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. Rachel
    Florida
    Reply

    I’ve been on pristiq, twice. Once for anxiety; once as an add-on to control seizures (I have a brain cavernoma in the area that affects anxiety). I will never use this medication again.

    My first time getting off of pristiq was after about 3 years of use at 50 mg. I chose to cut the meds, and experienced severe (undiagnosed) focal partial seizures/brain zaps for about 3 weeks. My experience may be unique in that I do have a seizure disorder. Pristiq causes seizures, and did with me, during the withdrawal phase. (I also had seizures once in awhile while on the meds, but the seizures were not yet diagnosed).

    My second time getting off of pristiq (25 mg) was after being on it for 3 months. Recent treatment for seizures may include adding an anti-depressant/mood stabilizer to minimize the seizures. I am also unique in that my seizures may be caused by my brain cavernoma (known to bleed and cause seizures; it has done both in my case). With one seizure medication (zonisamide), pristiq didn’t mix well…with another seizure medication (oxcarbazepine), it did fine. However, now that I am tapering off of the pristiq (I switched to venlafaxine 37.5 mg) I am experiencing withdrawal and a return of the seizure symptoms (so I am again not sure if my seizure meds are working or if it is the withdrawal from pristiq/venlafaxine). I chose to stop the pristiq because it wasn’t helpful, and I was concerned about getting off it (I hadn’t realized all forms of pristiq are xr, which means you can’t get off of it safely/without experiencing some kind of withdrawal symptoms). I hate it, I hate it, I HATE IT!!!

    Regardless of the cause or correlation, I will never use pristiq/venlafaxine again. The withdrawal exacerbates my seizure symptoms and it is horrible. During withdrawal, I have experienced vertigo(not the same as dizziness), nausea, brain zaps (seizures in my case)…even though I have tapered slowly. I wish I had never agreed to use pristiq again. Erroneously, I thought pristiq was not extended release, but all forms of it are. You cannot get off of it without withdrawal or needing to switch to another medication that you can safely cut…but you’re likely going to experience withdrawal. It completely sucks!

    FYI – prior to tapering off of my 2nd use of pristiq, I contacted the manufacturer to get tapering instructions. They had NONE. It was not helpful and now they try to contact me to “get more information about my adverse side effects,” since i mentioned that I had cut the pills in the past and experienced increased seizure activity. I already reported it, but don’t want to offer any more information. It feels like an invasion of my privacy, rather than a legitimate gathering of information for helpful use.

  2. Raziel
    Israel
    Reply

    Currently coming off 50 MGs been on for two years. I’d like to add my perspective, currently experiencing some discomfort.

    I say to the Brain: My Brain, My Brain, My Beautiful Brain, my source of comfort and familiarity you run my body so precisely at every moment I’m forever grateful.

    However in days passed we wondered off the path of positive thought and we imagined dogmatic realities and envisioned danger around every corner, the curse of the imagination took hold and depressed our natural zest and curiosity for life, and we needed some physical assistance to create the serotonin you so cherish.

    Today we know better, we no longer fall in to the trap of the evil inclination the imagination who makes us assume the worst at every turn, we can tell what’s real and here and now, from what’s not real and only exists in our mind, and we are therefore ready to take back control of our serotonin production.

    There is a however a necessary period of adjustment, and you, my strong capable Brain, will be at the forefront of it. We can do this together my beloved Brain, let’s not resist the change taking place within us, let’s welcome it, this is the door to our healthy future if we keep faith in one another we can beet this for sure. I will make everything in my life secondary to you my Brain in these few days where you need all my attention. I will rest if you want me to rest, work if you want me to work, be social or alone as you please, we will accept this transition together because we know it’s best for us in the long run and we will enjoy the rest of eternity in freedom together.

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