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Hey guys here I am again swinging wildly on med merry go around.   I'm gonna try and post updates here on how it goes.  If anyone has been on Pristiq and wants to share their experience that too is always greatly appreciated.

I switched from 300 mg Venlafaxine (generic garbage) over to 100mg Pristiq about 3 days ago.

First day i noticed no changes.  Second day nothing, but I felt very itchy all over.

   Third day I did notice a few small changes in my thinking, a bit more organization, alongside that I noticed some side effects, extremely dizzy and a little bit of nausea.  I also hear a buzzing noise in my head when I move my eyes from side to side or up and down.  Hard to tell if this is a withdrawal from effexor, or just a start up of Pristiq, I expected some adjustment effects so I'm none to concerned.

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Fourth Day on it I don't feel too much different, still out of it, dealing with a lot of dizzyness and confusion.

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Btw, Does anyone actually know what the difference between Effexor and Pristiq?  Only information I've seen is that they are processed in the body differently...

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15 minutes ago, BrianOCD said:

Btw, Does anyone actually know what the difference between Effexor and Pristiq?  Only information I've seen is that they are processed in the body differently...

Pristiq is a metabolite of Effexor. I guess you can think of it as getting to the point sooner.

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On 8/4/2019 at 9:25 PM, argh said:

Pristiq is a metabolite of Effexor. I guess you can think of it as getting to the point sooner.

Thanks argh

Last few days I haven't felt too good, especially a few hours after taking the Pristiq I feel dysphoric, and to add to the problems I'm starting to have insomnia.

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Pristiq can definitely cause insomnia. The dysphoria is concerning. I had that too when I took Pristiq. I took up to 150 mg with no help from it.

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Posted (edited)
4 minutes ago, mikl_pls said:

Pristiq can definitely cause insomnia. The dysphoria is concerning. I had that too when I took Pristiq. I took up to 150 mg with no help from it.

Ya it's mostly the 4-5 hours after taking the pill, it's a strange chemical feeling, absence of emotions, and further I get away from it the better I'll feel....Is that how you remember it?

I really wish I could go back to taking Effexor, why do they have to charge 3k a month tho

Edited by BrianOCD
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20 hours ago, BrianOCD said:

Ya it's mostly the 4-5 hours after taking the pill, it's a strange chemical feeling, absence of emotions, and further I get away from it the better I'll feel....Is that how you remember it?

I really wish I could go back to taking Effexor, why do they have to charge 3k a month tho

That's weird. I would assume that Pristiq would be processed quicker and have less side effects...Hmmm.

Brand name Effexor is 3k per MONTH??? That's insane. So the generic was completely ineffective for you, but the brand would still be working?

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2 hours ago, Blahblah said:

That's weird. I would assume that Pristiq would be processed quicker and have less side effects...Hmmm.

Brand name Effexor is 3k per MONTH??? That's insane. So the generic was completely ineffective for you, but the brand would still be working?

I can't say for sure if the Brand Name would be working, but every time I've been on Brand Effexor I've felt good.

Ya I don't understand the pricing of some of these drugs or why they do what they do, it's a shame.

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23 hours ago, BrianOCD said:

Ya it's mostly the 4-5 hours after taking the pill, it's a strange chemical feeling, absence of emotions, and further I get away from it the better I'll feel....Is that how you remember it?

I really wish I could go back to taking Effexor, why do they have to charge 3k a month tho

I just generally felt completely anhedonic while on Pristiq. Then again, that was what I was experiencing before I got on Pristiq 150 mg (the second time I took it). It just seems like Pristiq magnified the anhedonia.

I know it's a lot to pay for brand-name Effexor, still, but have you checked out GoodRX.com? Effexor XR 150 mg x60 is around $970-ish depending on the Pharmacy you go to. You could also try and apply for a patient assistance program from Pfizer to see if you qualify to get free brand-name Effexor XR from the pharmaceutical company.

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Posted (edited)
4 minutes ago, mikl_pls said:

I just generally felt completely anhedonic while on Pristiq. Then again, that was what I was experiencing before I got on Pristiq 150 mg (the second time I took it). It just seems like Pristiq magnified the anhedonia.

I know it's a lot to pay for brand-name Effexor, still, but have you checked out GoodRX.com? Effexor XR 150 mg x60 is around $970-ish depending on the Pharmacy you go to. You could also try and apply for a patient assistance program from Pfizer to see if you qualify to get free brand-name Effexor XR from the pharmaceutical company.

I'll look at the goodrx, good idea!

Their patient assistance program dried up last year, they have a card but only offer like 2000 worth a year which wouldn't nearly cover it...

Does anyone know why they charge so much?  It seems pretty fucked up to me...If I could get it for 200-300 a month I might be able to pull that, but wtf thousands a month?

Edited by BrianOCD

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Semi off topic, but have you considered a mood stabilizer, aside from lithium? As an AD, Wellbutrin works for me, but it seems i need a mood stabilizer to really smooth things out.

to be honest as awful as remeron was for me, it was pretty good when combined with an iffy mood stabilizer...i just got the hell off it and used the mood stabilizer with Wellbutrin instead of being on three meds.

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On 8/8/2019 at 7:29 PM, argh said:

Semi off topic, but have you considered a mood stabilizer, aside from lithium? As an AD, Wellbutrin works for me, but it seems i need a mood stabilizer to really smooth things out.

to be honest as awful as remeron was for me, it was pretty good when combined with an iffy mood stabilizer...i just got the hell off it and used the mood stabilizer with Wellbutrin instead of being on three meds.

I have seroquel, altho I don't use it much, only for sleep/anxiety issues

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9 minutes ago, BrianOCD said:

I have seroquel, altho I don't use it much, only for sleep/anxiety issues

I mean like a therapeutic dose and daily. Iirc seroquel needs to be in the  150 to 300mg range for mdd. Under that it acts mostly like a very strong antihistamine.

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Posted (edited)
On 8/4/2019 at 10:08 PM, BrianOCD said:

Btw, Does anyone actually know what the difference between Effexor and Pristiq?  Only information I've seen is that they are processed in the body differently...

Effexor (venlafaxine) is broken down by a liver enzyme CYP2D6 into O-desmethylvenlafaxine, which they have otherwise abbreviated as desvenlafaxine for the purposes of marketing (Pristiq).

The reason for even making Pristiq was because a vast majority of the therapeutic effect from Effexor comes from this specific metabolite. Those who are poor 2D6 metabolizers don't properly break venlafaxine down into desvenlafaxine, and as a result, even at normal doses (300mg), the patient may have an incomplete response. In this case, if the person is identified as a 2D6 poor metabolizer, doses of up to 600mg of venlafaxine can be administered if tolerated to reach the necessary plasma levels of desvenlafaxine to have a therapeutic effect.

Rather than have patients spend a fortune on 150mg pills, they came out with Pristiq (desvenlafaxine), which completely bypasses this metabolic dysfunction. On the one hand, Pristiq was made for those who could benefit from Effexor but are limited by their liver. On the other hand, Pristiq is an example of pharmaceutical "evergreening". Pristiq isn't necessarily more effective than Effexor, it might just work better in a certain patient population, and in some scenarios the response from Pristiq isn't as robust as the response from Effexor. Effexor can have analgesic effects where Pristiq does not. There's evidence that Effexor can interact with opioid receptors and it is actually structurally very similar to tramadol (a synthetic opioid). It's also not entirely clear if Pristiq has the same therapeutic effects on anxiety disorders as Effexor.

You've been taking Effexor for some time now and your body is probably getting used to not having the parent venlafaxine component around and just having the metabolite. This is okay. Effexor withdrawal is known to be rough. It's generally just rougher going in the opposite direction for some reason (i.e. from Pristiq to Effexor instead of Effexor to Pristiq). It may be that Pristiq generally has fewer side effects than the parent drug and what you're experiencing is truly just withdrawal symptoms that will subside with time.

@argh is right that more of a mood stabilizer punch may get you back on track. Taking 50-150mg of Seroquel every evening instead of 25-50mg as needed may make a huge difference. You might still feel a little spacey, but the goal is to eliminate any dysphoria that you may be having. That's the primary target always.

I see you've tried Abilify and Vraylar. I remember a bit of your Vraylar trial, and you said it didn't really agree with you. I would certainly recommend Rexulti for depressive issues. At low doses too. Only 0.25mg-0.5mg at bed time would do just fine and would likely make a world of difference.

Edited by browri

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Have you tried Fetzima? It's another SNRI, but unlike other SNRIs (except Savella, which isn't even indicated for MDD in the US) which preferentially inhibit serotonin reuptake over norepinephrine reuptake, Fetzima preferentially inhibits reuptake of norepinephrine over serotonin by about twofold. This theoretically benefits the noradrenergic cluster of MDD symptoms, like alertness, arousal, energy, and interest in life, as well as social functioning. My pdoc won't go above the lowest therapeutic dose of 40 mg though, so I suspect that's why my experiences of taking it have all been bad. I suspect I would benefit from 80-120 mg. She claims it will ruin your liver at higher doses, but I haven't seen any indications that it would do that.

I agree what has been said about the Seroquel. A higher dose nightly may help you out a lot better. Also, the addition of Lamictal may help out a little with depression symptoms, but also will keep you from dipping down into depression as often.

In addition to the recommendation of Rexulti, I would also throw in Latuda (low dose, like 20-40 mg) or Saphris (5-10 mg at bedtime or twice daily). Those two are also sedating (probably not as much as Seroquel... well... maybe Saphris... but yeah) and may help you with both sleep and mood.

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Posted (edited)

Hey haven't thought about that either Mikl, never heard of that one.

For the last few days the side effects have diminished, but I don't feel much benefit yet if anything at all.  I do feel a bit more organized mentally so maybe that's a good start?

I went today to see my PDoc, I've generally noticed just talking to him made me feel better, so I'm considering counseling again.

Anyways, he mentioned Viibryd or something again, but he wants to go up on Pristiq to 150mg saying that the generics are sometimes lighter, and since 300mg Effexor was an effective dosage I might get a benefit from increased norepinephrine, he seems really into trying wellbutrin too but I can't do it, both my experiences with Wellbutrin were horrific,  are there any alternatives to Wellbutrin out there?

Edited by BrianOCD

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Wellbutrin is an ndri. So you'll need some dopamine reuptake inhibitor. A stim perhaps?

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14 hours ago, BrianOCD said:

For the last few days the side effects have diminished, but I don't feel much benefit yet if anything at all.  I do feel a bit more organized mentally so maybe that's a good start?

At least a step in the right direction.

14 hours ago, BrianOCD said:

I went today to see my PDoc, I've generally noticed just talking to him made me feel better, so I'm considering counseling again.

Therapy and medication are each a leg and most people have a hard time walking with one leg ;)

14 hours ago, BrianOCD said:

Anyways, he mentioned Viibryd or something again, but he wants to go up on Pristiq to 150mg saying that the generics are sometimes lighter, and since 300mg Effexor was an effective dosage I might get a benefit from increased norepinephrine, he seems really into trying wellbutrin too but I can't do it, both my experiences with Wellbutrin were horrific,  are there any alternatives to Wellbutrin out there?

No really good alternatives to Wellbutrin other than Ritalin. It's a stimulant but more so an NDRI than anything. I would take your docs suggestion of going higher on the Pristiq because you can fill a 100mg and 50mg tablet prescription without insurance complaining about it and Pristiq does have somewhat more effect on norepinephrine than Effexor does.

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Well after 2 weeks and a few days I don't feel much different.  Just feel as dysphoric as I ever did, I'm supposed to go up again on the Pristiq so hopefully that will help.

I was talking to my PDoc and I said that maybe I'm just immune to Venlafaxine at this point after being on it for years, and he told me people "don't get immune"  Is that true?  I've always thought the drugs eventually poopout for everyone...

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