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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by lois on March 21, 2009, at 10:00:45
Hi,
I am concerned about the weaning and titrating process I am supposed to go be on.
I was told to stop the cymbalta cold turkey, which I did and stay on the wellbutrin and start the pristiq at the same time, which I am doing.
Stay on full dose of wellbutrin with pristiq for 3 weeks. Then half the wellbutrin for the 4th week. Then stop the wellbutrin. All the while on the 50mgs on pristiq.
I am worried about these directions.
Any comments?
Wouldn't I have too much ad effect in the 3rd week?
Thx,
Lois
Posted by Phillipa on March 21, 2009, at 13:05:46
In reply to changing from wellbutrin and cymbalta to pristiq, posted by lois on March 21, 2009, at 10:00:45
Most importantly is this your pdocs adivise and if it's working that's wonderful. Love Phillipa
Posted by lois on March 21, 2009, at 13:12:03
In reply to Re: changing from wellbutrin and cymbalta to pristiq » lois, posted by Phillipa on March 21, 2009, at 13:05:46
> Most importantly is this your pdocs adivise and if it's working that's wonderful. Love Phillipa
It is her advice. I'm only on the first week. I'm just a little nervous about week 3. But I'll just have to wait and see. Thx for posting
Lois
Posted by desolationrower on March 21, 2009, at 14:22:30
In reply to Re: changing from wellbutrin and cymbalta to pristiq, posted by lois on March 21, 2009, at 13:12:03
it doesn't sound ideal, i think you're right, but i don't think it will have too much downside. it all kind of depends on why you are switching, how you've done on the meds, etc.
-d/r
Posted by bleauberry on March 21, 2009, at 16:40:22
In reply to changing from wellbutrin and cymbalta to pristiq, posted by lois on March 21, 2009, at 10:00:45
It all depends on how long you've been on these meds, what doses, and how sensitive your biochemistry it. Impossible to predict. The doctor can't predict how it will go either. But, you have to start somewhere and have some kind of plan, so that is what you were given.
I not believe in sticking to that predetermined plan when trouble arises. We have to be prepared to make adjustments as needed. My doc had me weaning off Paxil over a 2 week period. It actually took 2 months. Zyprexa I was supposed to stop in one week. It actually took 3 months. Remeron I was supposed to stop cold turkey. It actually took 2 months.
The ADs you are switching are somewhat similar, so that should help.
I would say to try to follow the plan, but do not hesitate to get the doctor on the phone and make adjustments if you run into trouble.
Posted by lois on March 21, 2009, at 16:50:32
In reply to Re: changing from wellbutrin and cymbalta to pristiq » lois, posted by bleauberry on March 21, 2009, at 16:40:22
> I would say to try to follow the plan, but do not hesitate to get the doctor on the phone and make adjustments if you run into trouble.
I guess I'm wondering if symptoms of serotonin syndrome and withdrawal 'could' be similar, and how to know the difference. Since the way to treat one would be opposite of the way to treat the other...............
Lois
Posted by bleauberry on March 21, 2009, at 19:25:20
In reply to Re: changing from wellbutrin and cymbalta to pristiq, posted by lois on March 21, 2009, at 16:50:32
> I guess I'm wondering if symptoms of serotonin syndrome and withdrawal 'could' be similar, and how to know the difference. Since the way to treat one would be opposite of the way to treat the other...............
> Lois
>I see. Ok. Good concern and good question.
You want to be an expert on serotonin syndrome, how to spot it, how to differentiate it from something else, and how to treat it? You want to recognize it early? You can actually become an expert on it in about 20 minutes. You'll be able to know it exactly even if an emergency room physician isn't sure what's going on.
It has some very disctinct symptoms, and these symptoms progress in stages. There is no other disease, syndrome, or anything that follows the telltale pattern of serotonin syndrome. You will know without a doubt if what you experience is withdrawals or serotonin syndrome. Or more accurately, serotonin toxicity.
Here's how to become an expert in minutes. Go to PsychoTropical.com, or do a google search on Dr Gillman Serotonin Syndrome. He has studied it extensively and written on it. Every emergency room physician should be trained with his stuff in my opinion. Anyway, look for his writings on serotonin syndrome and read them. It only takes about 20 minutes maybe.
Posted by lois on March 22, 2009, at 8:27:37
In reply to Re: changing from wellbutrin and cymbalta to pristiq » lois, posted by bleauberry on March 21, 2009, at 19:25:20
Thanks for the very good info.
Lois
Posted by B2chica on March 24, 2009, at 12:57:32
In reply to changing from wellbutrin and cymbalta to pristiq, posted by lois on March 21, 2009, at 10:00:45
of course it all depends on your body. everyone is different.
but i was actually on this combination. exact same situation. EXCEPT that the wellbutrin hadn't been working for me so i was miserable.
the pristiq worked well the first week after that i went down hill for a while, SLOWLY getting back up. it took pristiq about 8 or so weeks before it FINALLY kicked in for me.
and my T told me that several of her clients that were on pristiq found similar issues averaging 6-8 weeks before they found their level.i would worry more about getting off wellbutrin too quickly. (you withdrawl sounds fine) but i know docs always worry about seizures when getting off wellbutrin too quickly.
if you are still concerned and at the end of the second week are infact feeling good on the combination you should ask your doc if you could start titrating down sooner.But if i were you i'd just hold on until then. pristiq seems to be a slow mover.
Best wishes!
b2c.
Posted by lois on March 24, 2009, at 14:44:53
In reply to Re: changing from wellbutrin and cymbalta to pristiq » lois, posted by B2chica on March 24, 2009, at 12:57:32
> i would worry more about getting off wellbutrin too quickly. (you withdrawl sounds fine) but i know docs always worry about seizures when getting off wellbutrin too quickly.
> if you are still concerned and at the end of the second week are infact feeling good on the combination you should ask your doc if you could start titrating down sooner.
>
> But if i were you i'd just hold on until then. pristiq seems to be a slow mover.
>
> Best wishes!
> b2c.
b2chica,
I actually was wrong about the taper. I am on the full dose of Wellbutrin for '2' weeks with the Pristiq, then on the 3rd week going to half the dose of WB, then the Pristiq alone after week 3. Hope this isn't too fast and hope this will work.
Thanks for telling me how long it could take Pristiq to work. How long have you been on it now? Is it still working?
Lois
Posted by B2chica on March 25, 2009, at 12:10:39
In reply to Re: changing from wellbutrin and cymbalta to pristiq » B2chica, posted by lois on March 24, 2009, at 14:44:53
that taper sounds just right. but keep in tune with your body and any eye weirdness or dizzyness and you may need to ring your pdoc. but with that taper i wouldnt suspect any issues.
i was on it from about end july to jan this year. i only stopped because i finally got pregnant.
but i FULLY plan to jump back into it when the time comes. it worked very well for me with only one side effect. its a weird one but i had a lot of hair loss.
LUCKILY i have really thick hair and normally have to have it thinned. well, after using pristiq, one less thing my beautician had to do :)
but i dont think that was a common side effect.Best wishes on it.
b2c
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