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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Roslynn on July 17, 2013, at 15:59:09
Hi everyone,
My pdoc is switching me from Pristiq to Effexor. The schedule is: 100mg Pristiq for 5 days, 50mg Pristiq for 1 week, then switch to Effexor 75mg for 5 days, then Effexor 150mg. Am I likely to get brain zaps from this schedule?
The other schedule he proposed was Pristiq 100mg for 1 week, Pristiq 50mg for 1 week, Pristiq 50 mg every other day for one week, then start Effexor 35mg. However, my depression is very severe and I need relief as soon as possible.
Am I more likely to experience troubling side effects if I start at the higher dose of Effexor?
Sorry, this is my first time taking Effexor.
Any help is greatly appreciated!
Thank you,
Roslynn
Posted by Phillipa on July 17, 2013, at 16:49:15
In reply to Switching from Pristiq to Effexor HELP PLEASE!, posted by Roslynn on July 17, 2013, at 15:59:09
Aren't they the same med one being time release?
Posted by SLS on July 17, 2013, at 16:59:27
In reply to Switching from Pristiq to Effexor HELP PLEASE!, posted by Roslynn on July 17, 2013, at 15:59:09
> Hi everyone,
>
> My pdoc is switching me from Pristiq to Effexor. The schedule is: 100mg Pristiq for 5 days, 50mg Pristiq for 1 week, then switch to Effexor 75mg for 5 days, then Effexor 150mg. Am I likely to get brain zaps from this schedule?I don't like the idea of an every-other-day schedule for Pristiq. Its half-life (11 hours) is too short. I think you would be more likely to experience withdrawal effects using this strategy than the one you described above. I can't predict with certainty whether or not you will experience withdrawal using this schedule.
What is the rationale for switching from Pristiq to Effexor?
What were the symptoms of your illness that Pristiq failed to improve? Did you try adding Wellbutrin or nortriptyline to it?
Will you be increasing the dosage of Effexor to 300 mg/day?
- Scott
Posted by SLS on July 17, 2013, at 17:01:11
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » Roslynn, posted by Phillipa on July 17, 2013, at 16:49:15
> Aren't they the same med one being time release?
Pristiq (desvenlafaxine) is the immediate active metabolite of Effexor (venlafaxine).
- Scott
Posted by Roslynn on July 17, 2013, at 19:15:05
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » Roslynn, posted by SLS on July 17, 2013, at 16:59:27
Hi Scott,
Thank you for your response! My main thing is I want to avoid the brain zaps...
Pristiq has done absolutely nothing for me...I think my pdoc has had patients that have responded to Effexor and not Pristiq, and vice versa. Can't this be the case?
I am in a severe depression right now that Pristiq has failed to touch. My doctor did suggest adding Remeron to the Pristiq, but I am very concerned about weight gain and appetite increase with this drug.
He did not mention adding Wellbutrin.
I don't know how far up my doctor is going to try to push the effexor, guess it depends on my response to it and any side effects.
Thank you,
Roslynn> I don't like the idea of an every-other-day schedule for Pristiq. Its half-life (11 hours) is too short. I think you would be more likely to experience withdrawal effects using this strategy than the one you described above. I can't predict with certainty whether or not you will experience withdrawal using this schedule.
>
> What is the rationale for switching from Pristiq to Effexor?
>
> What were the symptoms of your illness that Pristiq failed to improve? Did you try adding Wellbutrin or nortriptyline to it?
>
> Will you be increasing the dosage of Effexor to 300 mg/day?
>
>
> - Scott
Posted by SLS on July 17, 2013, at 19:37:28
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » SLS, posted by Roslynn on July 17, 2013, at 19:15:05
> Hi Scott,
>
> Thank you for your response! My main thing is I want to avoid the brain zaps...I hope you do well with the switch. If withdrawal effects become too uncomfortable, perhaps your doctor will allow you to cross-titrate, wherein you could take a combination of Pristiq 50 mg/day + Effexor 75 mg/day before moving on to Effexor 150 mg/day.
What do you experience as depression? Knowing this would help people give you more focused feedback.
- Scott
Posted by Roslynn on July 18, 2013, at 15:33:17
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » Roslynn, posted by SLS on July 17, 2013, at 19:37:28
> > Hi Scott,
Thank you for the medication tips.Here are my symptoms of depression: Despair, crying fits, feelings of horror/dread, worthlessness, suicidal ideation, occasional severe anxiety with derealization, irritability, decreased energy and interest, self-blame, hypersomnia, lethargy, rejection sensitivity, mood reactivity, slowed thinking, depression much worse in AM than PM.
Thank you,
Roslynn
>
> I hope you do well with the switch. If withdrawal effects become too uncomfortable, perhaps your doctor will allow you to cross-titrate, wherein you could take a combination of Pristiq 50 mg/day + Effexor 75 mg/day before moving on to Effexor 150 mg/day.
>
> What do you experience as depression? Knowing this would help people give you more focused feedback.
>
>
> - Scott
Posted by SLS on July 18, 2013, at 15:55:25
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » SLS, posted by Roslynn on July 18, 2013, at 15:33:17
> Here are my symptoms of depression: Despair, crying fits, feelings of horror/dread, worthlessness, suicidal ideation, occasional severe anxiety with derealization, irritability, decreased energy and interest, self-blame, hypersomnia, lethargy, rejection sensitivity, mood reactivity, slowed thinking, depression much worse in AM than PM.
Your depression sounds like a hybrid between melancholic and atypical depression. There might be some bipolarity involved.
How do you respond to tricyclics?
You may need to combine medications.
1. How do you define mood-reactivity?
2. What is your family history of mental illness?
- Scott
Posted by Roslynn on July 18, 2013, at 16:46:29
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » Roslynn, posted by SLS on July 18, 2013, at 15:55:25
Oh, dear. Well, my parent is bipolar. But the docs go back and forth on whether this makes me bipolar simply due to having a first-degree relative who has it. I guess mood reactivity would be refer to my mood changing out of proportion to the precipitating event.
I have responded in the past to a combo of prozac+clomipramine (weird, I know) as well as desipramine. Hard for me to tolerate nortriptyline, could not tolerate protriptyline.
>
> Your depression sounds like a hybrid between melancholic and atypical depression. There might be some bipolarity involved.
>
> How do you respond to tricyclics?
>
> You may need to combine medications.
>
> 1. How do you define mood-reactivity?
> 2. What is your family history of mental illness?
>
>
> - Scott
Posted by Roslynn on July 18, 2013, at 17:26:13
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » Roslynn, posted by SLS on July 18, 2013, at 15:55:25
Scott,
Which symptom made you think there might be some bipolarity?
Thank you,
Roslynn
>
> Your depression sounds like a hybrid between melancholic and atypical depression. There might be some bipolarity involved.
>
Posted by SLS on July 18, 2013, at 17:32:38
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » SLS, posted by Roslynn on July 18, 2013, at 16:46:29
> > Your depression sounds like a hybrid between melancholic and atypical depression. There might be some bipolarity involved.
> >
> > How do you respond to tricyclics?
> >
> > You may need to combine medications.
> >
> > 1. How do you define mood-reactivity?
> > 2. What is your family history of mental illness?> Oh, dear. Well, my parent is bipolar. But the docs go back and forth on whether this makes me bipolar simply due to having a first-degree relative who has it.
Your mood illness probably has the same biological underpinnings as your parent has. One can have a bipolar spectrum disorder and not display mania.
> I guess mood reactivity would be refer to my mood changing out of proportion to the precipitating event.
Mood reactivity is a phenomenon in which someone will feel significantly improved in response to a positive experience. It doesn't sound like this pertains to you.
> I have responded in the past to a combo of prozac+clomipramine (weird, I know) as well as desipramine. Hard for me to tolerate nortriptyline, could not tolerate protriptyline.
As I suspected. You are a tricyclic responder. You may yet respond to Effexor. If you respond to it, but only partially, you might ask your doctors about adding a second antidepressant to it rather than switching. It would have been nice if your doctors had tried adding lithium to the clomipramine and Prozac.
What was it about nortriptyline that you had trouble tolerating? How long did you take it for, and at what dosage?
If you are not a nortriptyline responder, it may be that you respond only to the imipramine series of drugs (imipramine, desipramine, clomipramine, trimipramine). In this case, amitriptyline would not be your next choice.
How do you respond to Wellbutrin?
Which mood stabilizers have you tried?
Which antipsychotics have you tried? Some of them have antidepressant properties and are known to treat bipolar depression.
I feel confident that you will find a treatment that works. You are not completely areactive to medication. It might take some time, though.
- Scott
Posted by SLS on July 18, 2013, at 17:45:55
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » SLS, posted by Roslynn on July 18, 2013, at 17:26:13
> Scott,
>
> Which symptom made you think there might be some bipolarity?
>
> Thank you,
> Roslynn
> >
> > Your depression sounds like a hybrid between melancholic and atypical depression. There might be some bipolarity involved.It wasn't really any single symptom that caused me to suspect bipolarity. It was that you had a mixture of symptoms of both subtypes of depression (melancholic and atypical). Superficially, bipolar depression looks a lot like unipolar atypical depression, but without mood reactivity.
- Scott
Posted by Roslynn on July 19, 2013, at 14:28:22
In reply to Re: Switching from Pristiq to Effexor HELP PLEASE! » Roslynn, posted by SLS on July 18, 2013, at 17:32:38
Hi Scott,
To answer some of your questions:
>
> Mood reactivity is a phenomenon in which someone will feel significantly improved in response to a positive experience. It doesn't sound like this pertains to you.I actually do have this! I was misinterpreting the meaning of it. My mood can brighten is response to a positive event, comment, etc. It can do the opposite too.
> As I suspected. You are a tricyclic responder. You may yet respond to Effexor. If you respond to it, but only partially, you might ask your doctors about adding a second antidepressant to it rather than switching.
My pdoc wanted to add Remeron to my Pristiq rather than switching me to Effexor, but I was worried about weight gain and appetite increase with Remeron.
>It would have been nice if your doctors had tried adding lithium to the clomipramine and Prozac.I actually am on 675mg of lithium as an augmenting agent, for several years now. I am not able to increase above this dose.
> What was it about nortriptyline that you had trouble tolerating? How long did you take it for, and at what dosage?I think I took nortriptyline for 6 months trying to get up to 50mg, but never made it due to dizziness and drowsiness/spaciness.
>
> If you are not a nortriptyline responder, it may be that you respond only to the imipramine series of drugs (imipramine, desipramine, clomipramine, trimipramine). In this case, amitriptyline would not be your next choice.
>
> How do you respond to Wellbutrin?I felt more alert, no effect on depression, had to discontinue due to facial tics.
>
> Which mood stabilizers have you tried?Lithium, lamictal (terrible cognitive effects, worst of all of them)
>
> Which antipsychotics have you tried? Some of them have antidepressant properties and are known to treat bipolar depression.I have been on 100mg seroquel for sleep/panic since 2007.
>
> I feel confident that you will find a treatment that works. You are not completely areactive to medication. It might take some time, though.
>
>
> - ScottThank you!!
Roslynn
This is the end of the thread.
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