast to weeks of low anxiety to the point that I was drinking green tea in the morning just to wake up b/c I was so tired without becoming anxious, and doing a fair amount of stuff on the weekends with my family.  I will see my pdoc also on Monday, her last suggestion was to up the remeron slowly and then go off pristiq but I didn't do that b/c I was doing okay and I don't think a high dose of remeron will be any better for my health than the pristiq, and after hearing on this forum so often about the remeron tending to poop out easily I need something that will give me long lasting relief like what I had in years past.  Of course there are extenuating circumstances that only add to the stresses, the summer vacation is coming up and I'd rather be working with people around, and a colleague just lost her sister so that brings back bad memories of the losses I have dealt with in the past year and a half.  But I know that when I am truly well I have a resilience that gets me thru such things, its seems I've lost that, though if I am honest with myself I have still managed to do a lot on my good days and sometimes on my not so good days.  I just wish there was something that would make the anxiety just go away quickly when it does act up, I can't will it away and the medicines, unlike before, only seem to go so far this time around.  Maybe its a matter of more medicine or time, who knows.  But I guess I can take some solace in that there are so many of us going thru this mess, and I just have to focus on the good as best I can. 
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Offline insights

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Re: Rough patch right now, still on pristiq and a bit more
« Reply #1 on: June 10, 2014, 09:24:32 PM »
Maybe its a matter of more medicine or time, who knows.

Given you're at the low end of the 50-400mg therapeutic range, I think upping the Pristiq dose should be the first option. IMHO, there is not much point in taking a med at doses that aren't fully effective. A higher dose may also allow you to discontinue the Klonopin and maybe even the Remeron.

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: Rough patch right now, still on pristiq and a bit more
« Reply #2 on: June 11, 2014, 09:47:17 PM »
Ian, I did try to up Pristiq to 100 once but it made me more anxious and my pulse and bp went up (how much was med and how much was anxiety I don't know) so I don't want to go that route again.  If Pristiq was available in smaller doses than 50 mg, it would be a lot easier to increase the dose but the nit wits who made it didn't make it in small doses, and there is no reliable information as to whether the pills can be divided into smaller doses since it is time release and a solid with a coating on it.  Also what is weird is while my pdoc does say some folks do better on more than 50 mg of pristiq (I think she has one patient on 200 mg) the actual studies by the company that made it found no real difference in response to it at higher does, but did find more side effects.  The good news is that today was better than yesterday, the remeron does let me sleep well, but when I got up the pulse was already up in the high 90s which for me means the anxiety is likely to be significant.  I got thru the early morning classes okay, but got very tense during my break, I couldn't even focus on what I was doing at the time, so I broke down and took a quarter of a .5 klonopin.  That did help my anxiety/mood, even though my pulse remained high for a while.  Later at home I worked outside till dark, the anxiety was less than yesterday.  At least I feel like sometimes that extra medicine may work when I am in that state, I usually try to ride it out but there comes a point where its ridiculous to suffer if I can avoid it, so I took the extra klonopin.  At this point I don't know if I will ever get off klonopin, but who knows what the future may bring, just maybe these setbacks will continue to get less frequent as time goes on.  One day at a time. 
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Offline 2sungo

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Re: Rough patch right now, still on pristiq and a bit more
« Reply #3 on: June 15, 2014, 04:31:28 PM »
Well its still been pretty rough, a day after I last wrote not only did I have fast pulse waking but also numerous pvcs.  That part lessened in subsequent mornings, but I've been pretty depressed and anxious this weekend, I got so tense this morning I just kept shaking my right hand/arm and finally took an extra quarter of a .5 klonopin just to get it to stop.  And I did get teary for a short bit as well, not had that happen in many weeks, I just feel so tired of it all.  I know I am stressed over going to the cardiologist tomorrow and later on to the pdoc, although the remeron does help me fall asleep and stay asleep pretty much till its light outside, I found myself not wanting to get up this weekend except to make sure I take the pristiq on time, then back to bed.  My energy levels are as low as my mood, and I feel like nothing works for long this time around, and its very frustrating. Just a week ago I was able to drink some tea and get things done, now I wouldn't dare touch anything with caffeine for fear of provoking more anxiety and feelings of unwellness.   Maybe I need more of both an ad and klonopin, I just don't know this time.  Maybe the norepinephrine part of pristiq and remeron is bothering me, but then again Lexapro didn't do everything I had hoped for either this time around.  In the past couple of episodes an ssri plus klonopin would take care of this, and then I could go off the klonopin.  Not so this time around, and its been a year and a half.  There have been times I feel I am doing well and getting better, and then these relapses come along and they are difficult to accept, not that I have a choice of course.  And the one thing that hasn't been so bad this time around, palpitations, seem to be coming back and anything heart related really gets my HA going.  The short dizzy spells which I think are palps really bother me because they are "new", even though they are rare. And I don't recall them before remeron and pristiq, even though my doses of both are not exactly high. I guess I should think CBT style in that my evenings are still better than mornings, even on a bad day, so that is evidence its just depression and anxiety, not something worse. Plus no palp has killed me yet, and I've had plenty of scary ones in past episodes and occasionally even between episodes when I was otherwise fine.  Sometimes I wish my whole block was full of people like me (who knows, maybe there are a few) and we could just keep each other company when we are freaking out, but the world is not like that.  At least my wife is supportive, but I hate stressing her out too. I just hope and pray this gets better soon.
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Re: Rough patch right now, still on pristiq and a bit more
« Reply #4 on: June 15, 2014, 09:08:48 PM »
Maybe the norepinephrine part of pristiq and remeron is bothering me, but then again Lexapro didn't do everything I had hoped for either this time around.

While Pristiq is a slightly stronger norepinephrine reuptake inhibitor than its parent Effexor (venlafaxine), this is saying much. At your current dose I suspect Pristiq is only acting as a SSRI. Remeron is such a weak serotonin and norepinephrine reuptake inhibitor that you wouldn't be able to physically swallow enough to have any effect.

The problem really is that you're not on a high enough dose. If you can't handle more than 50mg then maybe you should consider another antidepressant.

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Plus no palp has killed me yet,

They don't kill. Just about everyone has palpitations from time to time, but most don't notice, or care much if they do. It is those of us with anxiety disorders that get fixated on them.

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Sometimes I wish my whole block was full of people like me (who knows, maybe there are a few) and we could just keep each other company when we are freaking out, but the world is not like that.

It is a lot more like that than you may realise. About 25% of the population has, or will develop an anxiety disorder or depression at some point in their lives. So quite a few of your neighbours will have either personally battled these disorders, or be related to someone who is/has.

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: Rough patch right now, still on pristiq and a bit more
« Reply #5 on: June 15, 2014, 10:12:50 PM »
Thanks Ian for your always helpful replies.  I meet with the pdoc tomorrow as well as the cardiologist, she last suggested upping the remeron to replace the pristiq but I don't think that is going to happen.  Remeron lets me sleep well, along with .5 klonopin, but that's about all I think it does at the dose I take.  If I were to switch I could always try Lexapro again, hoping that my time off it might have allowed my body to become sensitive to it again in a good way, or Zoloft, which I haven't taken in years but which worked twice, though it was rougher the second time around (then again I was cross tapering with serzone which failed after several nice years).  Maybe Lexapro and a small amount of remeron might work, who knows?  Its all so complicated anymore, not simple (note I did not say easy, it never is) compared to before.  BTW I read your reply to the 16 yr old smoker, besides hitting the nail on the head as we say here, when you described what you went thru with the lung thing, I had to say to myself, damn, you're brave, makes my HA look so silly, but then again I guess HA is really silly, except for those of us who feel the pain of it.  It will subside if I can only get this depression/anxiety under control for good.  I have had good weeks, one barometer is that I tend to eat a bit more and don't feel any agoraphobic feelings, but they don't seem to last.  I think I might need more of something, just need to find the something that works with SE that I can tolerate. 
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Re: Rough patch right now, still on pristiq and a bit more
« Reply #6 on: June 16, 2014, 12:41:12 AM »
If I were to switch I could always try Lexapro again, hoping that my time off it might have allowed my body to become sensitive to it again in a good way, or Zoloft, which I haven't taken in years but which worked twice, though it was rougher the second time around (then again I was cross tapering with serzone which failed after several nice years)

Unfortunately, it is possible both will deliver more severe initial side-effects than before so I suggest you start on extra low doses, 2.5mg for Lexapro and 12.5mg for Zoloft should you decide to switch. Substituting Celexa for Lexapro might be worth trying too, the differences between them are subtle, but Celexa just might be a smoother ride.

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when you described what you went thru with the lung thing, I had to say to myself, damn, you're brave, makes my HA look so silly, but then again I guess HA is really silly, except for those of us who feel the pain of it

The mind is a very strange beast. Surgery doesn't particularly bother me, apart from the two lobectomies, I've had 4 other, more minor procedures, but I find starting a new antidepressant terrifying. I'm okay with other meds, but for some reason ADs are hard. All part of the rich tapestry of life when you're nutz, I guess!  :(

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 forever young

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Re: Rough patch right now, still on pristiq and a bit more
« Reply #7 on: June 16, 2014, 08:24:07 AM »
So when you switch meds you are like starting over? I thought if you were already on an anti depressant you may not be like starting from scratch. I switched from celexa to Zoloft and took it while home alone and I am afraid to take the klonopin by myself go figure. I have taken zanax but I don't know why I am afraid to take the klonopin. I was hoping I could take it and use it as a tool to face my going out of town fears. I am always home alone I thought it would be nice if I could take it at my therapist office but then I would have to drive home and if it made me sleepy would not be good. I have had it for 3 wks never taken yet.

Ina have you taken any benzos ?
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Re: Rough patch right now, still on pristiq and a bit more
« Reply #8 on: June 16, 2014, 05:35:25 PM »
I would have to drive home and if it made me sleepy would not be good. I have had it for 3 wks never taken yet.

Does Xanax make you sleepy? If not then there is a good chance that Klonopin won't either. But the only way to know is to try it. It does exactly the same thing in the brain as Xanax, it just does it for longer.

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: Rough patch right now, still on pristiq and a bit more
« Reply #9 on: June 16, 2014, 10:08:12 PM »
Today was a better day, got an echo done by the cardiologist, nothing wrong except for some impaired ventricle relaxation, which I have known about for a few years, and that is not unusual for someone older than 50.  He says to do more cardio, which is the last thing I feel like doing in this state, but when I get better I always do go back to exercising, usually weights but at this point I think light cardio would be better when I am ready. he also thinks my fast pulse is due to either anxiety or the meds, even in his office lying down the bp was low but pulse high, I didn't get numbers but my own check after waking revealed a pulse around 98-100.  I wake up to it doing that, and it wasn't doing that before.  Pdoc wants me to get to 15 mg on the remeron once summer vacation begins and stick to the pristiq to see how that works out, if it doesn't than a new plan is needed, could be to add back a small amount of Lexapro to the pristiq as I did feel pretty decent during the cross taper, or maybe consider vibryd.  I told her I haven't heard stellar things about vybryd, I'd rather try Lexapro again or consider Zoloft.  But that's not something I have to deal with yet.  She also was going to speak to the reps for Pristiq about the cutting pill issue, she seemed surprised when I told her that no actual live people are available at the number Pristiq gives in their info for folks to call for further information about it. She mentioned some pharmacies do compounding of medications but that can be pretty expensive from what I have heard, if you can find someone who does it. 
Ian you are spot on about the medication stuff, I also freak out over new antidepressants, a bit less so over benzos.  Surgery (gall bladder in my case) and invasive medical exams worry me a bit, but not as much as going on a new antidepressant or going off one. Been thru too much pain with the med changes, surgery and exams are easier, I knew what to expect and the pain or any other issues resolve quickly.  I am not as afraid of brain zaps as some, I find them more annoying than scary, but I don't like weird heart stuff or especially increased anxiety or depression which can happen with starting or ramping up some meds.  I also worry about certain ones increasing chances of diabetes or aggravating blood pressure or triglycerides and cholesterol, all of these I have in the family tree so I want to continue to keep them in check, in fact I am the only one of the four of us siblings that does not have high blood pressure--except sometimes when I am anxious. I'd probably be the healthiest person in the world if I had never had a panic attack (first one was in a gym) and the anxiety and depression that followed 25 years ago, as I was into running, swimming, and weights.  Each time this evil thing has hit, the exercise goes out the window until well after I am better, it does not make me feel better when my sympathetic nerves are overstimulated. 
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