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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by SLS on September 7, 2011, at 16:52:24
Has anyone responded well to Pristiq who failed to respond adequately to Effexor?
Thanks.
It looks like I will be discontinuing Nardil for lack of adequate response after more than a year of treatment. My doctor is not at all impressed with my lack of progress, despite my having had a few good days periodically. I have reached the limit of my patience for my current treatment. It is my intention to discontinue Nardil and replace it with either Effexor or Pristiq.
- Scott
Posted by Phillipa on September 7, 2011, at 17:07:29
In reply to Effexor Failure versus Pristiq Success, posted by SLS on September 7, 2011, at 16:52:24
Scott so sorry was hoping. I do know my pdoc soon to retire is doing well on pristiq she likes it. No idea what other meds shes taken 75 years old. So been around for all the meds? Phillipa
Posted by Lepus on September 7, 2011, at 21:33:15
In reply to Effexor Failure versus Pristiq Success, posted by SLS on September 7, 2011, at 16:52:24
Sorry to hear Nardil isn't working for you, SLS. Maybe the next one...:fingers crossed:
Posted by SLS on September 8, 2011, at 0:25:03
In reply to Re: Effexor Failure versus Pristiq Success, posted by Lepus on September 7, 2011, at 21:33:15
> Sorry to hear Nardil isn't working for you, SLS. Maybe the next one...:fingers crossed:
Thanks. That means a lot to me.
:-)
- Scott
Posted by Conundrum on September 8, 2011, at 13:03:09
In reply to Re: Effexor Failure versus Pristiq Success » Lepus, posted by SLS on September 8, 2011, at 0:25:03
> > Sorry to hear Nardil isn't working for you, SLS. Maybe the next one...:fingers crossed:
>
> Thanks. That means a lot to me.
>
> :-)
>
>
> - ScottHey Scott. Pristiq isn't a bad drug. For me it pulled me out of a dark place, but didn't hit anhedonic symptoms particularly hard. However if nothing worked for anhedonia, I would return Pristiq because it helped with sadness and suicidal thoughts. Will you still be on Nortriptyline?
Posted by B2chica on September 8, 2011, at 14:33:29
In reply to Effexor Failure versus Pristiq Success, posted by SLS on September 7, 2011, at 16:52:24
yes Scott. me.
effexor didnt work in that it gave me horrible rapid cycling, way up and way down, i felt 'unreal' i had visual issues and extreme anxiety.i have responded i think quite well to Pristiq. i still struggle but i must say i'm WAY better than i have in the past or on any other medication.
the only bad thing is it took me about 12weeks before pristiq really kicked in. and it's not just me. everyone that i know that its worked for it has taken no less than 8 to kick in. average 10 weeks.
my current cocktail is:
pristiq 50mg
perphenazine 2mg BID
adderall 20mg TID
Gabapentin 300mg TID or PRN
xanax 2mg
Posted by bleauberry on September 8, 2011, at 18:51:21
In reply to Effexor Failure versus Pristiq Success, posted by SLS on September 7, 2011, at 16:52:24
I thought you had already been on effexor? I guess only a personal trial would show if pristiq was better or not? Anyway, I remember reading a post at one of the med rating sites where a guy who reminded me of all of us....longterm, many meds, many years, etc....who was taking effexor and wellbutrin without much effect but then added milnacipran to the mix and resulted in remission. After dropping the wellbutrin, staying with just effexor and milnacipran, remission continued. Case study = 1 of course, but hey, at this juncture of the road I think anything that worked for someone else and is different than you've done before should be on the radar screen. That person certainly couldn't be the only one on earth that would respond nicely to that combo. I suspect it could be a potent combo for treatment resistance but of course no one would ever think of it as a combo to try. I mean, combine two SNRI's? Well, you know how that is , Effexor hardly even qualifies as an SNRI, and both meds have very different structures and differing methods of action, so anything's possible.
Anyway, effexor vs pristiq, I don't know. I just wish nardil had been more robust. Thought I would mention the milnacipran combo thing since you are already familiar with that med. Hang in there because many people here need you.
Posted by SLS on September 8, 2011, at 20:49:12
In reply to Re: Effexor Failure versus Pristiq Success » SLS, posted by Conundrum on September 8, 2011, at 13:03:09
> > > Sorry to hear Nardil isn't working for you, SLS. Maybe the next one...:fingers crossed:
> >
> > Thanks. That means a lot to me.
> >
> > :-)
> >
> >
> > - Scott
>
> Hey Scott. Pristiq isn't a bad drug. For me it pulled me out of a dark place, but didn't hit anhedonic symptoms particularly hard. However if nothing worked for anhedonia, I would return Pristiq because it helped with sadness and suicidal thoughts. Will you still be on Nortriptyline?Definitely.
I am discontinuing Nardil, but will start Viibryd in a few weeks. My doctor wanted me to try this drug first. If it doesn't work, I will then move to either Effexor or Pristiq.
Currently:
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mg* Viibryd to be started in 3 weeks.
- Scott
Posted by SLS on September 8, 2011, at 20:54:59
In reply to Re: Effexor Failure versus Pristiq Success » SLS, posted by B2chica on September 8, 2011, at 14:33:29
> yes Scott. me.
> effexor didnt work in that it gave me horrible rapid cycling, way up and way down, i felt 'unreal' i had visual issues and extreme anxiety.
>
> i have responded i think quite well to Pristiq. i still struggle but i must say i'm WAY better than i have in the past or on any other medication.
>
> the only bad thing is it took me about 12weeks before pristiq really kicked in. and it's not just me. everyone that i know that its worked for it has taken no less than 8 to kick in. average 10 weeks.
>
> my current cocktail is:
>
> pristiq 50mg
> perphenazine 2mg BID
> adderall 20mg TID
> Gabapentin 300mg TID or PRN
> xanax 2mg
Thanks for the information. I will consider it when I discuss with my doctor which drug to go with. He wants me to try Viibryd. I wouldn't have thought that this drug is very good, but my doctor is impressed with it on the limited number of people he has tried it on. A few TRD patients have responded well to Viibryd.
- Scott
Posted by SLS on September 8, 2011, at 21:05:44
In reply to Re: Effexor Failure versus Pristiq Success » SLS, posted by bleauberry on September 8, 2011, at 18:51:21
> I thought you had already been on effexor?
Yes, but I had combined it with only 75mg of nortriptyline. Since then, we finally established that I need 150mg, as I am a rapid metabolizer. Even at 75mg of Effexor, I experienced a partial, persistent response.
> ...effexor and wellbutrin without much effect but then added milnacipran to the mix and resulted in remission.
Wow. I know how much you like milnacipran. I guess you recall that I have tried this drug, but not with Effexor. I will keep this in mind.
> Anyway, effexor vs pristiq, I don't know. I just wish nardil had been more robust. Thought I would mention the milnacipran combo thing since you are already familiar with that med. Hang in there because many people here need you.
Thanks BB. I appreciate it.
By the way, my doctor wants me to try Viibryd next. Of course, I will need to wait 2 weeks after my last dose of Nardil to start it. With a little luck, I won't need to revisit Effexor.
- Scott
Posted by Phillipa on September 8, 2011, at 21:27:15
In reply to Re: Effexor Failure versus Pristiq Success » bleauberry, posted by SLS on September 8, 2011, at 21:05:44
Scott in a way you will be testing the efficacy of vibryd as so hard to treat. Please post your progress. And as usual the best of luck. How will you manage the two weeks til then. I know you will though. Phillipa
Posted by floatingbridge on September 9, 2011, at 0:40:00
In reply to Re: Effexor Failure versus Pristiq Success » Conundrum, posted by SLS on September 8, 2011, at 20:49:12
I am discontinuing Nardil, but will start Viibryd in a few weeks. My doctor wanted me to try this drug first. If it doesn't work, I will then move to either Effexor or Pristiq.
Currently:
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mg* Viibryd to be started in 3 weeks.
- Scott
________________Scott, best wishes for the Nardil wash. Will the nortriptyline be enough to see you through? I was astonished at how much I was affected by my Emsam withdrawal.
Please keep us updated about Viibryd. I agree with BB. We need you.
fb
Posted by B2chica on September 9, 2011, at 7:48:58
In reply to Re: Effexor Failure versus Pristiq Success » B2chica, posted by SLS on September 8, 2011, at 20:54:59
This has me very interested. please let me know how you do on this.
much appreciated
b2c.
>A few TRD patients have responded well to Viibryd.
> - Scott
Posted by Bob on September 9, 2011, at 16:39:40
In reply to Effexor Failure versus Pristiq Success, posted by SLS on September 7, 2011, at 16:52:24
> Has anyone responded well to Pristiq who failed to respond adequately to Effexor?
>
> Thanks.
>
> It looks like I will be discontinuing Nardil for lack of adequate response after more than a year of treatment. My doctor is not at all impressed with my lack of progress, despite my having had a few good days periodically. I have reached the limit of my patience for my current treatment. It is my intention to discontinue Nardil and replace it with either Effexor or Pristiq.
>
>
> - ScottIt saddens me to see this. I am under the impression that you haven't been on a drug with a serotonin reuptake mechanism in quite awhile right? It will be interesting to see how it goes.
Seems like you don't have a lot of faith in the viibryd?
Bob
Posted by Bob on September 9, 2011, at 16:47:23
In reply to Effexor Failure versus Pristiq Success, posted by SLS on September 7, 2011, at 16:52:24
> Has anyone responded well to Pristiq who failed to respond adequately to Effexor?
>
> Thanks.
>
> It looks like I will be discontinuing Nardil for lack of adequate response after more than a year of treatment. My doctor is not at all impressed with my lack of progress, despite my having had a few good days periodically. I have reached the limit of my patience for my current treatment. It is my intention to discontinue Nardil and replace it with either Effexor or Pristiq.
>
>
> - Scott
Scott... so what was your experience in summary of your most recent stint on Nardil?
Posted by morgan miller on September 10, 2011, at 1:47:11
In reply to Re: Effexor Failure versus Pristiq Success » SLS, posted by Bob on September 9, 2011, at 16:47:23
Hope you find the success your looking for with Viibryd.
Morgan
Posted by SLS on September 10, 2011, at 6:42:44
In reply to Re: Effexor Failure versus Pristiq Success, posted by morgan miller on September 10, 2011, at 1:47:11
> Hope you find the success your looking for with Viibryd.
Thanks, Morgan.
I am not expecting fireworks from Viibryd. However, I feel it makes sense to try something new first rather than to go back to something old. Still, Effexor is a logical choice, as I responded to it when it was combined with 75mg of nortriptyline. Subsequently, we discovered that I was underdosed on nortriptyline the whole time.
I'm going to nail this sucker.
- Scott
Posted by floatingbridge on September 10, 2011, at 7:33:26
In reply to Re: Effexor Failure versus Pristiq Success » morgan miller, posted by SLS on September 10, 2011, at 6:42:44
"I'm going to nail this sucker."
:-)
Yes, I believe it.
Posted by SLS on October 30, 2011, at 9:47:27
In reply to Re: Effexor Failure versus Pristiq Success » SLS, posted by Bob on September 9, 2011, at 16:47:23
Hi.
Is anyone else able to compare the relative effectiveness of Effexor and Pristiq? If my prescription plan covers Pristiq, I guess it makes sense for me to try it before returning to Effexor.
> Scott... so what was your experience in summary of your most recent stint on Nardil?
Sorry that I took so long to answer your post. I guess I must have forgotten it.
Nardil is a potent drug that usually reduces the intensity of my depressive state. It works better when it is combined with desipramine or nortriptyline. I found Nardil to be energizing. For me, it is more of a mood-brightener than Parnate is. Parnate did less to address anhedonia. Unfortunately, I wasn't enough improved to justify rejecting alternatives like Viibryd or Pristiq.
- Scott
Posted by Seige on November 2, 2011, at 10:03:29
In reply to Re: Effexor Failure versus Pristiq Success » Bob, posted by SLS on October 30, 2011, at 9:47:27
Hey Scott,
I've been on both (2nd and 3rd AD's I tried), and have actually just added Pristiq to my mirtazapine (I've basically got a patented version of California Rocket Fuel :D ).
The psych even did a cold-turkey switch from 225 Effexor to 100 Pristiq. They felt largely the same to me. They didn't alter my base mood (a good thing), totally wiped out my anxiety, but didn't touch my anhedonia.
I shared my opinions on Pristiq with my pdoc, and he did say he's seen people have success on Pristiq where they didn't with Effexor. I suspect a feeling it largely comes down to the liver enzyme thing.
Posted by Conundrum on November 2, 2011, at 11:50:09
In reply to Re: Effexor Failure versus Pristiq Success » SLS, posted by Seige on November 2, 2011, at 10:03:29
> I shared my opinions on Pristiq with my pdoc, and he did say he's seen people have success on Pristiq where they didn't with Effexor. I suspect a feeling it largely comes down to the liver enzyme thing.
They also are not identical in action. Effexor has dopamine reuptake which is stronger at higher doses and interacts with opioid receptors.
Pristiq has barely any effect on dopamine reuptake. The DA effects must be part of the parent molecule or some other metabolite. I have no idea what effects it has on opioid receptors. Pristiq also has a more balanced serotonin to norepinephrine ratio than Effexor.
Take into account the liver metabolism vs kidney metabolism and you have a slightly different medication.
Posted by SLS on November 2, 2011, at 12:17:29
In reply to Re: Effexor Failure versus Pristiq Success » SLS, posted by Seige on November 2, 2011, at 10:03:29
Posted by SLS on November 2, 2011, at 12:19:59
In reply to Re: Effexor Failure versus Pristiq Success, posted by Conundrum on November 2, 2011, at 11:50:09
Hi Conundrum.
> They also are not identical in action. Effexor has dopamine reuptake which is stronger at higher doses and interacts with opioid receptors.
What effects does Effexor have on opioid receptors? I hadn't heard that.
Thanks.
- Scott
Posted by floatingbridge on November 2, 2011, at 15:20:38
In reply to Re: Effexor Failure versus Pristiq Success » Conundrum, posted by SLS on November 2, 2011, at 12:19:59
I thought the opoid effect was removed and left to tramadol...?
Posted by floatingbridge on November 2, 2011, at 15:34:10
In reply to Re: Effexor Failure versus Pristiq Success, posted by Conundrum on November 2, 2011, at 11:50:09
You are correct according to wiki re: opoid receptors.
Interesting.
This is the end of the thread.
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