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Author Topic: Rough patch right now, still on pristiq and a bit more  (Read 764 times)

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Re: Rough patch right now, still on pristiq and a bit more
« Reply #10 on: June 17, 2014, 02:24:07 AM »
I told her I haven't heard stellar things about vybryd,

It appears to be an okay med, however, I think a SSRI and Buspar as separate meds is a better option as it allows the ratio to be fine tuned, rather than being stuck with the fixed doses of similar compounds in Viibryd.

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I am not as afraid of brain zaps as some, I find them more annoying than scary

I can understand why people get spooked by them. AFAIK, there is no studies showing what causes them. My hypothesis is that they are due by the breaking down of interconnections recently forged by the antidepressant which can't be sustained as the dose drops. I've seen folk experience zaps soon after they've had a stroke. But I could be way off beam on this.

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 #11 on: June 19, 2014, 09:49:48 PM »
Today I was tired for much of the day and a bit down/anxious later, but after visiting the therapist I felt better.  Maybe the 4 oclock .25 klonopin helped too.  I turned in the holter monitor they gave me to wear yesterday, and they said the doc would call today, but of course my cell phone has poor reception at work, so I called them, and the nurse or whomever couldn't find it and the doc was gone for the day.  So I'll try again tomorrow.  I did have a few distinct "pauses" that I think were pvcs when the morning I woke up with the monitor, not so much in terms of dizzy/fluttery ones which are far rarer and not something I usually experience.  Of course my anxiety rises until I get the report, and with my luck they always seem to find something that they are not overly concerned about but its never an all clear kind of thing for me, at least not since I've gotten older.  Still have to do a stress test on July 1.  Today not so much in the way of obvious palps, but I am trying to creep up on the remeron, got to half a pill plus half the remainder, so I guess that's about 11 mg or so out of the 15 mg pill.  Felt a little spacy today too and had some light zap feelings, especially when turning my head or stepping when I walk.  I would not expect those going up slightly on an AD, but anything is possible I suppose.  I haven't taken extra klonopin in several days besides my usual daily total of 1mg so maybe it has something to do with that, time will tell.  BP is fine or even low when I check, pulse tends to be around 90 in the morning when I get up, sometimes lower during the day, 80s usually, 70s if I am lucky.  I think the noradrogenic properties of Pristiq tends to raise my pulse, not sure how the remeron affects it though I suspect one or both of having something to do with the palps and higher pulse rate when waking.  I was a bit more hungry today, but not by much and I have lost weight in the last few weeks again.  At least I am not turning into a famished beast like so many folks on remeron seem to describe, but I guess its all individual and dose related, plus the pristiq doesn't seem to encourage appetite. The one thing that is good is that I sleep well, its the getting up part that sucks.  I also made myself a bit nuts reading all the stuff I could find on how to wean off pristiq if needed and that seems to be a hot mess of a situation, some break the pills but one is not supposed to do that, some go on Effexor and wean down on that (which doesn't sound like a lot of fun at all), some use Prozac as a bridge off of it--yet the one time I tried Prozac when I first got sick 25 years ago it had me climbing the walls, I was so friggin anxious I couldn't hardly sit down, never again, and some have used Lexapro.  I think if I were to go off of it, it would be a transition back to Lexapro or something similar, I try to calm myself down saying there probably is a not too painful way and going onto an ssri might be the trick if I find it doesn't suit me well in the future.  I am also freaked out by the fact that my pdoc will be away for a month during the summer with no covering doc, so I may try to find a fill in pdoc on my insurance plan for that time, its important to me to feel like I have support if I need it, and a nurse practioner aint gonna be enough for me to feel comfortable, at least not until I am feeling normal for a long time on a set medicine regimen I can feel confident in.  And in keeping with the theme that when it rains it pours my lower back has some kind of sharp pain that radiates to my right hip, it must come from doing too much bending and digging outside in the garden, it acts up at times and doesn't at others.  Normally I don't have back problems, and I just got over ramming my ribs into a table, that took 3 weeks to go away, mostly.  It helps for me to be active outside, I'd rather not sit inside and be idle, that is not usually a good thing unless I am in a good mood or my family is home too.  I guess I have to wait some more, maybe some of this is initial effects of increasing remeron, even if it a slow increase.  I also asked the pdoc about why not Lexapro plus a bit of remeron, she thinks that because remeron and pristiq affect both serotonin and norepinephrine from different angles that the combo of an snri and remeron was likely to be better than ssri and remeron.  Not sure if enough norepinephrine is hit by the doses I take, and I am not sure if norepinephrine stimulation is the best thing for my anxiety or heart, but I'm not the expert so its wait and see.  Hope tomorrow goes well, one day at a time as always.   
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Re: Rough patch right now, still on pristiq and a bit more
« Reply #12 on: June 20, 2014, 12:05:43 AM »
I did have a few distinct "pauses" that I think were pvcs when the morning I woke up with the monitor, not so much in terms of dizzy/fluttery ones which are far rarer and not something I usually experience.

IME, these are often more apparent to the patient than the monitor.

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Not sure if enough norepinephrine is hit by the doses I take

Remeron is doing effectively nothing, you couldn't physically swallow enough of it to have an impact, and while Pristiq does inhibit norepinephrine reuptake more than Effexor, it is still fairly weak, especially compared to some of the tricyclics.

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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Re: Rough patch right now, still on pristiq and a bit more
« Reply #13 on: June 20, 2014, 09:05:05 AM »
I also made myself a bit nuts reading all the stuff I could find on how to wean off pristiq if needed and that seems to be a hot mess of a situation,

While the makers warn against cutting or crushing the tablets, many psychiatrists ignore this advise and have their patients crush and dissolve the tablets in fruit juice (not grapefruit). For example Dr Steven M. Stahl in his Essential Psychopharmacology: The Prescriber's Guide (4th ed.) which many consider to be the psych drug bible recommends doing this (see p 61), though I think most would do okay with a faster taper than the suggested 1% dose reduction every 3-7 days. I'd try a 10% reduction every week until the dose got down to about 25% and then maybe reduce by 5%.

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 #14 on: June 22, 2014, 01:39:40 PM »
Thanks Ian for the info, my pdoc coudnt get a straight answer about discontinuing pristiq from the company reps.  In any case, I got the holter monitor results back, and though I have not read nor requested the report, it is normal, no ectopic beats even though I swore I felt three pauses that morning in bed.  So maybe our minds can make us feel things that are not what we think.  I must admit I was a nervous wreck while waiting for the results, so I had a bad day at the end of the week, but the good news cheered me a bit.  I also spoke with my pdoc, she said to decrease the remeron, which I have done, back to half a pill and that there are a couple of ways to go. We could try to increase the pristiq again now that my body is used to it, but that didn't go so great before, we could switch, this time she mentioned brintillex, a new SSRI she described as Lexapro plus, or, after I mentioned previous success on it, Zoloft.  I mentioned Zoloft because it worked twice for me, and I haven't had it in over 12 years or so therefore I imagine my body may be sensitive to it still. Not my favorite medicine but it did work well to get me out of anxiety and depression last time. I later switched to Lexapro b/c it had less side effects, but it seemed not to be as effective this time around.  I don't know if its the medicine, my condition being worse or that I am older, or external stuff that made recovery harder.  I cant say it didn't do anything, otherwise I would have never been able to return to work, but still it wasn't the cure like before. This weekend I notice mornings are a bit rough but I am okay later on, and I have been working hard gardening despite a bad lower back/hip pain problem.  Went to the regular doc on that one, was told to take ibuprofen, it helps, I should rest more but I do need to get a lot of stuff done. I don't know what I want to do come Monday when I speak or text my pdoc, maybe remain where I am or consider a switch.  The thing that concerns me about brintillex is that it is really new, so who knows what they will find out down the road, and also it seems to make a lot of folks throw up.  I don't throw up easily, but pretty much all of the ssris aren't for stomach comfort anyway, but IIRC with Zoloft it was bearable and I certainly didn't feel like throwing up.  At least I am happy to have had two decent days of late.
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Re: Rough patch right now, still on pristiq and a bit more
« Reply #15 on: June 22, 2014, 07:03:22 PM »
no ectopic beats even though I swore I felt three pauses that morning in bed

I thought this might be the case. Good news!  :happy0151:

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we could switch, this time she mentioned brintillex, a new SSRI she described as Lexapro plus, or, after I mentioned previous success on it, Zoloft.

Brintellix (vortioxetine) isn't that special. It is basically another SSRI which also has Buspar like effects on the serotonin 5-HT1A receptor. It is the same idea as Viibryd (vilazodone). I think a regular SSRI supplemented with Buspar is a better option as the two can be fine tuned to individual needs.

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 #16 on: June 23, 2014, 06:25:20 PM »
Well I texted with the pdoc today, I had left her a message that I couldn't make up my mind what to do.  She said a conservative approach for now would be to add back 5 mg of Lexapro, and when I asked if there would be a problem with the half a 15 mg remeron pill that I take in addition to the 50 mg of Pristiq, she said not likely.  So I will give it a go, the transition from Lexapro to pristiq wasn't that bad (minus a few night sweats) and maybe the low dose of Lexapro will up the serotonin effects enough to get a consistent positive result--I do remember feeling mostly good during the transition until a week after I dropped the Lexapro.  What I should do later I am not sure, maybe the combo will work well, or maybe I will use Lexapro to get off pristiq and either try it again (this time with the small dose of remeron perhaps) or transition to another ssri from Lexapro.  Ian I do feel leary about any new antidepressant that hits so many receptors like Brintillex, like you say maybe it isn't that much different than an ssri and buspar, plus I think more time is needed to see how good it really is and how long it works without pooping out for many. 
The remeron does seem to let me sleep and it does counteract the sexual side effects of pristiq.  So its good for something.  Today I did feel a bit miserable from stomach issues, a bit of dry mouth, a fast (for me) pulse in the low 90s and an aching back the latter of which has nothing to do with anxiety/depression or medicines, just too much hard work outside that I need to refrain from for a bit. Sometimes my eyes feel weird too, I think that must be a pristiq thing, but I see just fine.  On the other hand I had good news, my students did really well on their finals so that helped cheer me up.
I also wonder if there is  a time factor to this illness, when it first appeared some 25 years ago it took a good couple of years to fully recover, and during much of that time I was still productive even though I felt sick every day.  It kind of faded away after some time on effective medication, at that time Klonopin and Pamelor, but I didn't like the orthostatic hypotension and fast pulse with the latter or glassy eyes with the former. Eventually I transitioned to Zoloft, then serzone, both of which worked fine and were easy transitions, and dropped klonopin along the way at some point (though I always carried it "just in case").  Round 2 happened about 12 years ago, also starting off with a panic attack like the first one (though subtle symptoms of stress/depression may have proceeded both) and the move off serzone to Zoloft  was not fun.  However I was mostly better within 3 months and considerably better in a year or so.  At some point I got onto Lexapro and that was excellent until this current round, which did not start with panic, but rather sustained anxiety for 3 days and has proven more difficult to get under reliable control.  I also experienced much tragic loss during this time which certainly didn't help. Looking back I can say at least that I was productive this year, and there have been frequent good days/periods punctuated by bad days.  A really bad day means I get very anxious and then tearful, extra klonopin helps that a bit, but I often don't take extra or enough extra beyond my 1 mg daily total fast enough to stop the "meltdowns".  At least they have been few and far between of late. I hope that no matter what I do, at some point the illness just runs out of time and I will get better like before, of course I dread it happening again, I can see myself getting better only to start watching for its return around the 10 year mark.  But by then there will be a few more options, and maybe if I pay attention to early warning signs (I know I was stressed out for months before it happened this time over a move and some other stuff--but never did I think I would get sick again and I thought just raising the Lexapro would take care of it within a couple of weeks at most, boy was I wrong) earlier treatment can nip it in the bud before it goes ballistic again. 
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Re: Rough patch right now, still on pristiq and a bit more
« Reply #17 on: July 07, 2014, 05:25:43 PM »
Just another update, I have been better since I added on the 5 mg of Lexapro to the 50 pristiq and 7.5 remeron.  Still taking 1 mg klonopin in divided doses as before.  Today I did feel a bit downish, but not enough to stop me from doing some work until it got too hot and I came inside.  Last week I remember a day where I felt so "normal" it was almost scary.  I really savored that day.  The other days weren't as stellar but not bad at all, well within "normal" actually.  I think what got me today was the fact that I had a palp or something while out with some friends yesterday, it was hot, and while standing outside I felt not the typical flipped PVC feeling but just a moment where I felt like I was sinking or something and couldn't move/breathe whatever, it passed quickly.  I really couldn't say if I felt anything in my chest, it was more of a head feeling, but I didn't black out or anything.  Maybe it was some other weird body thing, but it upset me a bit  because throughout this long illness (year and a half so far this time) I have been spared palps or similar stuff for the most part till recently.  However I did a treadmill test last week and it was fine, the cardiologist said no problems I can exercise.  I am trying to rationalize my fears away, mainly with the idea that whatever it was, it didn't harm me and really no matter what I cannot control everything about my body or my life, as my therapist has pointed out we have less control over our lives than we like to think that we do.   Worrying does not help a situation like this, I got checked out, even if they missed something (oh how we anxiety sufferers tend to go there) worrying will not fix it, and only takes away from the possible pleasure one can have in that moment instead.  Also my back pain has improved since I last wrote, while I did have some joint/back pain today from some hard digging in the garden, it was not nearly as bad as a few weeks ago.  I will see the pdoc next week, I am a bit concerned that she will be away for 3 weeks without a pdoc backup (there is a PA who can write prescriptions I think) but even that worry is illogical because why should anything happen then that hasn't already happened, and I can always go to a regular doc or  emergency room (not that the latter is particularly useful in my experience anyway) if I have a problem.  I guess we anxious folks like to know our security blanket is always there, but docs and therapists have lives too.  I can always call my therapist as well if I have a bad experience or day.  Overall I am trending better, the bad days are not as bad and farther and fewer than before, and the good days can be really good.  I am less afraid of being by myself (and I have to be alone a lot during the summer months), and the agoraphobia is so much better than a year ago, if I feel any its small and I can fight it.   I am checking my bp/pulse less often, going days without doing either, but today I did check and even not feeling stellar at the moment the bp was low and pulse in the mid 80s, nothing to worry about.  I did get the weird top of the arm burning feeling today, thought maybe I had sunburn but it has calmed down by now so I think it was just some residual anxiety.  At some point in the future I will want to get off Pristiq since it has no official way of going down or up in increments (Ian I did read the fruit juice idea, it could work I guess but the time release factor would probably be compromised), if I am truly lucky Lexapro might work again (there seems to be no studies on whether a med can work a second time if it worked fully for years, then didn't work fully, and is tried again) though I have heard of a case through someone I know of paxil pooping out and then working again after a few months on another AD that didn't work so well. It would be good if the drug companies would do this kind of research (it wouldn't be hard, all you would need is a questionnaire, access to a large body of patients/former patients, and access to a computer for statistical analysis) but they have no incentive to do so, long term studies that might involve other meds they don't sell don't seem to matter to them.  But it sure would be useful for patients. 
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