Q. Can you offer me any ideas of how I can ease my withdrawal from Pristiq? My brain is cloudy, I am having brain zaps and I am agitated.

I should have never tried it out. Please help!

A. You must let your physician know what is going on. DO NOT stop this antidepressant suddenly. The withdrawal symptoms can be devastating.

Here are some stories to consider:

“I was prescribed Pristiq (desvenlafaxine) four years ago [this drug is somewhat similar to Effexor (venlafaxine) and Cymbalta (duloxetine) in that it works the same way] when Lexapro lost its effectiveness. Pristiq seemed to have no obvious side effects unless I forgot to take it in the morning. By afternoon, I would be experiencing brain zaps and hearing my eyes move. I would see “trails” when moving my eyes. This would go away within hours of taking the missed dose. I then tried to stop the drug myself, because I didn’t want to be on something that has that effect.

“I tried weaning off myself by taking a full dose (100 mg) then 75 mg the next day and alternating for 2 weeks then go down to 75/75. I went crazy after two weeks and had to go back to the original dose. Not only did I have severe suicidal thoughts every 5 minutes, but uncontrolled crying, extreme sluggishness, night sweats (when I could sleep), weight gain, irritability and mood swings. Physically, my blood pressure (which has ALWAYS been 110/78) jumped to 149/101.

“After two weeks of getting back on the drug, all symptoms (including high blood pressure) normalized. I am now under a doctor’s care to switch back to Lexapro (which she says will work again since I have given the drug a rest). She is having me take a full dose of Pristiq one day and then full dose of Lexapro the next day for a week. Then in 2nd week, Pristiq 1 day, then 2 days of Lexapro. She supplemented with Abilify daily. So far, the withdrawal symptoms have been manageable and I am in my 2nd week. I have added weekly acupuncture for the mood swings and am hopeful that I will have my life back.”
A. H.


“I was put on Pristiq almost a year ago. I got tired of taking this drug and I slowly started weaning myself off of the pills for about a month. As I’m typing this message my brain is shivering and zapping like nobody’s business. When I tried to explain it to my doctor he acted like he didn’t know what I was talking about. In the meantime, I suffer like crazy.”

Oscar


“I am coming off Pristiq right now. Was on 100 mg a day and my doctor pulled me off it cold turkey. I’ve only taken it for about 2 months, but I feel like I’m going crazy. I have the brain zaps so bad I can barely walk around my house. I’m terrified to drive. This is worse than anything I’ve ever been through, and that includes quitting smoking.”

Laurel


“I have been on a variety of antidepressants over the past few years for depression and anxiety. My latest prescription is Pristiq 50 mg once a day. I have been on it for 6 months. At first, I did see a difference in my depression and anxiety, but things began to change in the 7th month. I started having side effects from Pristiq. I haven’t had a brain freeze yet, but I have had other symptoms.

“I have had insomnia, headaches, GI upset, elevated cholesterol, blood pressure changes, joint/muscle pain, abnormal swelling all over, fatigue, agitation and ears ringing. From what I have read this is a hard medication to get off. I didn’t realize that this medication was making me sick until I went online and started to look up my symptoms. I really don’t know if I want to continue to take antidepressants if they are going to make me more physically sick.”
Julie


PEOPLE’S PHARMACY RESPONSE:

No one should ever discontinue antidepressant medication without medical supervision. As described above in vivid detail, the withdrawal symptoms can be terrible. We are especially concerned now that we see Cymbalta (duloxetine) advertised for arthritis symptoms. We wonder whether physicians are warning patients that getting off such drugs can be challenging (to say the least).

Here are some side effects to be aware of with Pristiq and Cymbalta:

CYMBALTA (DULOXETINE) & PRISTIQ (DESVENLAFAXINE) SIDE EFFECTS:

• Nausea, stomach pain, constipation, diarrhea, decreased appetite, vomiting
• Dizziness, fatigue, sleepiness
• Dry mouth
• Insomnia, anxiety, jitteriness, irritability, tremor
, weird dreams
• Sweating, hot flashes
• Blurred vision
, glaucoma
• Headache
, ringing in ears
• Sexual dysfunction, lowered libido, erection difficulties, lack of orgasm
, abnormal ejaculation
• Liver damage
• Serious skin reactions, rash, hives (requires immediate MD assistance!)
• Glaucoma
• Irregular heart rhythms
• Bleeding problems
• Blood pressure problems
• Interaction with other drugs (leading to serotonin syndrome among other reactions)
• Pneumonia
• Seizures
• Depressed mood, suicidal thoughts and behavior, suicide

Some people never experience such side effects and achieve substantial benefit from medications like desvenlafaxine, duloxetine and venlafaxine. But others find the problems with such drugs overwhelming. The sexual side effects alone can be disconcerting. They are also quite common. You can imagine that dizziness, dry mouth, lack of orgasm and excessive sweating might be enough to drive a person to want to stop such medication. But as you will see below, that can trigger a whole other set of problems.

Doctors have taken to calling this “discontinuation syndrome.” These clinical words do not do justice to what it is like to stop antidepressants like Cymbalta, Effexor (venlafaxine), Paxil (paroxetine), Pristiq (desvenlafaxine) or Zoloft (sertraline) suddenly.

SUDDEN WITHDRAWAL SYMPTOMS:

• Brain “zaps” (electric shock-like senstations in the brain)
• Dizziness, light-headedness, vertigo, feeling faint
• Headaches
• Anxiety, irritability, hostility
• Nausea, diarrhea, digestive upset
• Tremor, hands shaking, nerve tingles, strange sensations
• Fatigue, tiredness, lack of energy
• Visual disturbances

So, what is a person to do once started on the antidepressant merry-go-round? Sadly, doctors do not have clear guidelines about how to help patients stop such drugs. There is no clear-cut formula that will work for everyone. Patience is essential, though. This is NOT a do-it-yourself project. You will need help from a knowledgeable health professional. And you will need to take time. For some, a few weeks may be adequate to gradually phase off the drug. For others, it may take many months of very slow dosage reduction.

We offer our Guide to Dealing with Depression. It provides some additional insights into both side effects and withdrawal. It also discusses some other ways of coping with depression. Whatever you do, you will need great support from a health professional who understands the complexity of such medications.

You are also invited to share your experience with these drugs below.

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  1. Sue
    Illinois
    Reply

    I have tears of joy right now after reading these posts. I have been suspecting what I have been experiencing was related to discontinuing Pristiq, but wasn’t sure. After my visit to my Dr. today I felt even more crazy! My Dr. Put me on it 18 months ago for peri menopausal emotionality and hot flashes. She wanted me to come in every 6 months for a check-up. At the 18 month mark she suggested I discontinue. She told me I could do so cold turkey, or take it every other day for a while. In hind sight, that my was first clue that she was clueless. I was on the tail end of a cold when I was there, and a few days later felt horrible! It was like a hang over that got worse as the day went on. Nausea, frequent bowel movements, foggy brain, exhaustion and I could hear my eyes move! At that point I decided to tapper the drug because I thought I had heard you shouldn’t stop abruptly. I didn’t know if there was a correlation but I wasn’t taking a chance. I tapered it the next couple of weeks, every other, every third day etc.

    When I had been off for about 5 days, although not as severe, I had a horrible sick day. I had frequently been nauseated, emotional, foggy and could hear my eyes move, but this day was worse. The next day a bit better, but the head stuff lingered. That continued across the weekend, and whenever I was in the passenger seat of a car, I felt car sick. I called the Dr. this morning and got an appt. with the physician’s assistant for this afternoon. I left there feeling like I was crazy. She mentioned the possible withdrawal, but acted like it couldn’t still be that. She also said she’d never heard of the “hearing the eyes move” thing before. I felt like she was trying, but struggling to find a polite way of saying ‘it’s you’re imagination’. She did speak to my Dr. Who also claimed to have never heard of the eye thing.

    Their solution was to prescribe me Lexapro, since I’m experiencing occasional anxiety. I was hesitant, but didn’t disagree, because throughout this mess I had been thinking, if I was anxious or moody, it must indicate I was reaping addition rewards for more than just menopause. After reading here tonight that anxiety is one of the many withdrawal effects, and these symptoms fit me to a tee, I am not going to pick up that script, and I’m going to search for a new dr. I really would have appreciated a heads up on this withdrawal syndrome when she DC’d the drug. As well as not making me feel like a crazed idiot while I was in her office. Thanks for letting people post their stories. This helped me tremendously!!

  2. Sarah
    MA
    Reply

    I have been on Pristiq for several years. It helped me weather my divorce depression, which was worse than my usual depression.

    Originally, my doctor prescribed Cymbalta. Cymbalta helped a lot at first, but after a couple months I developed severe diarrhea — I had it about 20 times a day, including during the night. For 8 months I could not go anywhere, and sometimes had to shower and change sheets in the middle of the night. I had a colonoscopy and was told that I had developed microscopic colitis and would have it for the rest of my life. However, I was also referred to Mass. General’s Crohn’s & Colitis Center. As I was being interviewed by a doctor there, I mentioned that I was taking Cymbalta. He immediately stopped me and told me that they had seen quite a few post-menopausal women who had developed microscopic colitis after taking Cymbalta. He advised me to start weaning myself off it and see if the diarrhea continued. I slowly weaned myself off over the course of a few weeks and the diarrhea completely stopped and never returned. I told my shrink about this (she is on Harvard Med. School faculty) and she said she would discuss it with the drug manufacturer’s rep. Bottom line, the drug company said they knew nothing about any connection between Cymbalta and microscopic colitis … But I don’t believe it. Based on my own experience, and the doctor at MGH’s comments, I think the drug company is lying.

    Since then I have been taking Pristiq, but I have gained quite a bit of weight. I don’t eat very much and I have a healthy diet (need to exercise more). I know that it is difficult for someone my age (61 and post-menopausal) to lose weight, but my doctor did acknowledge that Pristiq can cause weight gain. Because I am feeling less depressed lately, I told my doctor that I wanted to try cutting down the dosage of Pristiq from 100 mg to 50 mg, to see if that would help me lose some of this weight. I have been taking the reduced dosage for about a week now, and I have to say that I have not felt well in the last week — migraine headache for 2 days, some feelings of nausea, lack of energy, irritability, increased depression. I am hoping that I can ride this out without going back to the higher dose. I would like to completely eliminate Pristiq from my life.

  3. Claire
    Australia
    Reply

    I’m going crazy….
    I have been weaning off 100mg of Pristiq for the past few months and have now had nothing for 4 days. I am actually losing my mind. I am rage-filled. And driving to work this morning I wanted to drive my car into a tree. My heart beats in my ears in weird bursts. I’m terrified that maybe I am crazy and that’s why I should stay on it… Or is it really the withdrawal symptoms? I am having very reckless thoughts that would destroy my marriage…. I want to buy a ticket to the other side of the world and never come back. Will this go away? If so how long?

    My Dr says I have to ride it out. But what if I actually lose my mind…?

    • Aly
      Australia
      Reply

      I’ve come off Pristiq before – had to go back on – and now coming off it again. I can tell you from my personal experiences that this is exactly how I get, too. Pristiq is a horrible, horrible drug to come off.

  4. Esther
    Victoria texas
    Reply

    I had been on Pristiq for over 5 years. I was taking it for hot flashes. It worked for me right away. Once I went out of town for a week and two days went by and I had this horrible headache that I couldn’t even think. The pain was so bad, my vision was blurry, I got very irritable. Looking through my meds, I noticed I had left this one at home. I managed to drive home, which was a 2 hr drive. I took it and I was better. Another time the pharmacy got my prescription mixed up and I went 3 days without it. I was bedridden because the headache, nausea, diarrhea and stomach pains were excruciating. I finally got my prescription and within hours I was okay. I decided that I wanted to get off of it and I DID! I was on 100 mgs and week one I took 1/2 a pill then the 2nd week I cut the pills in 1/4 ……..for the next week I had headaches but nothing an over the counter advil can’t take care. I’m doing so good without it. Good luck to anyone else trying to get off of it.

    • alice
      ridge ny
      Reply

      I am so afraid to stop. Prestiq worked for me but I am ready to stop. I’ve tried before and felt nervous, dizzy, and had really bad headaches. I went back on. I have to try- it’s been 4 years. I will speak to my doctor, thanks.

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