Pristiq (Desvenlafaxine) is an antidepressant drug that functions as an SNRI (Selective Serotonin Norepinephrine Reuptake Inhibitor). In other words, it prevents the reuptake of the neurotransmitter serotonin in addition to that of norepinephrine. It was created and marketed by Wyeth – a company that has now become part of Pfizer. This drug is extremely similar to that of Effexor (Venlafaxine) as it contains the same active metabolite.
The goal with the development of this drug was to take only the active portion of Effexor and eliminate the rest with the hopes of side effect reduction. It took many years for the FDA to finally approve this new antidepressant, but it’s widely debatable as to whether this drug really has major advantages over Effexor. As an analogy, most would agree that this drug is to Effexor as Lexapor is to Celexa.
It is largely thought that this drug was developed mostly to protect business for Wyeth. By creating Pristiq, the goal was to convince psychiatrists to switch from Effexor to Pristiq to protect the billions of dollars that Effexor generated in sales. They have done this by suggesting that Pristiq carries fewer side effects and is generally better tolerated than Effexor. However by now, most evidence suggests that is inferior to Effexor on several levels.
After trying Pristiq, many people find it intolerable and realize that it carries many unpleasant side effects. Others find that it simply doesn’t work as well as they had hoped to alleviate their major depression. Since many people don’t want to be on antidepressants for life, withdrawal from Pristiq is usually inevitable.
Factors that influence Pristiq withdrawal
When it comes to withdrawal from any antidepressant, there are various factors that play a role in determining severity of symptoms. These factors include things like: time you took the drug, dosage, your personal physiology and drug sensitivity, as well as how quickly you tapered off of the drug.
1. Time Span
How long were you taking Pristiq? In general, the longer that you take an antidepressant, the tougher it is to quit. When you take a drug like this for a long period of time, your body and brain become accustomed to functioning under its influence. Additionally, long term users generally need to increase dosage because they become tolerant. The shorter the term that you use Pristiq, the less withdrawal symptoms you will likely experience.
2. Dosage (50 mg, 100 mg, 200 mg, 400 mg)
In most cases, people start out at 50 mg and then if necessary titrate the dose up to 100 mg. If the 100 mg works for awhile, but then stops working, a psychiatrist may double the dose to 200 mg. Over time, the more you increase the dosage, the more difficulty you will have withdrawing.
By increasing the dosage, you are essentially forcing your body and brain to function under the influence of more Pristiq. Most research suggests that there is zero additional benefit to be had by taking more than the starting dose of 50 mg.
3. Individual Factors
It is also important to keep in mind additional factors that may influence withdrawal symptoms. These factors include things like: your physiology, daily habits, diet, exercise, social support, and other drugs that you take. Most people have different reactions to antidepressants based largely on individual factors.
One drug may work brilliantly for one person, and be an absolutely hellacious experience for another. It is the same concept in regards to withdrawal – one person may experience very severe withdrawal symptoms, while another may not notice much of anything during discontinuation.
4. Cold Turkey vs. Tapering
In the past, a major problem associated with Prisitiq discontinuation is that there wasn’t an intermediate dosage between 0 mg and 50 mg. Thankfully there is now an intermediate 25 mg dose of Pristiq that should help with the tapering process. Even though the 25 mg tablets may be an easier transition down to 0 mg (nothing), they are still “time release” tablets, meaning if you cut the tablet, it breaks the specially formatted “time release” coating.
Breaking this “time release” coating will cause the drug to be absorbed all at once within your system – which may be extremely intoxicating and is not recommended by most. Instead, what some knowledgeable doctors may do to help ease withdrawal symptoms from the 25 mg dose is prescribe another drug with an easier withdrawal – similar to a replacement therapy (fluoxetine is a popular choice).
Another common strategy for reducing Pristiq is to transition patients to its parent drug, Effexor (Venlafaxine). These drugs are molecularly similar, and since Effexor is available in lower doses, it may allow for an extended taper – making the withdrawal process more tolerable. Quitting Pristiq “cold turkey” may result in prolonged withdrawal symptoms that are more severe than had an individual tapered down to the 25 mg dose and jumped from 25 mg to 0 mg, or transitioned from 25 mg to a replacement antidepressant to make withdrawal more tolerable.
Anecdotal accounts suggest that some individuals have had success taking 25 mg of Pristiq “every other day.” Most educated professionals would argue that this is an ill-advised strategy, akin to playing “ping pong” with neurotransmitters and the brain – possibly exacerbating the severity of withdrawal. In any regard, working with a trained professional to taper off of Pristiq slowly should help minimize the number and severity of discontinuation symptoms.
Prisitiq Withdrawal Symptoms: A List of Possibilities
Below are a list of common symptoms that people have experienced when they discontinue Pristiq. Keep in mind that your experience may be different from that of others. Individuals have different experiences when it comes to withdrawal symptom intensity and duration.
- Anxiety: Any drug that inhibits serotonin reuptake can lead to major increases in anxiety when a person stops it. In many cases people get anxiety relief from taking Pristiq because it elevates serotonin levels. When a person stops the drug, their brain is expecting to receive the serotonin boost, but does not get it. This leads to abnormally low levels of serotonin and makes some individuals have intense anxiety during withdrawal.
- Brain zaps: It is common to experience “brain zaps” or electrical shock sensations throughout the brain during withdrawal. It is not known exactly what causes these, but most people attribute it to the brain going through neurochemical readjustments. It is attempting to return to homeostatic levels of various neurotransmitters and in the process, people feel “zaps.”
- Chills: Many people experience extreme chills while taking this medication. Some people get used to the drug though and after awhile they subside. However during withdrawal, many people re-experience “chills” and feel as if they are really sick. These chills may last weeks, but will eventually go away as the body and brain readjust.
- Concentration problems: It is very common to experience foggy thinking while on Pristiq and other antidepressants. However, when discontinuing the drug, concentration problems can become very unbearable. Most people are frustrated by all the symptoms that they are experiencing and in addition to these symptoms, they experience reduced cognitive functioning. Many people have described this as “brain fog” that takes weeks to gradually improve.
- Confusion: It is common to experience mental confusion upon withdrawal. This may be a result of memory problems in addition with an inability to properly concentrate. If you feel extremely confused during your withdrawal, just know that this will improve over the next couple weeks.
- Crying spells: Many people endure periods of crying spells because they cannot cope with the crazy emotions that are triggered during withdrawal. If you feel more depressed than before you started Pristiq, it’s largely due to the fact that your serotonin and norepinephrine levels are abnormally low.
- Depression: When withdrawing from an antidepressant, it is common to experience a resurgence of depression. This depression may be significantly more severe than prior to your usage of Pristiq. It is important to understand that during the withdrawal period, it is expected that your depression will be very severe. This is because your brain is in neurochemical imbalance as a result of the drug. This imbalance will naturally correct itself as you learn to cope with life without the drug.
- Depersonalization: Perhaps one of the worst feelings during withdrawal from Pristiq is that of depersonalization. If you feel weird, unlike your natural self, and more like a zombie or like you are living in a dream, it’s likely that you are depersonalized. This is a result of changes in neurotransmitter levels as well as your brain attempting to make changes to reestablish normal functioning.
- Dizziness: Feeling dizzy is something that nearly everyone experiences when they quit an antidepressant. For some individuals the dizziness may last a week or so and get better. For others, the dizziness may linger for weeks and/or months before it improves.
- Fatigue: Since Pristiq is known to give people increased levels of energy, coming off of it may result in fatigue. You may feel mentally, emotionally, and physically fatigued when you quit taking this drug. The fatigue is mostly influenced by drops in neurotransmitters and your body using energy to try to restore normative functioning.
- Flu-like symptoms: As someone who has used Pristiq, I experienced flu-like symptoms when I first went on the drug. It is very common to experience these symptoms upon discontinuation as well. You may feel chilled, nauseous, dizzy, achy, have a fever, and in some cases you may actually vomit.
- Headaches: In addition to feeling dizziness, headaches are always among the most reported withdrawal symptoms. Most people notice that their headaches typically improve over the course of a few weeks. In order to manage your headaches, be sure to get plenty of rest, drink water, and consider taking headache relief.
- Hopelessness: The depression that you experience during withdrawal may lead you to feeling completely hopeless about life. It is important to recognize that this is merely a phase of withdrawal and that you will regain hope for the future. For this reason, it may be necessary to seek out help from a therapist if you are unable to find hope in your situation.
- Insomnia: Due to the activating nature of this drug, it can lead people to experiencing unbearable insomnia while taking it. In other cases, it can also lead to people to developing severe insomnia during discontinuation. This insomnia is thought to be a result of low serotonin levels – which result in abnormally high arousal, anxiety, and inability to sleep.
- Irritability: You may notice yourself become increasingly irritable during withdrawal. Innocuous things may lead you to become very angry and/or short-tempered. Just know that being irritable is very common during withdrawal. This symptom should gradually improve over time.
- Mood swings: Moods may transition from feeling hopeful and energetic to feeling completely depressed and hopeless. You may feel angry one minute and better about your future the next minute. Mood swings may last for an extended period of time until your brain has repaired itself.
- Nausea: This is a very common symptom to experience when coming off of Pristiq. You may feel very intense nausea – almost like you’re halfway to the point of vomiting. The nausea should gradually die down after a few weeks.
- Panic attacks: The fact is that many individuals experience panic attacks during withdrawal from antidepressants. You may not have had much anxiety prior to your usage, but the drug tweaks your neurotransmitter functioning to the point that anxiety can become abnormally high during withdrawal. High anxiety may lead you to experiencing a full blown panic attack. Do your best to manage the feelings of anxiety by engaging in relaxation and activities that will help desensitize your nervous system.
- Sensitivity: Many people experience an increased sensitivity to loud sounds and bright lights. This is usually caused by hyperarousal and the fact that when your nervous system is highly sensitized, normal sounds can seem amplified and/or threatening.
- Sleep changes: Antidepressant withdrawal can wreak havoc on your sleep. You may notice that you feel increasingly tired throughout the day, but cannot seem to sleep at night. Your sleep cycle may become unpredictable. Do your best to make sure that you are getting enough sleep so that your body and mind can recover.
- Suicidal thinking: During discontinuation from any antidepressant, a person may develop suicidal thinking. The suicidal thoughts during discontinuation may be very intense and difficult to deal with. They are thought to be a result of low neurotransmitter levels as a result of withdrawal.
- Sweating: Another very common symptom that people experience during withdrawal is that of sweating. You may sweat profusely during the first few weeks of withdrawal. This may lead to sweats throughout the day and during sleep (night sweats).
- Tingling: Some people have reported tingling sensations in their hands and feet. Just know that this is likely a result of your nervous system attempting to function normally without the drug. Since it is not receiving the drug, it is generating a “tingling” feeling. This will subside over time as your body adapts to functioning without the drug.
- Vomiting: Certain individuals have pretty severe reactions when coming off of Pristiq. In less common cases, some people actually experience nausea so extreme that it leads to vomiting during withdrawal. This vomiting should subside within a week or two. If not, you may need to come up with a slower tapering strategy.
Note: It is understood that Pristiq stays in your system for approximately 2.54 days after your last dose. Many people notice that withdrawal symptoms become most severe after the last bit of the drug has left their system. In other words, discontinuation symptoms may really start to emerge after 3 days of being Pristiq-free.
Pristiq Withdrawal Duration: How long will it last?
Pristiq is considered a very difficult drug to withdraw from, especially for those who have been on it for a lengthy period. There is no dose lower than 50 mg – which further complicates the “tapering” process. Work with your psychiatrist and determine the best plan to gradually taper off of this medication. By conducting a gradual taper, it is thought that you will lessen the severity of withdrawal symptoms and experience a quicker recovery.
There is no set withdrawal “time frame” for any antidepressant medication. Some people may quit taking the drug and notice minimal withdrawal effects that last for about a week or two, then completely clear up. For individuals that are highly-sensitive to medication and withdrawal effects, the symptoms may last for weeks or months. Individual factors have a major influence in determining the intensity of the withdrawal phase.
Understand that the average withdrawal period lasts between 6 and 8 weeks – just as long as doctors say it takes an antidepressant to kick-in. However, I would argue that unless proper tapering is conducted, the withdrawal effects actually last much longer. For many individuals I recommend reevaluating symptoms after 90 days (i.e. 3 months). By taking 90 days, you are giving yourself a lengthy period of detoxification and time to heal.
Many people have incredible difficulty when it comes to withdrawing from SNRI’s because they create imbalances in two neurotransmitters: serotonin and norepinephrine. Therefore it can seemingly take longer for many people to recover. During withdrawal from any antidepressant, it is important to make sure that you are getting plenty of sleep, take good care of your body, and get quality social support. If you have experience withdrawing from Pristiq and/or are currently going through withdrawal, be sure to share your experience in the comments section below.