Friend stopped taking Pristiq (sp) abruptly and I'm not sure if this is a good idea

In My Humble Opinion (IMHO)
#1

She seems fine, but I can’t help but think this isn’t the best idea she has had in her life.

Some background: Beautiful person, depressed on and off (part genetic, part life events), very proactive in trying to help herself, has been seeing a doctor for years and has shown some signs of feeling better overall. This weekend I visited her, and she she tells me she stopped taking her meds on Friday. Forgot her daily dose on Friday, then said the hell with it. Outwardly, everything appeared to be ok. Four days and she feels great.

I looked online and all I found were nut case stories - obviously heavily embellished with lurid details that could not possibly be true. I’m worried she is going to have side effects, but I’m not sure what kind. I tried talking her into taking half a pill a day for a week, then a quarter pill a day for another week to taper off, but she’s not having it. She won’t speak to her doctor either. She says she is done with pills and doctors.

I made her promise to call me any time of the day or night at the first sign of anything being the slightest bit off, and I know that depression and psychotic breaks are not the same thing, but I don’t want her to sink into a deep depression because she doesn’t want to swallow a pill a day.

Realistically, what could happen?

#2

Realistically, your friend should talk to her doctor about tapering off her dose.

Pristiq is a serotonin & norepinephrin uptake inhibitor - it changes the way a person’s brain processes certain chemicals. Suddenly going off that sort of medicine is a real shock to the system. It can produce a whole host of unpleasant side effects, including nausea, dizziness, and vomiting. It can also cause mood swings and an increased risk of suicide.

See here for more information:
http://www.walgreens.com/marketing/library/finddrug/druginfo1.html?particularDrug=Pristiq&id=656173

Going off serotonin-affecting medicines cold turkey can make a person terribly sick. If your friend wants off the drug, that’s her business, but she should talk to her doctor about tapering off gradually.

#3

I agree, but she refuses and from what I understand, she can’t be forced. She’s not threatening to harm herself or anyone else.

I spent an afternoon trying to talk her into speaking with her doctor about this, or at the very least tapering off on her own. No dice.

#4

I can sympathize. I have mention before that in March of 2010 after 15 years of meds & therapy, against doctors orders, I quit all meds & therapy.
In April of this year, after a brief stay in the psych-ward I went back to therapy and meds. And now once again, I have quit. It wasn’t helping, just like the last time. I expect I will hear from my caseworker (or the possibly police even) soon.

When I came of the meds in 2010, I taper myself off, but still had some loopy feelings/withdrawal effects. This time, I just seem to have a lot of headaches this past week, but that could be from not eating anything but coffee & ibuprofen. It’s hard to tell.

Don’t nag her about the doctor, just be there for her. She should see her doctor, but you can’t force her. I wish the best for her.

#5

It’s not a good idea to cold-turkey off an SSRI, but it’s not illegal and it’s her body. You can’t do anything except, when she starts feeling like shit from withdrawals, encourage her to start taking them again and taper down slowly. I personally experienced brain zaps and dissociation when I cold-turkeyed after only taking an SSRI for a few weeks… I hated the way they made me feel and what they were doing to my sex drive, and my doctor hadn’t told me not to stop taking them abruptly. It was freakin’ horrible, lesson learned.

Also please be aware that half-pills may not be a viable alternative if her pills are time-released. If that’s the case, she will have to actually get her doctor to prescribe a progressively lower dose for several weeks.

If feeling like shit doesn’t motivate her to taper, well it sucks but it’s still her decision. Just try to watch her more closely than usual, and call the police if she gets suicidal. That is all you can do.

#6

There’s not much you can do except let her know that you are there for her. I had the misfortune of abruptly stopping my SSRI (zoloft) before, although not intentional, and it was a terrible ride. If it wasn’t for the benevolence and presence in my life of a very good friend, I don’t know if I would have ended up getting my medication filled when I eventually could (she did it for me). So perhaps just be there, periodically checking with her.

#7

She’s five days in and so far so good, thank God, but I’m still anticipating disaster. Her only symptom so far is what she describes as a brushing noise in her ear, as if her ears are opening and closing like Star Trek doors.

We are meeting for dinner tonight, but she sounds ok. She’s on the heavy side so I’m starting to wonder if maybe her weight is causing a bit of a delayed reaction.

#8

I suppose it’s possible for some people to not have side effects from quitting meds cold turkey although it sounds like most do. When I was 16 I stopped taking my Zoloft very abruptly and as far as I recall nothing happened. I’m not overweight and wasn’t at the time so that couldn’t have been a factor. I quit Prozac the same way when I was 20, but I’d only been on it for a short time so maybe that’s why it wasn’t a big deal.

Despite what I said above, I don’t endorse quitting medication without medical advice. But if your friend says she’s ok and seems ok then odds are she is. As others said, just let her know you’re there for her in case something does take a turn for the worse.

#9

My mind is rather fuzzy at the moment, but I did ask a psychiatrist once if my weight (about 375 at that time) would effect how the meds work (would I need more being so fat) she said no. She did explain it more but that’s the part I don’t recall. As has been said not everyone experience the same effects good, bad or ugly.

Also, don’t keep anticipating a disaster, just be her friend, like I assume you have been all along.

#10

Also, it took several days of being off Zoloft before the “unfortunateness” began; and even then it began in a not-altogether bad way. I started experiencing what I described at the time as “clarity of thought” and the seeming ability to form my thoughts more completely and thouroughly. This only lasted a short while, however, and the devastating, paralyzing (no pun) depression soon swooped in to take over. So while I wouldn’t keep expecting disaster, at the same time don’t take your eye off her because she may only now be entering the difficult times.

#11

Any idea what her dose was? If it was minimal to begin with, then stopping may not hit that hard.

Of course, the underlying depression that the Pristiq was meant to be treating may return.

#12

I got a look at the label and got the name of the doctor and pharmacy in case I need it.

50 mg Pristiq, one tablet by mouth every day. She’s been on it for at least five years.

#13

All I can say is it might (but probably won’t) help to ask her if she felt better (or even just different) immediately the day after she started the pills, or did it take a few days?
If the answer is a few days after she started, then you can ask her why she thinks it proves anything that she still feels OK the day after she stops.

#14

FWIW, that’s the lowest available dose of Pristiq, so there isn’t really a way to taper down from there anyway. Some people have attempted a switch, where they stop Pristiq, start a low dose of Prozac, and then taper the Prozac, but I think that’s not widely accepted.

#15

It is absolutely possible to stop taking antidepressants cold turkey with no bad side effects. I stopped Paxil that way and had virtually no side effects. It’s different for every person, just how some lose weight on them, and others gain.

#16

Pristiq apparently has a pretty short half-life of 11 hours, so I’d think she’d be experiencing some of the discontinuation symptoms by now if she were going to. Back in my antidepressant days, I’d start suffering the “brain zaps” 2-3 days after stopping Paxil (21-hour half-life) or Celexa (35-hour half-life).

I find it amazing that some people don’t get them. It’s been years and I still get the occasional flashbulb burst in my brain when I move my eyes sideways.

#17

It’s a very, very, very bad idea to stop taking a psych med cold turkey. I’ve been depressed all my life, but the only times that I have ever been suicidal were in the wake of medicine withdrawal. Keep a close eye on her.

#18

Given the high correlation between medication withdrawal and suicide, is it really worth the gamble to find out if you’re one of those people?

#19

I have to be the sole voice of disagreement here. I stopped taking this exact med along with 2 others prescribed for bi-polar II disorder very suddenly as I no longer had insurance. Although I felt dissociated for a week or two, it was mild and I had no lasting side effects.

I believed I was over prescribed anyways. As far as being suicidal, not even a little bit. I would hope that if you had thoughts or starting making plans to off yourself… most people would get help.

#20

Your friend is fortunate that Pristiq is not a benzodiazepine.
Withdrawal from benzos is one of the few withdrawals that can actually cause death.
Alcohol withdrawal is the other one that I know of.

She is also lucky to have a good friend by her side.