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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Reggie BoStar on August 28, 2009, at 20:51:15
Hi Everyone,
I've been on 100mg Pristiq since the drug came on the market. It's done essentially nothing positive that I'm aware of and may have caused almost constant feelings of exhaustion and drowsiness.I'm not sure about the exhaustion part. I'm on a large mix of all kinds of meds. I only know that the exhaustion got even worse when I started Pristiq.
To combat the exhaustion and drowsiness and maybe help with depression (I thought that was a nice touch), my pdoc added Wellbutrin to the mix. After gradual increases I got to 400mg per day and stayed at that dose.
The Wellbutrin did help me stay on my feet a little better. I was still sleeping 12+ hours per day but at least I was getting things done in the 12 waking hours. Unfortunately there was no change in depression one way or the other.
I'm constantly in the Medicare prescription coverage gap ("donut hole") because of the high costs of my meds. I had been getting free samples of the Pristiq for the simple reason that the donut hole made it impossible for me to pay for the stuff.
Although I had been voicing my frustrations with Pristiq and Wellbutrin, my pdoc did not change the combo until he started running out of Pristiq samples. Two days ago he started me on a gradual changeover from Pristiq to the new generic version of Effexor. Generics are covered by my Medicare supplement.
What the... I told him I expected no change in the depression because Pristiq is nothing more than a metabolite of Effexor. Same active ingredient, same effect on depression - none.
Supposedly Wyeth did this to isolate the active ingredient in Effexor while reducing side effects caused by other ingredients. Pristiq also appeared the same time that Effexor went generic and Wyeth lost the patent. Now they have a new patent on Pristiq, which has the same active ingredient as the Effexor generic and of course costs hundreds of dollars for a one month supply. What a fortunate coincidence for everyone, right?
I had been taking two 50mg tabs of Pristiq per day. The plan was to replace one of those with one 100mg tab of Venlafaxine (generic Effexor) for a week. After the end of one week, I would replace the remaining 50mg Pristiq tab with another 100mg tab of Venlafaxine. That would result in a daily total dose of 200mg Venlafaxine.
It's only been one day - ONE DAY - and already I'm on my petard with exhaustion and drowsiness that's a lot worse than it was with the Pristiq. I slept for 17 hours. It was a totally drugged out deep sleep with no dreams I can remember. I had to force myself to get out of bed and now that I'm up the only thing I want to do is get back to sleep before I nod off while I'm standing or sitting.
This is how I feel after replacing just one 50mg Pristiq with one 100mg Venlafaxine. Active ingredient or not, it looks like Wyeth did accomplish something with reducing the side effects after all.
Anyone else experience this with Venlafaxine (Effexor), that is total exhaustion and drowsiness? Anyone get any help with depression from it?
I did ask my pdoc what the point of all this was. If the active ingredient is the same and all we're doing is playing with the side effects, why try either drug? I see him for relief from depression.
On the other hand, maybe sleeping 24 hours per day IS the fix for depression.
I should get some sleep
Reggie BoStar
Posted by floatingbridge on August 28, 2009, at 22:29:09
In reply to From Pristiq to Effexor, increased exhaustion?, posted by Reggie BoStar on August 28, 2009, at 20:51:15
I'm sorry Reggie--both or your fatigue and because it doesn't sound like a you're expecting much from the switch--and I can see why you wouldn't. However, I've heard that some respond to effexor and not pristiq....(I think effexor may be more 'activating' when it kicks in?
I was on 100 pristiq for about 7 weeks--before that 5 months on 50mg. The 100 definitely causes me fatigue that I did not experience at 50! Tonight I go down to 50. Hope I feel o.k.
Your situation sounds very frustrating--maybe others will have more to say.
best regards,
fb
Posted by Reggie BoStar on August 28, 2009, at 23:29:41
In reply to Re: From Pristiq to Effexor, increased exhaustion? » Reggie BoStar, posted by floatingbridge on August 28, 2009, at 22:29:09
Thanks floatingbridge,
Thanks for your response and good luck to you with lowering that dose of Pristiq.Frustrating is an understatement for my situation. It's been a long history of meds and even ECT treatments. That's the main reason I don't expect much from the switch to Effexor. I've been on it before, just with a different combination of other meds. The theory is that it will "work better" with the current combo.
It's all random experimentation as far as I'm concerned.
Again, best of luck with that change in Pristiq,
Reggie BoStar
Posted by Phillipa on August 28, 2009, at 23:45:32
In reply to Re: From Pristiq to Effexor, increased exhaustion? » floatingbridge, posted by Reggie BoStar on August 28, 2009, at 23:29:41
Hummmm if pristiq is more sedating than wouldn't it cover anxiety also? Reggie wish I could get the sleep you do for one day at least and then accomplish all I'd like to. Phillipa
Posted by Reggie BoStar on August 29, 2009, at 1:38:47
In reply to Re: From Pristiq to Effexor, increased exhaustion? » Reggie BoStar, posted by Phillipa on August 28, 2009, at 23:45:32
Hi Phillipa,
Nice to hear from you again. Actually, per my first post I'm finding Effexor more sedating than Pristiq. Floatingbridge is the one who's found Pristiq too sedating and is trying to cut the dose.Of all the prescription meds I've tried, by far the most sedating was Zyprexa. The samples I had were 5 mg tabs. I couldn't even hack 1/4 of one of those tabs; it knocked me right out for over 12 hours and left me feeling hung over the next day.
Melatonin tops the sedation list for OTC meds, though it's very easy to control because I can get it in 300 microgram tabs which I can cut into even smaller doses. I use it to regulate my sleeping schedule and it works great.
If I take more than 300 micrograms of the stuff I'll go to sleep in about the same time but I'll have vivid, unsettling dreams - not nightmares, just disturbing.
But I digress.
Reggie BoStar
Posted by floatingbridge on August 29, 2009, at 11:29:45
In reply to Re: From Pristiq to Effexor, increased exhaustion? » Phillipa, posted by Reggie BoStar on August 29, 2009, at 1:38:47
Reggie, Melatonin gives me baaaad sleep--though works for many.
I remember my start-up of effexor as being a bit debilitating--like I ha a flu almost--then it passed and I felt more energy--along w/ jaw-clenching, etc--but workable side-effects. But you've been on it already.
What combo are you working with this time? Maybe it will work.
fb
Posted by Phillipa on August 29, 2009, at 20:06:54
In reply to Re: From Pristiq to Effexor, increased exhaustion? » Phillipa, posted by Reggie BoStar on August 29, 2009, at 1:38:47
Reggie this may sound wierd and was years ago before it was taken off the market for a while I took some melatonin and before falling asleep just didn't want to take the effort to breath? It scared me and didn't take it again. I've been reading and 3mg of melatonin seems to be a good starting dose. The agomelatonin seems to work well for quite a few. Phillipa
Posted by Reggie BoStar on August 30, 2009, at 21:16:42
In reply to Re: From Pristiq to Effexor, increased exhaustion? » Reggie BoStar, posted by Phillipa on August 29, 2009, at 20:06:54
Phillipa,
That does sound creepy. In fact, on top of everything else I'm a hypochondriac. Any sensation like the one you describe would do more than just scare me.3mg would be far too much for me. I was lucky to find out about this on only 1mg, which was bad enough. I've never even tried 3mg.
I looked for agomelatonin and got redirected to Agomelatine. That does look interesting. The Wiki article compared it to Paxil as an antidepressant, but said that Agomelatine doesn't have the same "discontinuation effects". I know what "discontinuation effects" are like with Paxil. They're not fun at all.
I've never heard of this stuff. According to the Wiki article, it may not be approved for use in the US until 2012. Novartis has dibs on it here. Who knows what all that means given the political climate over health care in this country. Anything could happen.
So when you say it seems to work for quite a few, are you talking about patients in the EU?
Oh, here's the Wiki article. Like all Wiki articles it's worth reading provided you check the sources.
http://en.wikipedia.org/wiki/Agomelatine
Later,
Reggie
Posted by Phillipa on August 31, 2009, at 19:02:10
In reply to Re: From Pristiq to Effexor, increased exhaustion? » Phillipa, posted by Reggie BoStar on August 30, 2009, at 21:16:42
Reggie there is a site for this new med. Sending babblemail. Phillipa
Posted by West on September 17, 2009, at 21:04:46
In reply to From Pristiq to Effexor, increased exhaustion?, posted by Reggie BoStar on August 28, 2009, at 20:51:15
Reggie,
Your experiences sound familar. It's funny, I have a brother diagnosed with BP2/(3?), atypical, always a project on. I couldn't sleep on effexor, which fairly normal, whereas he had no issues at all. He didn't have any response either. Not to citalopram, moclobemide and all the other things usually cycled in britain. He currently takes Nardil (concord formulation) with Lamictal along with a microdose of T3, plus DLPA, Rhodiola and Zinc.
He has struggled with somnolence from the off, spending much of his days asleep and unable to muster the energy to make a cup of coffee, but has finally after 6 hour long appointments and a lot of downplaying of knowledge on his part, including a completely trivial trial of a lightbox and endless mandatory but senseless displays of cooperation, persuaded his psychiatrist to prescribe modafinil.
He really suffers from what users call 'the nod' so he needs it. He had said 200mg helps initially but only 400mg after, and he got it today. He's fixed, and what a victory it is for him- finally hitting the combination which- had he had the keys to the medicine cupboard would have put himself on 3 years ago instead of spending inordinate amounts of money buying 'extras' online just to have a life to call his own.
I suppose the real difference here is in the way healthcare is run. He is costing the g'ment £2800 per year for his provigil. And what are you supposed to do if you're depressed and out of work? I wouldn't know if your medical assistance programmes offer drugs as expensive as provigil when ironically it's sounds like just the thing you need.
Posted by Reggie BoStar on September 17, 2009, at 23:31:19
In reply to Re: From Pristiq to Effexor, increased exhaustion?, posted by West on September 17, 2009, at 21:04:46
Hi West,
Discussing the politics of healthcare reform is a risky business here in the US. It could easily start a really nasty thread here, which I'm sure Dr Bob would not want to see, so I'll stick to the facts of our Medicare program.Medicare is government funded healthcare for people aged 65 or older, and for those who are disabled. I'm in the latter category for mental health reasons though I'll be reaching the age qualification soon anyway.
You've more or less guessed right about the drug coverage for people on Medicare. Starting at the beginning of a calendar year, medications are covered until the covered amount exceeds a maximum. I'm not sure Dr Bob wants us to talk numbers here so I'll leave at that. It's not a very high amount for people on expensive psychiatric meds. Many of us reach that limit only a few months after the start of the year. After that, a everything must be paid out of pocket (or with expensive private insurance) until another maximum is reached. After that second maximum is reached, "Catastrophic Coverage" kicks in for the rest of the year.
The second maximum (total out of pocket expenses) that must be paid before coverage starts again is about twice the maximum that's covered at the start of the year. It's a huge amount. For all intents and purposes, most of us simply aren't covered for the rest of the year once the first maximum is reached. If we can afford it we buy "Medicare Supplemental" insurance which provides limited coverage during this gap. The most affordable plans typically cover generic drugs but not name-brand drugs. So you're out of luck if you need an expensive name-brand drug for which there is no generic.
There are more expensive supplemental plans which do cover name-brand drugs but no one I know can afford the extra cost of the premiums.
That's roughly how it works. So yes, unless an expensive medication has a generic form, you really can't rely on being able to take it for a full year if you're on Medicare. Some other kind of coverage will have to be procured somehow.
I haven't said anything about Medicaid, another type of government-funded healthcare, because I know little about it except that I don't qualify for various reasons.
You said your brother was diagnosed BP2, "always a project on". That's exactly my situation. It's finishing the projects that's the problem. I multitask constantly, but before I can finish any one project, I start another. At this point my house is a museum of unfinished projects.
It's actually kind of funny. Whenever I walk in the door after I've been out all day, I do get a chuckle out of what I see. The unfinished state of things is on every scale you can imagine. I'm sure your brother understands perfectly what I mean here. I have many bookcases, at least 10 floor to ceiling, none completely finished. There are hundreds of books in stacks on the floor as I move them to one set of shelves, decide I don't like the arrangement, and move them to another set of shelves but sorted a different way. About halfway through each cycle, I change directions to go back some other way. There are unfinished hanging shelves, some consisting of only wall brackets and loose boards. The "office" (a small spare bedroom) where I keep my PC has trails that must be negotiated between piles of things left out of arrangement and waiting to be stored. In the cellar, I have a massive model train table, the size of two ping-pong tables in an "L" shape with another half table at the corner of the "L". It too is only half finished, though I've at least got all the legs and platforms in place.
I could go on, but - no, really I COULD go on. I'd also never finished this message. I should at least finish this. For now I'll end by saying that I have to go check on some of those drugs you've named. I've heard of Provigil, Effexor, and Nardil. I'm not sure about some of the others or whether or not they're even available over here. Once I figure them out, and assuming I remember this thread, I'll try to keep it going.
Thanks for your post and talk to you soon!
Later,
Reggie BoStar
Posted by West on September 18, 2009, at 10:31:27
In reply to Re: From Pristiq to Effexor, increased exhaustion? » West, posted by Reggie BoStar on September 17, 2009, at 23:31:19
Reggie,
In some respects I do harbour a degree of envy towards you (soft) bipolars. The idea of completing projects, maintaining flow, is as absent as the presence a future tense in the arabic language, when I'm down/deep on down/in my personal hell.
My intuition is there are more 'light on/light off' moments in the course of a day or week say, in this subsect which must also translate chemically: less/episodic periods of uncontrollable stress = less chronic cortisol release = less brain atrophy and hippocampal shrinkage = (in my baseless theory) less memory loss and subsequently, greater preservation of 'self' or character (memory being central to identity).
In my experience of what is a cosmically cruel joke (note: any theists reading - and there can't be many- bow your heads now), the final process described earlier characterises the whole, and carries on in this unrelentingly rude style until eventually treated. And though it has admittedly grown progressively more slippery a beast to pin down over the years, I have found it is usually resolved with liberal application of an SNRI, actually scrap that, Effexor. This obviously has its disadvantages and I am trying to fend off tome cognitive brain cloud that has come part of the package. I do however think treating anyone within the BP spectrum is more difficult, and potentially contains greater personal sacrifices on the part of the patient.
Actually I often see a correlation between intelligence (and what does that word mean at the human scale? I would like to see it replaced with 'sensitivity') and BP2/1/atypicals, certainly a taste for the arts- something perhaps to do with all the books thrust under the white heat of your gaze, while simultaneously organizing in reverse alphabetical order by genre and tempo your music collection AND mentally rearranging the rachmaninoff concertos playing full tilt from the roofs of your houses.
How about style in writing? What of style? Should you for example find my writing write too dense, convuluted even, rest assured it is simply the result of a lifetime having read next to nothing, the ongoing struggle with not reading despite the pleasure gained from it, and the consequent frustration felt by that. Classic insecure male compensatory behaviour. Maybe, just possibly, I am drawn fatally, like moth to flame, the rhythm of things too much - at the cost of other existing realities. What if life is just a set of rhythms played at the same time, most jarring, but in momentary richness, gloriously harmonising, like the sun breaking through a low and stormy sky and bathing the land in a pool of of winking golden light, before dissappering again behind the clouds..? (pretentious a bit!)
You say you are have nearly reached the mellow age at which you are eligible for senior medicare, I'd say that puts me only just comfortably over a third of your years. But on the subject of the meds, I'm sure you'll work it out. You sound eminently capable (:
There you go, an message to match yours in length, if not in detail.
This is the end of the thread.
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