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Pristiq - Side Effects (Should I call my pdoc?)

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Hi everyone,


I'm new here, and after reading through many of the threads, I found the information and your experiences very helpful so I thought I'd post my question. 


A little background history on myself: I don't have much experience with pdocs or psychotherapy. I've seen several over the past years but nothing every mounted to a full-on, lengthy relationship with a pdoc or with specific meds. I do not know what is wrong with me. When I was 15 yos, I was diagnosed with BD by a pdoc who spoke with me for five minutes, in front of my mother, and based off of my recorded responses to a questionnaire, provided that diagnosis. After reviewing the medications he wanted to put me on, my parents removed me from therapy with the psychologist who referred me to that pdoc. In college, I went to see the on-campus pdoc about my severe social anxiety and panic attacks, both provoked and unprovoked. I was prescribed Celexa, and it did absolutely nothing for me. I was still experiencing the same amount of anxiety, panic attacks, and severe mood swings. I stopped taking it after a month. Within the same year, I went to another pdoc about those same issues. She diagnosed me with GAD and panic disorder but not SAD. I was taking, ad hoc, Ativan and a variety of ADs - first was Zoloft, which did nothing for me. Second, I was placed on Lexapro. That sent me into a full blown rage. I was crying for no reason, having rage fits, a lot of violent thoughts, screaming, staying up all night, and drinking heavily. I was immediately placed on Effexor (and was supposed to be placed on Abilify as well but my insurance denied it). The Effexor was okay. It just stopped working after awhile. I was placed on Xanax temporarily and my pdoc told me, "If you want more, then you have to sign up for a Toastmasters meeting to work on your speech." That pissed me off, and I stopped seeing her even if that meant I wasn't going to be prescribed a benzo (the only medication that helped). 


After experiencing an extremely low depressive state for the past 8 months, I went to my current pdoc. She never gave me an official diagnosis, but she prescribed me Pristiq 50mg. I've been taking Pristiq for two weeks.


During the first week, I experienced:

  • Insomnia 
  • No appetite (I was eating ~500 calories a day before taking it - now it's down to almost nothing)

  • Racing/loud thoughts

  • Nausea

  • Rambling speech/fast, incoherent talking

  • Dilated pupils/wide eyed

  • Palpitations and high blood pressure [Note: I am taking a beta blocker for my autoimmune disease, and it still has that effect]

  • Blurred vision

  • Tremors

  • Lack of concentration [i have really bad concentration because of my disease, and Pristiq made it a whole lot worse]

  • Anxiety

  • Mood swings

  • Jaw clenching/grinding

  • Blurred vision

Then one day over this past weekend, I crashed. I overslept for 11 hours. I guess my body needed that rest.


Yesterday, I felt "normal," just blank. I was also extremely tired. My appetite slowly returned, but I'm still under-eating. I can sleep throughout the night, but I wake up after 5-6 hours of sleep. It's something though.


Today is what worries me. I woke up in a blank state but it's slowly transitioned into anger and rage. I'm currently at work trying to fight my emotions. I'm extremely pissed off and irritable. I want to fight someone. I casually had a suicidal thought that dissipated as quickly as it came. I absolutely have no concentration today. I've been very fidgety, and I clench my hands to try and release some of that energy (to no avail). My anxiety is through the roof. Oddly, I am also tired but not as bad as yesterday. Even writing this has been really difficult. I had to go over and over it to correct all the spelling and grammar mistakes. 


So, here's my question: will these side effects work themselves out or is it enough to call my pdoc with my concern? I guess today really scared me, because I'm not myself. I'm not sure if I should just wait it out for the full month.


Any response would be helpful - thank you!

Edited by gwu2011
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Don't wait until your next appointment--call your pdoc and tell her exactly what you have written here.


Thank you for your response. I took your advice and called my pdoc's office. Her staff told me that I'd have to come in for an appointment (scheduled in the next 6 days) and didn't transfer me through to my pdoc. I'm feeling really discouraged, and my symptoms have only gotten worse. I'm not sure if that's normal for the doctor's office to do?

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Hi there, no problem.  I'm sorry you're feeling so unwell and discouraged.  Sometimes unless you specifically state that you have immediate, urgent concerns about your reactions to your medication and ask to speak with your doctor ASAP, the staff might not know to put you through to her and will try to help you as best they know how.  The side effects you described sound very troublesome in nature, as are your increased anxiety, anger and irritation, and suicidal thought(s) that have started in the last day or two.


I have not had any firsthand experience with Pristiq so I'm afraid I can't speak to the side effects and whether they might go away with time (hopefully so), but if I were you, I would call the office again tomorrow and ask to speak with your doctor as soon as she is available so that you can share what's been going on and she can direct you from there.  As a pdoc, she should be used to getting phone calls like yours.


I hope you get some relief from these side effects soon.

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Hi gwu2011. This is my rather long rant about Pristiq, before, during, and after.


While I can't say our circumstances are exactly alike, I have experience with SSRIs as well as SSNRIs, benzos, and am currently taking an SNRI (started this past week, still weening myself off of Pristiq).


I took Celexa for one year, for major GAD, SAD (social anxiety, not seasonal affective), and panic attacks. It did take the full 6wks for it to kick in well, but when it did, my anxiety decreased A LOT. I may have come close to having a panic attack a few times, but I could manage it with a small dose of Ativan (.5-1mg). Sometimes I wouldn't even need that (then again, sometimes I would need more). The problems that arose with Celexa came on slowly.

1) Weight gain. About 10-15lbs over the year. Couldn't lose it, didn't really have the motivation to do much about it. But weight gain made me incredibly self-conscious, leading to depression and more anxiety!

2) Flat emotions. I mean, cognitively I understood what I should be feeling. And in a sense, I would respond. But I just didn't have a handle on it. It was bizarre. And with lack of emotion came lack of sex drive.

--I'm married. Weight gain and no desire for sex isn't exactly the key to a happy marriage. = More anxiety.


So, after sticking it out for as long as I could, I did my own reserach and asked my pdoc for Pristiq. He had suggested Cymbalta, which is also an SSNRI. But I wanted to go my own way, and he was okay with it. My reasoning was that I do enjoy my wine and cocktails when I want them, and Pristiq isn't metabolized by the liver in the same way as Cymbalta or Effexor.


Now, transitioning onto an SSNRI is unlike anything I've ever experienced. My system was highly affected by the norepinephrine boost. It was  energy overload. I woke up one morning and told my husband I was going for a jog and he looked at me like I had absoutely lost my mind (obviously, jogging is not something I do normally). That was the very beginning.


The side effects were moderate and did subside, for the most part--some flushing/hot flash-like symptoms (which I attributed to elevated blood pressure which IS a common side effect), initial weight loss, insomnia, light buzzing headaches.


On the other hand, my anxiety relief was unparalleled. I felt like I was "cured" for the first time in the 5 yrs that I've been suffering through anxiety & panic.


It was not without its cons, though. I didn't drink as often on Pristiq, but when I did, the following day was SO BAD. Anymore than a few glasses of wine and I was useless for a day/the day was useless to me. My heart raced, I was incredibly nauseous, headaches, sweats. . .

After the 6wks, my Pristiq "honeymoon" was truly over.

I gained over 20+lbs in two months. My hunger was insatiable even though I KNEW better. It's not like I was working out in any way.

I also began to experience ADD-like symptoms, without ANY of the energy associated with the disorder. I could get through my daily routines, sometimes, but beyond that I was becoming more lethargic than I have ever been in my life. More often than not, you would find me wrapped in a blanket on the couch, watching tv. I didn't even have the attention span to read more than a few pages of a book!


Emotionally, I was a bit less irritable MOST of the time, with occasional outbursts of anger that didn't seem justified. Better sex drive, but nowhere near my "old" self.


That became too much. I really felt like I was on the way to diabetes/heart attack. It really was that bad with no sign of improving. So, back to the pdoc I went. I asked for Wellbutrin b/c again I have heard it may help with weight loss and energy levels. I am on an incredibly low dose while tapering off the Pristiq.


I will tell you that missing a dose or withdrawal from Pristiq is one circle of hell after another. My body is so uncomfortable, I am "zapped" intensely and randomly. I sweat. I am flushed. My heart races. I want to crawl out of my skin. I imagine this is what detoxing from opiates is like. It is slowly subsiding, but wow. As much as Pristiq helped my anxiety, it is equally as strong leaving my system. I really can't say if the Wellbutrin is going to be a good alternative. But I do know that I would be wary starting a medication as strong as Pristiq EVER again. Good luck, I hope things get better for you.

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