Healing & Antidepressants

Polyvore by grace2244

As we depressed people heal, the need for medications like antidepressants and/or anti-anxiety may become unnecessary or may be reduced. This article is about Pfizer's Pristiq and the issues that have arisen with my weaning off of it.

First of all, I write of my healing since my last post here.  At that time I had dropped from a dosage of 100 mg to 50 mg to 25 mg and then to 25 mg every other day when I ran into a problem. That led me to extensive research about this drug. I do want to note I definitely needed this level of antidepressant in mid-2011. I had no side effects whatsoever, unbelievably, going off Cymbalta to Pristiq. I had been at maximum Cymbalta dose and was suicidal. The Pristiq fully kicked in about a month later and kept me stable.

No one looks up weaning off of a drug when placed on it. Also I had no choice and was just grateful there was something similar to Cymbalta, which had been the first antidepressant in my life I could tolerate. It was released in 2003 and I started it in 2005 at the lowest dose and remained there till after my nearly 10 surgeries in 18 months between 2007 and 2008. Cymbalta has it's own withdrawal issues which I didn't experience. Also Cymbalta's lowest dose is 30 mg and highest dose is 180 mg.

Pristiq has two dosages: 100 mg and 50 mg. Pfizer officials have no safe weaning plan from their drug. They don't recommend cutting the 50s in half, though that's what many do. While some suggest alternating the 25 mg every other day (or the 50 every other day without cutting it in half), studies for the main ingredient indicate taking it every other day makes the brain go a bit bonkers. It needs a daily dose. So if you want to wean from Pristiq, you will need to cut the pills (at your own risk) although it is what my psychiatrist recommended.

Cutting the pills in half is not an exact split. Pill cutters aren't accurate. Also, Pristiq crumbles easily. Fortunately I have a math minded husband and we have a digital scale that weighs milligrams. While some have made their Pristiq into a liquid solution, it is not recommended. It's considered insoluble. I did find the suggestion to crush the pills either with pestle and mortar or smooshing with the back of a spoon to work.

I emptied some herbal capsules so they could be filled with a measured 25 mg. (I did back up to going on 25 mg daily after having difficulty with the switch to every other day.) I will be taking the 25 mg measured dose capsules for a week. Then I will try 1/2 that amount. Possibly, with my sensitivity, I may need to go between the 25 mg and the 12.5 mg and may also need yet a lower dose before my brain lets me not get insanely dizzy without it. Crushing the meds allows for the varied dosages.

I'm not understanding, except from the financial perspective, why Pfizer made this drug without a withdrawal plan. Suggestions are on several forums to contact Pfizer directly to complain about lack of lower doses for this purpose.

From my own experience and reading numerous other perspectives, trying to go cold turkey with Pristiq may cause horrendous side effects. When I dropped from 100s to 50s I felt no ill effects for three days so thought I'd just try to stop. Three days after that my head started spinning so badly I couldn't see or walk straight and had nausea. This backlash happened a second time. After being on the 25 mg for a week, I stopped. My psychiatrist said I should be fine then. Three days after stopping I was hit with incapacitating dizziness again and slight nausea although not the strong cyclone earlier on. Others have experienced more side effects. Several forums exist online if you just google "Pristiq withdrawal". The Mayo Clinic has a discussion forum and there is one called Surviving Antidepressants.

As an aside, some compounding pharmacies will make the lower dose capsules for you. My pharmacy said they only made a liquid solution and that would have cost nearly $200 for a month's supply. Smooshing and measuring and clear pill capsules is the least expensive. Even if you need a digital scale, you can purchase one for about $55. Instructions for how to do this were found through the Surviving Antidepressants website.

My psychiatrist has been apprised of my choices. It's always good to wean from a medication under a doctor's supervision. I've been fortunate to have a psychiatrist who works with me. If that's not the case for you, perhaps a new psychiatrist is in order.

Today I woke up several hours earlier than usual feeling awake. Overnight...but it has been about two weeks on the 25 mg instead of the 100 mg. I'm also beginning to be able to cry again...appropriately...like to sappy movies. I'm hopeful to successfully wean off Pristiq even if it takes longer than hoped. I know I'm better at 25 mg than the original dose. Now to get to zero.

I have experienced light dizziness and light headache daily since lowering the dosage but started feeling a bit clearer yesterday. Then I had the earlier wake up today along with feeling more clear. I'm hoping those who wish to reduce or go off antidepressants when the time is right for you is as symptom free as possible.

A Matter of Medication

Recently I posted about a medication change that was not explained fully and apparently was in a manner that caused concern. I apologize for those who may have felt that way. My personal reality is that I am on medications for several physical conditions. Except for an antidepressant, I take little else for anxiety symptoms. My main medication for depression is Cymbalta. I've been at the maximum dosage for two years (120 mg/day). I had been trying an adjunct antidepressant in much smaller doses because it seemed as if I had become more depressed. I had been working with my psychiatrist on the adjunct meds which weren't working.

When I met with him last week, I spoke of feeling overly dosed since, logically, I was not nearly as depressed now as I was when I was in the midst of surgeries and a body falling apart and not working correctly. I was indeed a mess in 2008. My dose before all that happened was just 30 mg/day of Cymbalta. I asked if I could begin cutting back 30 mg for a two week period and then another 30 mg to see if I might stabilize at 60 mg.

He agreed it was worth a try. I've been on 90 mg a day for five days and yesterday I began to feel lighter. We both agreed the adjunct stuff was not working and was just causing me to deal with side effects each time I tried something new. But I never touched the dosage of my main Cymbalta without speaking to him first.

I am hopeful 60 mg will be my new daily maintenance dosage which would also allow room if I ever do need to go up a notch or so due to life circumstances rather than trying a second medication.

Most who are trauma survivors seem to be medication jugglers. I've just found that my intuition is often right and I find doctors who allow me to try what I sense to be right. We both know if I start to crash, it's not the right decision.

Because of what happened to me in 2007, I have learned to be a much more proactive patient. And I encourage all patients of any doctor to be knowledgeable in what is going on with their care and why/what medications are going to do. Speaking up doesn't come easily to many trauma survivors, but your medical care is a place where I believe it to be essential.

Ups & Downs of Recovery

The first week of April I began aquatics therapy three times a week. What hurt in "land" therapy, did not hurt in the water. Even though I was sore between sessions, I was able to do the work. We all agreed that I would "ride out" the pain between sessions as long as muscles were building while working out in the pool. Aside from focusing on my one shoulder (the reason for the therapy initially), the pool allowed me to work on rebuilding all muscles that had atrophied while recuperating from all my pelvic prolapse surgeries in 2007-2008.

Because of my art therapy group on Polyvore, issues kept coming up in my art even though I wasn't focused on them consciously. Just before the move to aquatics therapy, my mood had crashed...feeling lack of ability to heal, angry that I couldn't deal with the pain to get better, frustrated that my partner was more of a caretaker than an equal.

The first week of May we vacationed a few days in Washington DC and I was able to walk the entire day for sightseeing. Was so proud. I've continued the aquatherapy three times a week and just this past week ran into a problem with too much pain. Another crash but have spoken to the physical therapist and we are going to adjust the exercises to go backward on the painful one and progress much more slowly.

My goal for this year is to heal physically...rebuild my body...not be limited by my lack of muscle or strength. I can see how sense of body ability and sense of worth are strongly intertwined for me. When I crash into depression I still have the default of "the world would be better without me. BB would be better without me." So I struggle through that until I'm "up" sufficiently not to be fighting that message.

I can only wonder if that will ever not be my default. Between the surgeries in 2007 and the year of my trip to Italy (2005), I had changed the default. It is possible. It just was knocked back down so quickly with bad things happening.

I see the vulnerability in all survivors through art by members of my group. Constant struggle. Healing, even at my level of functioning, is still a roller coaster. Such traumatic beginnings are indeed lifelong at some level. I'm fortunate to have new friends and family who know me for exactly who I am and love me. Good times are in my life to help balance out the bad times. Surely that's a good thing. I wish that for all survivors...balance in all areas of life.