This is the inaugural entry of a new occasional feature we’ll have here on World of Psychology, On the Couch with Dr. John Grohol. These entries will be interviews with various movers and shakers in the world of psychology, mental and behavioral health, and psychiatry. The schedule is to do at least one a month, so if there’s someone you’d like to see interviewed, please drop us a note!
Last Wednesday, I had the chance to sit down and talk to Dr. Phil Ninan, the Vice President of Wyeth’s Medical Affairs, Neuroscience on the telephone about their newest antidepressant medication, Pristiq. Pristiq is a “chemical cousin” of Wyeth’s existing successful antidepressant, Effexor (and its descendants like Effexor XR).
Dr. John Grohol: Pristiq has been approved for use in the treatment of depression in the U.S. The pipeline for depression drugs has been not as full, I think, as some people would like to see it sometimes. So, I was wondering if you could talk a little bit about how Pristiq is better, or different, than its chemical cousin, Effexor.
Dr. Phil Ninan: To start out with, you are quite correct that there has been a tremendous amount of effort over the past decade, decade and a half, to try to come up with what I would say would be revolutionary advances in the treatment of depression and anxiety.
And by and large, those attempts have not been successful, which is why we haven’t had medication with new mechanisms of action available on the market. And we at Wyeth too have put a tremendous amount of resources into those, and have not been successful so far. But, we continue to do that, and we have several other options in the pipeline that we are exploring.
But in the meantime, while we are waiting for the revolutionary advances, it’s important to understand that there are still patients who are not getting treatment. They’re not tolerating the medicines that are currently on the market, or they’re not getting the degree of benefit or the subjective sense that they have when they are on the medicines is not something that they are satisfied with, and therefore they discontinue medication.
In that sense, Pristiq an evolutionary advance that allows some advantages in individual patients, and hopefully that will result in them getting the full degree of benefit, so that they can get back to living their lives to their fullest potential.
Dr. Grohol: What were some of the most common side effects discovered in the clinical trials for Pristiq?
Dr. Ninan: The most common ones were GI ones, like nausea, decrease in appetite, constipation. Some side effects that are common with medicines that affect the norepinephrine system, like dizziness and sweating, as well as sleep disturbance.
We also had some patients who experienced an increase in anxiety, and also had sexual dysfunction. So, those are the most common ones.
Dr. Grohol: How typically would Pristiq be prescribed? What would be a common starting dose, and how would that be titrated up?
Dr. Ninan: This is in some ways a unique situation for this class of medications, the serotonin and norepinephrine uptake inhibitors, where the starting dose is the effective dose. And at that dosage, which is 50 milligrams a day, what we found in our clinical studies is that the proportion of patients who discontinue the medication because of adverse events is no different from placebo.
And what that means, generally, is that it would be very well tolerated, so that a larger proportion of patients could have the medicine delivered so that they would get the benefits.
Dr. Grohol: I haven’t heard of very many medications where that’s the case. Is Pristiq unique in the anti-depressant class of medications, where the starting dose is really the clinically effective dose as well?
Dr. Ninan: Within the SNRI class that is unique. If you do that with some of the other medications, then what happens is the side effect profile shifts and therefore a greater number of people can’t tolerate that initiating dose, and therefore they have potential trouble with it.
So, in that sense, particularly for general practice physicians who are seeing a large number of patients who are struggling with depression, it uncomplicates the management of depression. And the kind of contact that might be necessary to adjust the dose of medication may not be necessary. You would still need to have close contact with people when you’re initiating treatment, but the dose adjustment is something that is not necessary in this situation.
Dr. Grohol: What is the price point for Pristiq compared with something like Effexor XR?
Dr. Ninan: I’m in medical, and I’m not in the commercial part of the company, so all I know is that a pill of Pristiq at the retail level is supposed to be $3.41. And it’s the same price whether you are buying a 50 milligram pill or a 100 milligram pill. And I’m told that’s about 15-20% lower than the price of Effexor.
Dr. Grohol: There’s been more talk in recent years about greater concerns about withdrawal syndrome. And so I was wondering what the research has shown what the withdrawal profile on Pristiq looks like compared to other drugs in its class.
Dr. Ninan: First of all, I think, one should distinguish what is a withdrawal syndrome from what we would call discontinuation symptoms. Withdrawal is traditionally associated with medicines that one has got physiologically dependent on. And there is a whole set of not only symptoms, but physiological changes that occur that can be potentially dangerous.
You see that with alcohol, you see that with benzodiapams, the anti-anxiety and sleep medications that can cause physiological dependence. And you see that with pain medications, particularly opiates and that class of medications. So, those can be medically problematic and potentially dangerous in some people.
We should distinguish that from discontinuation symptoms, where those medical risks are not present. And these are not medicines that you become physiologically dependent on, but you can get adaptive changes that have occurred, that then the body and the brain needs to readapt to not having those medications onboard.
And you see this with blood pressure medications where if you suddenly stop certain blood pressure medications you can get a rebound increase in blood pressure that is very transient. And you see that with several other medications. You see that if you take Benadryl on a regular basis and you suddenly stop taking the Benadryl, there are rebound symptoms that could occur.
So, what we have here are discontinuation symptoms that have been reported with antidepressant medications that get out of the system very quickly. And most medicines that get out the quickest are more likely to have discontinuation symptoms, because the brain is not having a chance to adapt to not having that medication occupy the receptors in the brain.
And the longer you’re on the medication, the more the adaptation has taken place, and therefore the more likely you are to have the discontinuation symptoms. So, we know that there were medicines that were the biggest culprits in terms of having discontinuation symptoms. Effexor was one. Paxil is the other.
And Prestiq being an active metabolizer effecter and also having a fairly short half-life, we would expect would have the potential to discontinuation symptoms. And that is exactly what we have found in our clinical trials.
So, these discontinuation symptoms can be anything from just physical kinds of symptoms, which would be things like dizziness, headaches, nausea, those kinds of symptoms that are common side effects of these medications to symptoms that might be unique.
So, patients who are coming off Effexor and Paxil have described various words like "brain shivers" and things like that, which we consider to be under a term called paresthesia, which are physical symptoms that you might be having within your body. And you can also have associated anxiety depressive symptoms.
Now unfortunately, the scales that we use to measure these are not very good. Because what we find is that anywhere from 20 to 30 percent of patients who are on placebo are also demonstrating some of these symptoms. And so there’s the high level of noise in the mechanisms that are standard in the field to try and measure these symptoms.
What we find is that what happened in our studies is when we discontinued these medications rapidly, was that a substantial number of people had these discontinuation symptoms. So, when we started tapering the medication, a number of these patients who were having discontinuation symptoms were reduced. But, they were still present.
And so we would recommend clinically that if a patient is planning to stop the medication, they should do it under medical supervision so that they’re being guided about what are the mechanisms that you can use to reduce the discontinuation symptoms, so that they don’t cause excessive distress, and they can be managed medically.
119 comments
While others may see this in a different light, it reads like a paid-for Wyeth ad drafted from a sales rep’s script. It even has a little PR picture of the drug. No small consideration that Dr. Ninan is a Wyeth vice president. I’m particularly distressed by the glossing over of side effects and virtual dismissal of the FDA’s black-box warnings on antidepressants. There’s a huge difference between what a company says about a drug that’s being launched and the acid test of a couple of years in the real world. I hope the acid test gets equal time.
Yup, so please add your suggestions for folks you’d like to see interviewed as well. Pristiq is a new antidepressant and it seemed timely and relevant to get some answers to questions relevant to the drug. I can’t (and wouldn’t want to) control the interviewee’s responses — you get what they say.
Absolutely the worst “discontinuation” withdrawals I have ever had in my life. In fact, this is the worst two weeks of my life — I advise NO ONE to even attempt to take this drug. Please read all the forums with posts from people that have had horrible, long-lasting affects after quitting — either from tapering slowly to cold-turkey — which the latter is not recommended at all. Can cause suicidal tendencies along with other drastic effects. Many of these people, like myself, were given free samples. Get ya hooked for a few months until you start feeling like a zombie. Then, the hard part — quitting. I am on my third week of feeling the worst that I have ever felt in my life. Please read about this drug very carefully before considering starting it up.
I weaned off effexor xr over a 3 month period. The last dosage was effexor 37.5mg which the psych had me break in half and take half twice a day. OMG Whatever this over educated idiot thinks or lies about, it is discontinuation syndrome!!! On effexor I had no feelings, could not even cry when I found my mother dead. Off it, I can cry at the drop of a hat. Brain zaps,in groups of 3 about every 5-10 minutes. Dizzy, hostile, aggressive, my therapist said I was not the same person and I ran out of her office telling her to prepare the bill. These drug co know these things, yet they want the money. It’s all they really care about.
I feel like sueing Wyeth. I’ve only been on this drug for seven weeks and ended up suicidal. This is after it made my anxiety – the reason I was taking it – worse to a factor of 100 times. Now I’m having severe withdrawal symptoms – spaced, vomiting, seasickness, dizzy and losing balance. You can’t taper because the smallest dose is 50mg. I can’t cut the tablets because it makes me extremely ill. I’m not going to go on another drug to fix this. If anyone plans a class action against these irresponsible pharmacists just let me know.
How the heck do you taper off Pristiq????
Thank you. It helped me understand better the patient’s situation when taking such medications (better than the standard patient-information handout).
Dear Dr. Ninan (who will probably never see this)
I am an MD on a fixed income, without insurance and have been taking Effexor XR since it came out for major depression and panic disorder. I have been getting samples of Effexor XR from my psychiatrist since. Effexor XR has made me functional again and able to work part-time.
Now since Pristiq has appeared, the drug reps will no longer leave Effexor XR samples with my psychiatrist. So I am forced to try Pristiq, because I cannot affird $300 per month for Effexor XR, hoping it will work, or suffer becoming non-functional again.
It seems obvious to me that Wyeth discontinued Effexor XR samples to force pyschs to switch people to Pristiq which is heavily sampled by the drug reps.
Why? Were is all of that almost out of date Effexor XR going?
Welcome to the worst medical system in the Western world.
Dr. Bill
Dr. Grohol, thank you for the reply and in particular that you are open to suggestions of people/professionals to interview. I’m very glad to have that opportunity – can we send suggestions to you directly?
(Dr. John, I know this isn’t a bulletin board, but I hope the circumstances make it okay this time)
DR. BILL …
Please check http://www.neededmeds.com
It has information about every patient-assistance program offered by all the drug companies for people who meet financial and insurance criteria. You can also download the application forms at needymeds.com … The application process is not difficult and you hear back quickly from a drug company about whether you qualify for its program or not.
Wyeth has just started providing me with free Protonix through their patient assistance program. (Thank you, Wyeth.) Protonix went generic earlier this year, as Effexor will within the foreseeable future, so there are no more samples being distributed. I had been relying on my doctor to help fill in some of my gaps, as you have been.
I have no insurance, and I could never pay out-of-pocket for a fraction of my meds. Five companies are providing more than $12,500-worth of the three most expensive medications I must take, as well as the three different types of insulin I use.
I found information about all the programs at needymeds.com … it’s a non-profit group that does nothing but find information and post it at the site. No fees, no registration, just information.
I hope this helps.
You bet!
http://psychcentral.com/about/feedback.htm
Dr. Bill – I mistyped the address – it’s http://www.needymeds.com (not ‘needed’). I’m very sorry.
The whole discussion between withdrawal and discontinuation syndrome is a load of crap.
People have severe WITHDRAWAL symptoms on these drugs…to use the term discontinuation syndrome is simply a euphemism…
adaptive changes vs. physiological changes?? I’d like to know if there is actually a difference in meaning of those two words as well…not a scientist but they both suggest changes to the body on a subtle level which sorta sounds, well, physiological…
also I know people who have been made permanently ill from SSRI and SNRI withdrawals…yeah, real medical problems which he seems to be denying…
please please interview some victims of these drugs…that’s my request…I know you can find them…there are lots of us out here in blog land. Take your pick.
I agree Gianna.
I have been taking effexor XR for a year now, for anxiety and stress. It works well against my stress symptoms, however the sexual side effects are frustrating to say the least. It caused me to get a divorce. Now my doctor switched me to Pristiq since it does not have sexual side effects. I’ve been on it for just 4 days now, and my sex drive is back in full force. I feel like a new man. Thank God for Pristiq, I feel like I am 18 again, and my girlfriend is very appeciative.
As Dr. Bill stated above…sales rep are discontinuing supplying Effexor.
I will be scripted Pristiq this Thursday. I find the reason I will be receiving Pristiq to be very interesting and a good bit disturbing.
I have Medicare Part D and by May of each year I go into the The Gap and can’t afford Brand meds. So, I seek out samples from the docs. One sample has been Effexor. How interesting that the psychiatrist that oversees my Effexor MUST change me to Pristiq ONLY because the slaes rep will no longer supply the clinic with Effexor. ONLY Pristiq will be supplied as samples.
I am NOT happy about this!
I read “Dr. Carlat’s take: Top 5 Reasons to Forget about Pristiq.â€
Hard to know who is right!
I only see Wyeth as covering the profitable a** since Effexor’s patent will be ending soon. They needed something to replace Effexor with. Did they do a simple reformulation and rename the medication?
Do not take pristine, the effects of this medication is not worth the withdrawals.
I just wanted to provide some feedback concerning Pristiq. I have been taking it for a little over 2 months and it has helped me quite a bit. I’m more productive than I have been in a while and I’ve lost a noticeable amount of weight (needed). I’ve taken Effexor in the past and had a good result on it but this seems a little better. Thanks for making more information possible. I hear a lot of people are curious about this medicine.
I have been taking EffexorXP for a few years. I was involved in a trial study at Emory University. Dr Ninan was on the staff. Recently my primary care physician has continued to prescribe EffexorXR. I am complaining about exhaustion, bored and feeling like quiting all my activities. My primary care physician has prescribed Pristiq. Humana has my class D drug coverage and has refused to approve Pristiq.
I WAS JUST GIVEN A 5 WEEK SAMPLE PACKAGE OF PRISTIQ FROM MY DR. I HAVE BEEN TRYING TO RESEARCH THIS DRUG TO FIND SOME ONE THAT HAS BEEN ON IT FOR A WHILE BECAUSE OF SOME OF THE WARNINGS AND SIDE I READ ABOUT ON THE INFORMATION PHAMPLET THAT CAME WITH IT , I AM A BIT LEARY TO START ON IT. CAN SOME ONE REASSURE ME THAT IT WONT MAKE ME ANY WORSE THAN I ALREADY AM.????
I am on day 3 of no Pristiq. I tapered for 2 months and finally got to the day I was ready to stop. I was fine the first day, but the last 2 days have been hell. I am disoriented, dizzy, nauseas, my speech is slow, my exercise routine is at a complete stop and I am trying to not just lay in bed all day. I am reading now that it can last 7-14 days!
If I knew that I would go through this I would never have accepted the many weeks of “free” samples and the discounted pills I received before paying for them for another 18 months.
Run away very fast from this medication.
Pristiq is terrible. I caused me to become so depressed that I was unable to go to work or express interest in my kids. My husband was about to leave me (not really). I think I was driving him crazy. I did actually realise it was a problem on my own, thank God. But the lasting effects at work are embarrassing. I would advise anyone to try to work through depression before taking pills.
I see that I am a tad late getting in on this topic, however I wanted to mention to “wordmeister” and others that my doc prescribed venlafaxine to me as a generic for Effexor. I must say though, that since taking venlafaxine, I have put on about 20 lbs and have experienced all of the nasty effects of ‘The Pause’ -to the max, and then some. So we decided to gradually withdraw from the drug altogether. Tomorrow is my last 37.5mg dose and then…I don’t know what. When I saw the commossion about this new Prestiq I was very interested. Still, with my pitiful insurance, I can see that it will be out of my reach. At this point, I honestly don’t know for certain if I am: depressed, bi-polar, mental-pausing, or just plain weirded-out. How do we know if symptoms are from hormones (or lack of!), or chemical imbalances in the brain? Didn’t mean to vent here – just thought perhaps venlafaxine may be an option to someone else.
Amazing to me how different we all are, at every possible level. Makes me envy my dogs!
No,no I wouldn’t want to change those differences for a second, but it would be so wonderful to be able to depend upon ourselves
with His help instead of depending on those bitter little pills. Uh oh, a can of worms I nearly opened!
Suffice to say, “it takes all kinds to make a world”, and I feel blessed to learn how others cope. Ultimately, it’s all good.
I have nerve damage and am in pain most of the time. I have accepted the pain and adjust my days according to the level of pain. I am not depressed and my husband and I don’t understand why I was given and anti-depressent drug to take. I was not told it was for that and assumed it was for the pain level. Does it help pain???
Pristiq is the worst drug I have ever taken and the worst drug I have ever tried to stop taking. I have been trying to stop taking this drug for 3 weeks and for 3 weeks I have been miserable. I imagine this is what a drug addict feels like. The pain in my head, numb tingling face, vertigo, vomiting and disorientation becomes so bad that I scramble to dig a Pristiq from my purse just to make it stop. But it really never goes a away. The pills can not be split so you are advised to space the time between taking it. Well after three weeks I can make it 3-4 days between pills before I am overwelmed by the sickness and I can no longer function. I wonder just how long this will take. A drug that causes problems like this to so many people should not be legal, someone should be doing studies on the victims of this drug to see what it is actually doing to us before pushing it on others. If anyone of their employees experienced this pain I can guarantee they would no longer stand behind this product or allow it to be pushed on so many unknowing people. Stop the madness…Stop Pristiq…..Listen to what we are saying.
BC YOU ARE SO RIGHT!
Pristiq has made my normal blood pressure (120/78) in October shoot up to 156/90 (Stage 1 hypertension) in December. I am still on the meds and my blood pressure is still sky high! I just found out (today) about the increased blood pressure side effects and my doc never told me nor monitored my BP. I am angry, upset, and now worried about withdrawal symptoms. What is so sad is that this medication actually helped my anxiety disorder…..where Lexapro actually made me depressed (and I did not suffer from depression). I am going to attempt to taper myself off and hope I have better luck than BC (I wish you well and hope you can get some relief!). I would stay away from this Medication!
I have been taking Pristiq for 5 months now, and have to say that it has really made a big difference in my life. I’m much more focused, functional, productive, generally happy, much less anxiety, and content.
Though I was at first skeptical, all in all this has been good. The adjustment at first was strange (tremors), but that has subsided, and now I feel much more like the person I was before I had to go on medication.
Same as how I felt the first year, and then I started going into the Zombie like stage of it and decided to go off of it. Then came the hellish part of this drug.
My Dr. gave me some samples because I expressed that I’m having night sweets, and experincing trouble sleeping. he said this was used to treat side effects of menopause.
I’m skeptically because I’m sensitive to medication, I don’t think it’s good to take drugs that change your biological chemistry. What do you think?
Be EXTREMELY careful with this “stuff”. I was on it for FIVE DAYS, missed a dose, and oh my God is all I can really type. I cannot go out an enjoy the lovely sunny day because of these “brain zaps” I have when I turn my head.
Dr. Ninan THE WITHDRAWEL symptoms are HELL-AFTER FIVE DAYS on this neatly packaged drug???
You, have sold your soul to the pharmaceutical company. Be ashamed, be ashamed.
Janice, from my experience,Pristiq really,really sucks.
I was put on Pristiq after taking Paxil for 9 years in an attempt to lessen sexual side effects. My doctor first put me on Effexor and Lexipro and tapered the Paxil. I only wanted to be on one med. and didn’t see much improvement in the sexual side effects. I noticed right away with effexor the increased jitters and brain freezes. I would like to get pregnant in the near future and want to be off of all meds when I do, so I’m trying to go off of Pristiq. The side effects of missing one day of this med. after only being on it for less than 2 months is hell on earth. I cannot believe how much my body is reacting to one little pill. The dizziness and brain freezes are the worst, and the nausea isn’t fun either. I’m going to start splitting the pills, but just want to be off of this drug and all other anti depressants.
I have been on Prestiq for a few months, after I could not tolerate Cymbalta (that drug caused high blood pressure for me). I must admit that I saw better benefits in managing my anxiety on Cymbalta, but have seen fewer side effects on Prestiq.
I have a few questions:
Have you seen weight gain in higher doses? Did the trials see a benefit to a higher dose?
Is it okay to have a few drinks while taking Prestiq, if you do not have any other physical issues prohibiting you from consuming alcohol?
I’ve been on prestiq for about 3 weeks now and I’m experiencing many of the published side effects, like dizziness, depression, constipation, one stomache ache and just feeling drugged and weird. If these don’t subside in another week or 2, I’ll talk to my doctor about them and a possible change to something . I’ve been on several different anti-deppessants for the last decade and havn’t been happy with most of them. Zoloft has probably worked the best for me for the longest time period, but my husband thought it had stopped working I’ll try and update this in a few weeks.
Withdrawal symptoms, discontinuation syndrome. Ta-MAY-toe, toe-MAH-to! It’s the SAME thing with different wording.
I was advised to switch to Pristiq after experiencing serious weight gain on Effexor. I was on Pristiq for about 1 month. I am now 3 weeks off and STILL experiencing the brain zaps/brain shocks (call them what you want) and various other “discontinuation” symptoms. Why are we not warned of this before these drugs are basically forced down our throats?!
I am now WAY worse than I was before I ever started taking antidepressants. This has probably been the worst 3 weeks of my entire life.
Also note, the Pristiq still caused the sexual side effects for me. In an earlier post someone asked, “Did they do a simple reformulation and rename the medication?” The answer is YES!!! Be very wary of switching to Pristiq, especially if you had problems on Effexor and/or coming off of Effexor. Mind you, the withdrawal/discontinuation symptoms coming off of Effexor lasted about a week, and I was on Effexor for months. As I said earlier, I was only on Pristiq for about 1 month, and I’m on week 3 of feeling like death and being shocked every single day. My advice: think twice.
Free samples?
Don’t heroin dealers give you the first hit for free also?
This type of behaviour probably seems normal to the average person in the US needing this type of medication (I like Americans!). But trust me, from the outside looking in it is completely immoral. They give you free meds to get you hooked and then you have to switch to another one of their drugs when they stop the free samples? HOLY SHIT!!
Here’s Dr. Carlat’s point of view on free samples (worth the read):
http://carlatpsychiatry.blogspot.com/2008/09/are-free-samples-bad-for-patients.html
I have had exactly 15 doses of Pretiq and I want out! I was on Effexor xr 150 mg for 2 years and wanted to try something different due to sexual side-effects. Well let me tell you-I have been in hell. Thanks for the word “brain zaps” because I couldn’t find a word to suggest the activity in my head I was feeling. I can barely write-life is in a cotton ball feeling and just wanting to sleep til it all goes away. I am out of work due to a back injury and chronic pain. So depression sets in and now I have no life! Please watch this med and I would recommend if you are sensitive to any meds-don’t take this one. It truly sucks to be me and try to get off it. I pray every day that it will get better. Now I am every other day for 1 week to get off this med. I told my Dr. I want to try and live without any of these anti-depressants. Anxiety is my biggest issue-No my Dr. didn’t want to give me Xanax just for the anxiety, which I had at work- So I am not working so I want to try it without crap. Oh, yea she (my Dr. ) stated she didn’t want to give me Xanax because of the addiction stuff-well I feel like this must be like getting off of herion!!! After only 15 pills!!!
you should publish quickly material about withdrawl from pristiq. i went through a prolonged, uncomfortable withdrawl, and my md was really suprised since there was no literature on this. i found pristiq not the ‘medical miracle,’ publicized, but actually a marginally effective drug.
I have been on Pristiq for 10 days. I have been searching for REAL info about side effects for 10 days. I decided yesterday to convince my MD that my life has been a living hell since starting this drug. He did not give me any warning of the horrible side effects. At first I thought I was getting hysterical due to reading patient complaints online, which is all the info I could really find. After missing 1 dose, I am thoroughly convinced this drug is dangerous. I feel like I have food poisoning, the flu and have taken an overdose of some psycho drug. Wyeth should be INVESTIGATED for withholding patient info that try to mitigate their responsibility in their black box warning of suicidal thoughts. Please, medical professionals – stop prescribing this horrible drug at least until you, yourself, understand or have experienced the horrible side effects. We are trusting you to take care of us during difficult times. Don’t sell out to Wyeth.
I went off pristiq after being on it for about 12 weeks. Off now for about 1 week and having bad headaches and being in a bad mood. I went off of itmainly because I was gaining weight [about 15 pounds] and I felt a way I didn’t like.
I wanted to comment on what was said about the starting dose of pristiq, and that it was so special that the starting dose is the same as the continuation dose.
When I started on prozac, I started out with 20 mg, and I stayed on that same dose for ten years. At some point I increased this to 40 and this was again many years ago.
So, I am not so sure how special this really is.
I must though say, that sometimes I forget to refill the prozac for a few days, and it’s no problem at all, most likely because it is long acting.
It otherwise also has discontinuation symptoms, and major, but they don’t happen in none day.
People taking any anti-depressants should have open, honest, communication with their doctor. If your doctor puts you on something and it doesn’t work after some time, get your doctor to try something else. Whatever you do, tell your doctor before you stop taking something.
I’m not a doctor nor do I work for a drug company. I’m someone currently taking Pristiq. I’m on day four. It’s begun to help. I’ve got four weeks of samples. So far, only side-effect I have is some insomnia.
I have been taking Pristiq for 2 months. I am disappointed in the lack of information my doctor seems to have concerning this medicine. He did give me a discount card to be used at my pharmacy which saves me $25.00 off the total price.
This medication has been HORRIBLE for me. I have informed my physician of the effects this pill has had on me. He said to stop taking the medicine, which was Monday, and to call the office on Friday to let him know how I was feeling. Well it is now Thursday and I feel TERRIBLE, dizziness, headaches, hot flashes, thought process amiss. I would NOT recommend this medication.
It clearly states to not stop taking this medicine abruptly, but is is clear from some of the previous posts that it does not to wean off the med’s either. Please reconsider before taking this medication, I for one wish I had.
i have been on Pristiq 8-9 wks. My depression got so much worse that I have no interest in socializing,want to go to bed early, have inorgasmia,feel stoned, forgetful,yes,calm,calm like I think I’m on some psycho tranquilizer that makes me just stare at tv or just stare for long times. Tried to quit,sick had to take one-afraid to try to quit again-I recommend this drug for healthy people who want to know what depression feels like.
hello.
i had been prescribed Pristiq a few (?) months ago. early on (50 mgs / once a day) i presented with the maddening sensation of bugs crawling over/beneath my skin, severe headache and, later, abdominal bloating. the itching was insane-making, but i stuck it out and eventually that symptom subsided. as someone who is (healthily) weight/fitness-conscious, my doctor reassured me that the bloating would definitely “go away”. (with so little known about this drug, i don’t know how she could have been so confident.)
after about 8 (?) weeks of “persevering” on Pristiq – – and now looking as though i were PREGNANT (the girth-gain = freakish) – – i had had more than enough! my doctor placed me on a “weaning off” protocol (one day on/one day off) for 8 days. by only day 9 or 10, the WITHDRAWAL symptoms kicked-in, full-force: disabling migraine-intensity headaches, severe nausea and dizziness, sweats, chills, flu-like symptoms and – what i can only think to call – “mental instability”, lasting nearly 2 weeks. i was prescribed 10 mgs of Prozac to “counteract the withdrawal symptoms” (i had initially refused to go on another med but was in such dire straights, i agreed). the 10 mgs of Prozac did, indeed, calm my psyche. however . . .
now, about 3 weeks post-“weaning off”, i still have bouts of severe headaches when i don’t have “just” a continual drone of head pain. and, for this (usually) slender and athletic woman (50-something), my girth has further spread: i tried on 2 summer dresses last night and, to my utter shock and dismay, they were *skin* *tight* . . . now, *that*, folks, is a cause for depression.
i find the writer, who takes great care (and length)in distinguishing “withdrawal” from “discontinuation”, to be blatantly (deliberately?) irresponsible in his parsing of words. my own doctor has been concerned about my “WITHDRAWAL” from Pristiq. Big-Pharm-Talk at work here, me thinks.
btw: my doctor, recommended Pristiq to me (i have taken Prozac on a few occasions in the past) precisely because she knows weight-gain is unacceptable to me, understood from her sources that “weight gain would not be an issue” (!). i would be interested in reading the (accurate) data that is published and given to physicians.
(yes – i also was started on 4 weeks of “free”
samples, before having a prescription filled at the pharmacy.) my doctor also described Pristiq to me as an “improvement” upon Effexor; that it was “Effexor, without the side effects” (!). and, as angry and frustrated as i still am, i believe that my physician (psychiatrist) believed the literature she was given and was conveying what she understood to be so to me.
with best wishes –
Urban Gal
Hi Urban Gal,
Thanks for your comments. My dr.just recommended I take pristiq and now after reading mostly negative comments I feel that if I take this drug I will regret it hughly. I am in your age range and part of my propblem I thinke is menopausal for me at least and mood/anxiety. I am currently on a small dose of cipralex and I think I’ll stay there. Did do Prozac once and it made me manic until it wore off however with the way I feel I am tempted to try Prozac again to shake this damn depression I am in AGAIN. I appreciate yur comments and the others and I will not be taking Pristiq.
Thanks a million to all who commented.
Looking for peace.
I have taken Pristiq for nearly a year with very little problems. Recently I joined the growing ranks of unemployed Americans… I’ve lost my health insurance and no longer afford my medicine. I took my last Pristiq pill about two days ago.
As I sit here typing this, I am watching myself slowly unravel…I’m becoming a mess. Over the past 24hrs I’ve become oddly more emotional, shaky, confused and overall depressed. It’s like a weird sense of sickness (nausea?) and laziness of not caring and unable to do anything to fix my situation. I worry as the clock ticks that I’m losing a battle…
I have no idea what to do, but too nervous (confused? hesitant?) to tell anybody help is going to be needed. So I’m here typing this message and deep deep inside is a scary/sad nagging worry that things are winding down. My life has become a big disappointment for all.
If I’m able to get up tomorrow…to call the dr., I don’t even know what to do, how to ask for help. I think this will get worse until – I really don’t know what’s going to happen. But I’m starting to wonder if it’s worth it.
As tears come uncontrollably (embarrassing) and my head is cloudier and harder to type, I hope my withdrawal symptom and this last sentence will forever haunt the Wyeth dr.
Blood pressure spike and weight gain have been horrible with Pristiq. I did not do my research on this before switching from Lexapro. I was not feeling better ob Lexapro so I was happy there was a new latest and greatest. After doing research on blood pressure effects, I am astonished at all of the posting and all of the side effects people are experiencing. Going to talk to doctor about getting off and now I am so fearful of all of the symptoms of withdrawal. Geeze…what have I done. Any suggestions on how to wean off of this drug?
Urban Gal, I can not take the weight gain either!! Where are you in all of the process of getting off Pristiq? Any updates on any of the other people who posted? Especially would like to hear from AfterToday…
I was on Pristiq for about a month, and I am now on the 4th day of being off of it. I did not ween off due to the posts of it not being helpful to do so, and I feel the sooner it is gone the better. I first thought the pristiq was helping, but the insomnia was bad, and I still had some anxiety and depression, so how was that better than being off antidepressants? Today was a pretty good day. I am hopeful for another good day tomorrow. I do have “brain zaps” but not continuously, and since others have written about them, I know what they are. I am still having trouble sleeping. The dr. had originally given me 5 xanax (.5 mg a tablet) So when I take a half of one of those, I can get 4-5 straight hours of sleep. That is better than waking up every hour. I have an appt. with a psychiatrist on the 24th. That was as close as I could get. I have been seeing a counselor, for about a month and a half, who I guess feels a psychiatrist can help more, due to the medicine knowledge. A general dr. gave me the prescription for prestiq, first lexapro (immediately knew this was bad for me) and she told me that she only offered me these because she had samples for them. (I didn’t ask for samples, I have good insurance) So I have no confidence in her knowledge of these drugs.
Anyway, just hoping for better days. Also, I too am wanting to hear back from AfterToday. I certainly am concerned about you, and I hope things have gotten better for you. You are not alone. Hang in there.
I have taken a lot of different anti-depressants. Each has a plus and a minus, but Pristiq is the most horrible thing I have ever encountered. It raised my blood pressure to dangerous levels and is hell to stop taking. This article is condescending and really out of touch with the real experience one can have on this medication.
Caveat emptor!
I had a long success with Zoloft, but as with most of these drugs, it pooped out on me after a decade.
After trying several other SSRI’s my doctor and I agreed to move on to the SNRI’s. Cymbalta seemed to work great, but as I increased the dosage, I began to experience confusion, memory loss, and extreme temors. One positive for Cymbalta however, was the lack of sexual side effects.
After finding extreme disappointment in the Cymbalta, I agreed to try Pristiq to treat my Anxiety, OCD, and Major Depression. At first, the 50 mgs seemed great, but after 4 weeks, they seemed to be losing their effectiveness, so my Doctor increased my dosage to the 100 mg. BIG MISTAKE. Instead of controlling my OCD, it exacerbated it horribly! Along with the increased OCD, I experienced memory loss, horrible confusion (when I left my house, I began to be afraid of getting lost and I couldn’t recall one day from the next, I had to write everything down on the calendar or put it in my iphone) I felt overly agitated, my depression worsened (thoughts of suicide began to creep back into my mind), I lost all focus (doing a load of dishes or laundry was almost impossible) and worst of all, my panic attacks returned. Oh yeah, forgot about the sexual side affects…no arousal or orgasms to be found while on Pristiq) We decreased my dosage back to 50mg, thinking the 100 was just too much, but the damage had already been done, the side effects remained on 50mg, so I weaned off of this drug, however, weaning has done little to help with the horrible withdrawal symptoms. I thought withdrawal from Zoloft was bad, but it had NOTHING on the withdrawal from Pristiq. The dizziness, “brain zaps”, and nausea have been the worst part. For those thinking of trying Pristiq, I’d advise doing a little research before starting this drug. I’m not going to totally trash it, because I’m sure there are many out there who have experienced great success from this drug, but there are also many others who have experienced horrible side effects that are not included or even mentioned on the insert (such as the memory loss/confusion). I find it hard to believe that these symptoms were not experienced in studies, because it took me all of a 30 second search on the internet, to find story after story, from other patients that experienced extreme loss and confusion on this drug.
I feel so sorry for everyone who posted on here. Reading this doctor’s comments about the medicine felt like watching some horrible “Thank you for Smoking”-type scene that unfortunately contributes to real-life trauma for people.
I was on Effexor XR for six years. I went off the medication last January. The first week was terrible – migraines, chills, sweats, strange dreams, brain shivers – everything described from typical Effexor withdrawal (I refuse to say “discontinuation syndrome” except to my doctors who prefer that phrase).
Eventually I found the users’ comments online that mentioned opening the capsules and taking granules out a couple at a time every day – worked wonders! Combined with my herbalist’s recommendations and some exercise, I was able to do well and get off it.
So, now I’m experiencing depression that I feel is situational (unemployed, feeling pretty lousy about it). Going to a therapist after having a couple of panic attacks while starting a new job (that I had to quit)…long story short, they want me on meds. And not Effexor (cost, I’m sure, is the factor) – they want me to try Pristiq because, as the psych says, she has unlimited samples in the trunk of her car.
‘Nuff said. So I took some samples home (did not take them, I want to make a really informed decision). Feeling really depressed one day, starting to feel like I should just swallow a pill, and then I did the research and ended up here.
All of my suspicions about the nature of the pill being tablet, not capsule, form and how that would affect the withdrawal in the worst way possible are confirmed by your unfortunate experiences (which, in my opinion, border on criminal negligence if not outright illegal dishonesty on the part of Wyeth).
This profit-at-all-costs junk has to stop. It really has to stop. People are suffering and desperate, doctors. People are trusting you! And you deny, deny, deny or mislead us as sheep to pasture, except you lead us over a cliff (we’re already standing on a rather tall rock). This is so highly unethical, immoral and abusive.
Ok, I’m done with my rant but I seriously hope that all of you, all of us, are able to find ways to become un-depressed, to become happy and joyful and alive and full participants in our lives. We have to do it – and until we ourselves start developing pills, big pharma is going to keep taking advantage. I realize the pills help – Effexor XR helped me immensely – but as they’re developed, they need to develop them with the mechanisms for properly and easily (as much as possible) stopping the medication.
I know this is not in the company’s short-term thoughts about their best interest, but imagine how many people will line up for meds that relieve depression/anxiety/BP/OCD/pain, etc. that are proven to have absolutely no withdrawal syndrome?
Reading all these comments, it’s so terrible and I really feel sorry for the victims.
I also feel offended by what is probably a lot of confabulation , the comparisons to placebo ‘side effects’, like, that 30% of ‘placebo users’ stopped using the drug due to some type of terrible side effects. Am I supposed to believe this? Sorry, but I don’t!
I also do not buy the thing about 50 mg for all or otherwise 100mg for all. They used to say the same thing about prozac, but in fact, i know many who open the capsules and regulate the amount according to their own need. Is that patient bad for not following doctor’s orders? No, in fact that patient is very wise, as really only the person who takes the medication can know and tell if the dose is right, or too low or too high. If 50 mg of Pristiq doesn’t do it, go and double the dose?
I am amused, (but really not) at the thought of having a high blood sugar and someone telling me to double my dose of insulin.
Oh god, i could go on forever, even if I personally have had such great luck with prozac, and from the start. But then it’s really not all about me, is it?
I have been taking Pristiq for over a year. I absolutely love it. It has the least side effects of any SSRI I have ever taken. Don’t listen to all the horror stories above. Anyone reading half the previous posts would be terrified to take something that might be the best thing that ever happened to you. Anyone who takes 5 or 6 different kinds of depression/anxiety medications are in no mental capacity to give advise about what will help the average person.
Melissa,
I am not normally on any anti depressant. This one was horrible to get off of. I was on the lowest dose possible due to situational depression & anxiety and even at 1/2 a pill every other day if I go longer I get horrible brain zaps, and all the other symptoms. I am not one switching from one anti depressant to another. This drug is seriously bad. I agree, it did work to alleviate the depression so I could get through these difficult times but at what cost to my brain now? I am still trying to get off of it and am using my doctor’s recommendations of 1/2 pill every other day but if I go longer without it, all hell breaks lose & it is excruciating. Good luck to you, I hope when you go off of it you don’t experience this but please believe all the other comments, they are correct! You will think you have the flu or something but it’s not the flu.
THIS IS A VERY DANGEROUS DRUG. MY SYMPTOMS OF DEPRESSION WERE NOT LESSENED AT ALL BY THIS DRUG. THE WITHDRAWAL SYNDROME (NOT DISCONTINUATION SYMPTOMS) IS EXCRUCIATINGLY PAINFUL. I DO NOT THINK THAT WYETH/PFIZER HAS DONE SUFFICIENT STUDIES OF THIS MEDICATION AND CERTAINLY HAS NOT PRINTED OR PROVIDED INFORMATION STRESSING THE SEVERITY OF WITHDRAWING FROM THIS MEDICATION. IF THERE IS A CLASS-ACTION SUIT FOR EFFEXOR, I CAN ALSO SEE ONE IN THE FUTURE FOR PRISTIQ. MY DOCTOR TOLD ME HOW I WAS TO WITHDRAW FROM PRISTIQ AND I DID EXACTLY AS INTRUCTED. SADLY, I HAVE BEEN IN HELL FOR 3 WEEKS.
I just recently went off Pristiq because of the cost. I was on it since it came out and my doc switched me from Effexor XL, also because they stopped providing samples. Anyway, it did help my depression. However, the side effects, sexual dysfunction, high blood pressure, slight seizure-like symptoms throughout my body, high cholesterol(in spite of being on statins) were bothering me greatly. Going off has been a nightmare. I am off 2-weeks now but am still sweating, having the night dreams, dizziness, emotional, severe downs. I am hoping that I do not have to go back on it because the cost is depressing in itself. I can only manage to save $25.00 a month but spend hundreds on medications monthly for heart disease. My sanity is on the back burner right now!
JMM
I have been on this medicine for 5 days and I stopped taking it because I have the worst headaches now and I am unable to have a organism anymore. Since I stopped the medicine my headaches are extremely painful. I would advise someone to pay close attention to their body and immediately notify their doctor if anything changes.