Is this standard? Switching from SSRI (Lexapro) to Pristiq--Need feedback from similar situations!?

Posted:: 8 Aug 2009 by izzothecat
Topics:: lexapro, pristiq, sexual dysfunction, ssri induced

Details:

I have been on 20mg of Lexapro for a little over a year. I saw my doctor yesterday and told her that despite the difference Lexapro had provided, I was still not very "happy" (and never had been... it basically made me dysphoric rather than crying all the time), and the fact that I have gained 19 pounds from the medication alone (no change in my activity level over the time I was on the drug) did not make me too happy. So, she gave me a sample pack of Pristiq--as well as a prescription--and told me to take the Pristiq one day, and then the Lexapro the next. She wants me to alternate the two meds for one or two weeks, and then switch over to Pristiq completely.

My questions: Is this really necessary (i.e., if Pristiq is an SNRI, why would I still experience withdrawal from Lexapro)? Furthermore, isn't there a chance that I could experience Serotonin Syndrome by switching back and forth like this (or is this a common procedure)?

Could people who have switched from an SSRI to Pristiq (or anyone who has switched from an SSRI to any other type of anti-depressant) please reply and let me know how they were informed to do so, and how it worked out in the end? I would really appreciate as much feedback as possible, b/c I am considering just switching to Pristiq right away... I have tried the whole cabinet before, and never was I "weaned-off" of one before starting the other; I was always just switched over on the day of the visit.
Thank you all for your help!!
Kiera

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Answers (8)

jcgunhrun

11 Aug 2009

Hi Kiera,

I've trialed several psychotropic medications throughout the past ten years or so for the treatment of Generalized Anxiety Disorder, Depression, ADHD, and Post-Traumatic Stress Disorder. In addition, I am fortunate enough to have the experience of working in the field of working with Emotionally/Behaviorall Disturbed children, which involves a great deal of researching and staying up to date with psychotropic medications.

Expand this post...

While I have not personally taken Pristiq, I have been on Lexapro, which my physician slowly tapered me off of. In my personal and professional experience, most doctors prefer to taper off one medication prior to initiating a new medication due to the fact that if you change two factors at one time, there is no way to tell which of the two is causing a result. For example, if you are decreasing the Lexapro dosage to every other day while simultaneously starting a completely new medication (Pristiq), and your behavior or mood changes, you will have no no way of determining which drug caused that change... the decrease in Lexapro or the introduction of Pristiq?

Hence, my best advice to you, at this point is to first check out the links I attached below and possibly discuss your concerns with your doctor. If you are worried that he/she will think you are acting like you know more than him/her, it might be helpful to word your question in a similar fashion to the following statement: "I feel concerned and confused about why I need to be on Lexapro and this new medication, Pristiq, at the same time. How will I know which of the two drugs is causing any changes that might happen during this time period? Also, I read some information about Seratonin Syndrome, and I'm pretty scared about it. Do I need to be worried about the information I read?" I know it sounds a little corny, but from my experience working with colleagues and as being a patient, most physicians don't seem to like it when they're "told" what to do. They appear to prefer the "patient plays dumb" approach.

I did some research and found some links which may be of use to you. Feel free to check them out, and hopefully you will find some useful information:
http://www.drugs.com/sfx/pristiq-side-effects.html
http://www.mayoclinic.com/health/serotonin-syndrome/DS00860/DSECTION=causes
and the page that follows it (see below):
http://www.mayoclinic.com/health/serotonin-syndrome/DS00860/DSECTION=risk-factors

*** If you go to drugs.com and click on "Interactions Checker," type in "Pristiq" and "Lexapro." A major drug-to-drug interaction pops up on the next screen warning of the potential of Searatonin Syndrome.

I hope some of this information was helpful. Sorry it was such a long reply.

Good luck.

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izzothecat 12 Aug 2009

Thank you for all of the info. I too have been through points where doctors wanted to change 3 meds, but I stopped and explained to them that I would have no idea what was causing any increase or decrease in my mood if I were to do all of this at once (not to mention all the non-medical circumstances that could be changing my moods).
Luckily, I was able to talk to the pharmacist today when I filled the script for the Pristiq. After I explained to him the process that my doctor had planned, he thought that it would be very effective, and he thought it sounded like the best decision. He particularly alleviated my concerns of serotonin syndrome, as well as potential w/d symptoms from the Lexapro (he said that if I experience any, they should not be for long, and certainly not nearly as bad as just coming off of Lexapro). Thank you for the links... I will definitely check them out.

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subzero58 10 Mar 2010

what a great approach "patient plays dumb" sad but its true.i think every person is responsible to themselves befor they start blindly taking any medications. and a doctor who should be ashamed of themselves for prescribing medication that they don't much about. we are putting pills in our bodies that were not sure of the side effects it may have on us.

izzothecat 12 Mar 2010

What a positive, informative, and productive comment from the epitome of hypocrisy. And what a better approach you take--"patient is stupid." I think it is sad when people take morphine for years, and their doctors don't even warn them that opiates are addictive! And congrats on switching from an opiate agonist to an opiate agonist to another agonist! Wait... that's not quite right... I messed that one up. Congrats on being able to switch from morphine to methadone, and then to buprenorphine (I promise you that it will be oh so much harder to come-off of that sub than the morphine would have ever been. But this is our faults for not having medical degrees (or at least b/c we did not go to pharmaceutical training) on top of our other occupation...

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and the doctors who don't know everything about newly-introduced medications that haveusually undergone--at most--a few 4-6 week trials in some small sample studies! Damn doctors for their ignorance, and damn my idiocy!! Why can't we all just know everything???
Why doesn't the FDA and the US government provide every single person with a newly-revised edition of the PDR within a month of any new medication being added to the pharmaceutical market so that we can know exactly everything about any potential effects of newly-introduced drugs? I mean seriously, it would only require about 3 books shipped to each person every day... is that too much to ask?? Wait, if the medication is new, how can we know about the long-term effects? I'll stop playing stupid next time I receive a medication for something... I promise to study not only the currently-available formulations for ALL medical problems, but also to make certain that I am up-to-date on all of the newer prescriptions that have been released within the last 3-4 months before my appointment.
Why leave a completely pointless comment on a question that was answered months ago? How many orange pills had you tried to hold underneath your tongue before before you realized that drinking the alcohol at the same time could probably cause you to accidentally swallow them?
Thank you for your partially legible comment that added absolutely nothing to an EXTREMELY old question. I suggest that you type it up in a word document, print it, and then read it everyday for a year or so. Who knows? It may serve as a very effective component of your eventual tapering process? Furthermore, after the year or so of reading over your comment, you can take it to your therapist and explain to him that you finally understand what "projection" is, and why it is important for learning about one's own feelings (that is, when you finally do understand it... don't bring it to therapy before then; it will not be of any use if you just fake it). Oh, and please be sure to add-in all of those missing letters when you type it up! Otherwise, it may lose its ability to facilitate the learning process, and could ultimately just confuse you further...
Sincerely,
Completely pointless, abrasive, and blaming my doctor(s) for my problems

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suzanne66

11 Aug 2009

Your doctor is being cautious by alternating drugs. The aim of treatment is to reduce Lexapro slowly so as to not precipitate withdrawal symptoms and to introduce Pristiq slowly so as to not risk serotonin syndrone.
You should keep in close contact with your doctor whilst you are switching medications and follow your instructions. If you experience anything unusual contact your doctor.

You may also find the forum useful in finding people who have had similar experiences.
http://www.drugs.com/forum/

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izzothecat 11 Aug 2009

Thank you so much for finally being the first to respond to my question!

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izzothecat 11 Aug 2009

The link which you provided is the generic link to all forums. Did you have one in particular that you meant to send to me, or for me to read? I have been through both the Lexapro and the Pristiq forums... they are the initial places where I learned how I managed to gain 22 pounds despite no changes in diet or exercise. I have not been able to find any information yet that describes a person's process with switching from a tapered drug to Pristiq; the Lexapro forum is mostly a bunch of people--who like me--have gained weight and are now wondering if they will even be able to get it off (even when they are off of Lexapro)--and nobody seems to offer any hope, and the Pristiq forum involves a few people who absolutely hated it, as well as the majority of the forum members who did like it because it seemed to begin working for them right away, and it helped them with their weight, essentially by making them anorexic...

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lynnette10

1 Dec 2009

I also was on lexapro for over a year. It was awful for me also. I gained 20 pounds and that made mw feel worse. I was switched to pristiq about six months ago. I was told to stop lexapro cold turkey and start with pristiq the next day. I didn't experence any withdrawl symptoms. Be careful because everyone is different. I was not told I was being switched from a ssri to a snri but it worked out well for me. I still have not lost the lexapro weight and that worries me but all in all it was a good switch. I hopes this helps you and good luck.

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izzothecat 13 Mar 2010

Thanks for sharing your experience; I have not lost the weight either. In fact, it appears that I have gained another pound (although I think that it is water weight, as I drink A LOT of water during the day now--as compared to before--due to the slight dry mouth I get from the Pristiq).
Anyway, I am certainly glad that you did not experience any w/d's from the Lexapro... luck was on your side for sure!
Take care, and thanks again-
Kiera

Anonymous 29 Apr 2010

I have been on Pristiq for 4 weeks and stopped my SSRI and started the Pristiq the next day. For me the side effects were very mild and I have felt the best I have in a long time. Pristiq is a wonderful drug and I think you will be happy with it.

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barbles2413

1 Dec 2009

I was switched fromLexapro to cymbalta. Cymbalta is the same idea of prestiq. It is both a ssri and a snriwhen I made the switch I did not have to wein off Lexapro to go on cymbalta.I just finshed Lexapro one day and started yhe cymbalta the next. The Doctor told me that they were so much alike that I could just stop one day and start another.Believe me the cymbalta which is the same as Pretiq is so m uch better than Lexapro. For me anyway. I also lost about 12lbs when I stopped the Lexapro and the Effexor xr that I was on prior to the Lexapro And I have not experienced any side effects. Thank the Lord. Good Luck this. Changing meds is a big step as you are feeling awful anyway now you are not knowing what you are going to experience on a new medication. Good Luck and God Bless

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inpain777

29 Apr 2010

i found out through my own shrink, that prestigue is just another name for paxil..which, ive heard dangerous things about. please ask your doctor, many wont tell you the facts !! or dont even know them for that matter...

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inpain777 29 Apr 2010

and also, generics are a big difference. they only have about 70 % of the real drug, God only knows what else is in them. i asked the pharmasist if this was true, she said no, i said then why are the generics so much cheaper, she then didnt have an answer..guess that was the answer !!!

izzothecat 3 May 2010

If "Prestigue" is meant to be "Pristiq," then you have your info. all messed up. It is not Paxil; Pristiq is the (supposedly) active stereoisomer of the drug that is (the racemic mixture) Effexor (XR). Furthermore, Pristiq is an SNRI, whereas Paxil is an SSRI (a very nasty one at that too, esp. when it comes to coming off of it).
-Kiera

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hoped4aimee

18 Dec 2010

I was on Lexapro and switched to Pristiq. It's been about a year and half now. I'm very happy with Pristiq compared to Lexapro and had no weight gain with Pristiq. My Dr. just had me immediately start the Pristiq. So as far as that goes I can't really say what to do. I will just say that I'm very happy with Pristiq and seem to always tell friends and family they should try it as opposed to whatever anti-depressant they are on. I started off on the lowest dose of 50mg and after about 6-9 months I did feel I needed a little more and the Dr. upped me to 100mg. I definitely noticed a difference and have been very satisfied at this dose for quite some time and he says I'll probably end up staying at this dose. Hope I helped a little.
Aimee

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Rachy252

17 Jun 2011

i have just been changed from sertraline to pristiq and i have had to have time off i was getting anxiety and just crying its been horrible its been 6 days and i just want to feel better but when they changed me it was from one to the other. i dont know how everyone else was feeling but i just hope all goes well cause i cant keep having time off and feeling like i want to hide away from everyone.
i am feeling for all that is having a hard time please give some feed back to your experience

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zengurl72 17 Jun 2011

I also just switched from sertraline to Pristiq! No tapering, just cold turkey switch. The first week I had withdrawals without the sertraline and Pristiq once a day. At the end of the second week I was increased to Pristiq 50 mg twice a day. I feel amazing now that the withdrawals are done! My doctor does have me out of work for a few weeks while we worked through all of the changes. After being on medications for depression since I was about 18 {I'm 39 now} I have been through many kinds and I know how most of you are hurting! My prayers go out to each and every one of you. God bless!

Rachy252 17 Jun 2011

It means so much to me to hear how other people were with changing it's so so hard and some people just don't understand that haven't had anything to do with depression thanks again

izzothecat 18 Jun 2011

To everyone who replied to my original post regarding the switch I made from Lexapro to Pristiq:

Expand this post...

I first wanted to follow-up with those of you who had initially reported positive results with the Pristiq. I also--as several of you have indicated here--initially felt an almost immediate "lift" after beginning Pristiq. Unfortunately, just as has happened so many times before, its effects waned about 4 months after having been on it.
After a lot of researching and whatnot, I have since taken a strikingly different approach; I have slowly--yet completely--tapered off of all of the SSRI's/SNRI's and other medications that had been dumped into my body with the help and supervision of a psychiatrist I located. In fact, the only medication that I am still taking (and which I intend to taper off of within the next 5 months or so) is Lamictal, 200mg per day. I--and all of the experts in psychopharmacology--have no clue about how it actually works (e.g., it is prescribed to children for behavioral issues, bipolar disorder for reducing manic and depressive cycles, and a wealth of additional... and extremely varying... psychiatric "problems," especially as there are virtually no reported side effects... i.e., little to no adverse physical events or alterations have been noticed from the use of the "antiepileptic" medication). Although I do not have Bipolar Disorder, this medicine has been incredibly helpful for me, and all of the former side effects that were associated with the antidepressant medications are no longer present. It is very strange... yet at the same time, the fact that this medication's mechanism of action is unknown is still very disturbing (hence, my reason to continue to withdraw from all psychotropic medications... this being the last of them).
I have planned--with a new psychiatrist--to taper off of this medication (having already tapered off of the others successfully); this whole "biochemical imbalance" crap that Psychiatry and, ever more so the parmaceutical companies, have HYPOTHESIZED has no basis for its validity in the first place. After years of being on different psychotropic drugs (and after reading about the length that others havve been using the mind-altering medications), I simply feel sick to my stomach with how--in my own opinion--we have been duped into following this nonsense and taking these medications that cause our brains to become chemically imbalanced.
So, to everyone still reading this long-ago written post (and/or anyone who may stumble across it one day), I just want to leave a message for those of you who feel as I do (i.e., no matter how many are thrown at us by the doctor(s), the medications just do not seem to help or work very much; this leads to the doctor(s) increasing my doasages, or throwing more meds at me in a blind attempt to find something to help ease the sufferring; the doctor(s) pull advice and information--if they have any at all--from their asses b/c they really have no clue):
To all of you who trully wish to find some comfort, enlightenment, and--eventually--a chance to regain your life, I highly recommend that you attempt to learn "the other 'side's info/story" and please read the following books. There are many books similar to these, but I have included these 2 particularly b/c they are written for people going through the struggles mentioned above, and those that many of us have to deal with on a daily basis. That is, neither book is intended for the use of doctors only, and they are not overly technical (in fact, they are very widely informative, and encompass a lot of serious issues). Lastly, these 2 books have been among the most sobering sources for me:

"Your Drug May Be Your Problem: How and Why to Stop Taking Psychiactric Drugs/Medications" by Peter R. Breggin, M.D. & David Cohen, Ph.D.
AND
"Psyched Out: How Psychiatry Sells Mental Illness and Pushes Pills that Kill" by Kelly Patricia O'Meara.

If you choose to read these or any other similar books that take a serious and critical look at psychiatry and psychotropic medications, I hope that you find them to be as helpful and eye-opening as I have.
Thank you all for your feedback and your time... I wish you all the best in your current struggles and I hope that you can find your way through it all eventually.
Take care-
Kiera

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bexmg

19 Oct 2012

Hi Izzo,
I just came across this site and wanted to let you know my story, and maybe it will help. I was on Zoloft for many years and when I started going thru menopause, it stopped working and I went back to having SEVERE anxiety and panic attacks. With the help of 2 great doctors in my town, (my PCP and psychiatrist) we switched me SLOWLY from Zoloft to Pristiq. He would lower my Zoloft each week or 2, along with me taking the Pristiq, until I was completely off the Zoloft. I (in my personal opinion) would never suggest going off an SSRI cold turkey and switching to something else.
I know this is an old post from you, but I hope this helps you in some way, and that you are doing well now on your medication!!!

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kootenaidog 29 Oct 2012

Hi Bexmg

I just wanted to say Thank You. I started sobbing when I read your post because it was validation that my aniexty/panic attacks may be related to menopause. I'm 51 and have yet to physically start it, but I believe I'm close. It was just so good to see that someone else has felt the same. I'm starting Pristiq tomorrow and I have high hopes that this will finally bring me some peace. Thank you for sharing!

bexmg 29 Oct 2012

Oh sweetness!! I'm so sorry you are going thru this. I know ALL too well how you are feeling!! Oh my goodness... :(((
I would be glad to talk with you via email, so that it would be a bit more "personal" than on an open site.I would like to help if I can.
Would you like that? Please let me know and know that peace is headed your way soon! :))

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