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Thread: pristiq anyone?

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    pristiq anyone?

    is anyone taking pristiq? how did you find it? how long did it take to get full effect from it and on wat dose?

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    Equinox's Avatar
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    What do you take it for? I took it for a month at 50mg, only side effect was jaw clenching/pain. I stopped it because of that issue so I can't comment on effectiveness since antidepressants usually take about a month to start working. Dosage wise I think its normal to move up to 100mg after the first month if necessary which might work better for anxiety/depression.

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    I have been on Pristiq for 15 months, I noticed pins and needles in my hands for the first ten days and some headaches that subsided. I was taking 100mg I had little motivation and was more apathetic though my anxiety was lessened. It took a good month for it to start to work in which time I was suicidal. I am now on 50 mg and have more motivation less apathetic but my anxiety is back. Go figure.

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    I was on it for about six months. I started at 50mg, but moved up to 150mg. It was great for getting rid of my anxiety, a lot of the symptoms, but it also turned me into a zombie. I slept all night and all day. I tried going back down to 50mg, but then it did nothing for me at that dose. Everybody's different though.
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    Antidote's Avatar Rude & Shouty
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    I was on 50mg for several weeks. Went slightly manic the first few days then remained hypomanic and chatty for the next few weeks (which I didn't mind). I had to stop it promptly though because I was unable to go to the toilet on it.

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    I was on it for a week it did not end well, Usuall I don't let my anger get the better of me.

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    Pristiq:

    Basics from DrugBank
    Indication Desvenlafaxine is indicated for the treatment of major depressive disorder in adults.
    Pharmacodynamics Desvenlafaxine is a selective serotonin and norepinephrine reuptake inhibitor. It lacks significant activity on muscarinic-cholinergic, H1-histaminergic, or α1-adrenergic receptors in vitro. Desvenlafaxine does not appear to exert activity against calcium, chloride, potassium and sodium ion channels and also lacks monoamine oxidase (MAO) inhibitory activity. It was also shown to lack significant activity again the cardiac potassium channel, hERG, in vitro. Compared to other SNRIs, desvenlafaxine undergoes simple metabolism, has a low risk of drug-drug interactions and does not have to be extensively titrated to reach a therapeutic dose. Some of the limitations of desvenlafaxine include moderate efficacy in the treatment of major depressive disorder, similar safety and tolerability profile to other SNRIs and possible transient discontinuation symptoms upon cessation of therapy.
    Mechanism of action Desvenlafaxine, the major active metabolite of venlafaxine, is a selective serotonin and norepinephrine reuptake inhibitor. The clinical effect of desvenlafaxine is thought to occur via potentiation of serotonin and norepinephrine in the central nervous system. Unlike venlafaxine, desvenlafaxine is thought to have a differential serotonergic and noradrenergic activity profile.
    Absorption Absolute bioavailability is ~ 80% and is unaffected by food.
    Volume of distribution 3.4 L/kg, distribution into nonvascular compartments
    Protein binding ~ 30%, protein binding is independent of drug concentration.
    Metabolism The primary route of metabolism is via conjugation mediated by UGT isoforms. Desvenlafaxine also undergoes oxidative N-demethylation via cytochrome P450 3A4 to a minor extent.
    Route of elimination Excreted in the urine. Approximately 45% of the total oral dose is excreted unchanged in urine. Approximately 19% of the total oral dose is excreted as the glucuronide metabolite and < 5% is excreted as the oxidative metabolite, N,O-didesmethylvenlafaxine. Excreted in human milk.
    Half life The mean terminal half life is 11.1 hours and may be prolonged in patients with renal and/or moderate to severe hepatic impairment.
    Clearance Not Available
    Toxicity The safety and tolerability of desvenlafaxine is similar to other SNRIs. Common side effects upon initiation or dose increase include increased blood pressure and heart rate, agitation, tremor, sweating, nausea, headache, and sleep disturbances. May cause sexual dysfunction and weight loss in some patients. May cause increases in fasting serum total cholesterol, LDL cholesterol, and triglycerides. Withdrawal effects may occur and thus, the dose of desvenlafaxine should be titrated down prior to discontinuation.

    So, desvenlafaxine is a synthetic form of the isolated major active metabolite of venlafaxine
    , and is a new (SNRI). Someone lost their patent on Effexor and it is generic now. Interestingly, 70% of Effexors benefit come from it being metabolized into desvenlafaxine.
    It can have the same nasty discontinuation side effects like Effexor. So, if you ever come off, titrate down slowly. Often an SSRI is used during this time to help stabilize the changes in 5HT.

    This is a meta-analysis on Pristiq. It focuses on major depression. It has a lot of good info:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947544/


    Note these 8 week studies examine anxiety remission in patients with MDD:

    Analysis of the Effect of Desvenlafaxine on Anxiety Symptoms Associated with
    Major Depressive Disorder: Pooled
    Data from 9 Short-Term, Double-blind,
    Placebo-Controlled Trials
    Karen A. Tourian, MD, Qin Jiang, MS, and Philip T. Ninan, MD

    FOCUS POINTS

    • Symptoms of anxiety are commonly associated with major depressive disorder (MDD).
    Desvenlafaxine is a serotonin-norepinephrine reuptake inhibitor approved for the
    treatment of MDD.
    • This post-hoc analysis evaluated the efficacy of
    desvenlafaxine (50–400 mg/day) compared
    with placebo in the treatment of anxiety symptoms associated with MDD, using pooled individual patient data from 9 short-term, randomized,
    double-blind, placebo-controlled clinical trials.
    • Desvenlafaxine treatment was associated with
    significantly greater improvement on measures
    of anxiety compared with placebo in outpatients
    with a primary diagnosis of MDD.

    ABSTRACT

    Background: This analysis evaluated the
    effects of the serotonin-norepinephrine reuptake inhibitor, desvenlafaxine (administered as
    desvenlafaxine succinate), on anxiety symptoms
    associated with depression.
    Methods: Data were pooled from 9 randomized, placebo-controlled, double-blind, 8 week
    studies of desvenlafaxine (50–400 mg/day, fixed
    or flexible dose) in patients with major depressive disorder (MDD), without a primary anxiety
    diagnosis. Changes from baseline in scores on
    the anxiety/somatization factor of the 17-item
    Hamilton Rating Scale for Depression (HAM-D17)
    and on the Covi Anxiety Scale at the final evaluation (last observation carried forward) were
    compared between desvenlafaxine and placebo
    groups using analysis of covariance.
    Results: In the overall data set (intent to
    treat n=2,913 [desvenlafaxine, n=1,805; plaCNS Spectr 15:3 © MBL Communications, Inc. 187 March 2010
    CNS Spectr. 2010;15(3):187-193
    INTRODUCTION
    Although major depressive disorder (MDD)
    is characterized primarily by depressed mood
    and a loss of interest or pleasure in daily activities, many cases also are accompanied by some
    symptoms of anxiety1
    ; ~50% of cases in the
    Sequenced Treatment Alternatives to Relieve
    Depression (STAR*D) study met criteria for anxious depression (defined as a score of >7 on
    the anxiety/somatization factor of the Hamilton
    Rating Scale for Depression [HAM-D]).2,3 The
    coexistence of anxiety symptoms, especially
    severe anxiety, increases the severity of depressive illness and worsens functional impairment.
    In some reports,3-5 but not all,6,7 anxious depression decreased the likelihood of response or
    remission, and/or increased the time to achieve
    response or remission with treatment for MDD,
    which underscores the importance of treating
    both depression and MDD-associated anxiety.
    A significant overlap exists in pathophysiologic
    components of depression and anxiety, and treatment of both.8
    Antidepressants from a variety of
    classes, particularly selective serotonin reuptake
    inhibitors and serotonin-norepinephrine reuptake
    inhibitors (SNRIs), are effective in treating anxiety
    disorders9-15 in addition to treating symptoms of
    anxiety associated with MDD.4,16-18
    Desvenlafaxine (administered as desvenlafaxine succinate), the active metabolite of venlafaxine, is an SNRI approved in the United States
    for the treatment of MDD.19,20 Several phase III,
    randomized, placebo-controlled, double-blind
    studies have established the efficacy, safety, and
    tolerability of desvenlafaxine in treating MDD in
    adult outpatients.21-25

    Based on the established efficacy of other
    SNRIs in the treatment of anxiety symptoms
    associated with MDD or primary anxiety disorders,4,16,26-28 it is expected that treatment with desvenlafaxine will result in significant improvement
    of anxiety symptoms associated with MDD. The
    objective of this post hoc analysis of pooled shortterm studies was to compare the efficacy of desvenlafaxine and placebo in reducing symptoms
    of anxiety in outpatients with a primary diagnosis
    of MDD. The effects of baseline anxiety on overall
    treatment outcomes and the relationship between
    improvement in anxiety symptoms and remission
    were not evaluated in this analysis.
    CONCLUSION
    In this population of depressed patients, desvenlafaxine was associated with significantly
    greater improvement in anxiety symptoms compared with placebo. The demonstrated efficacy in
    reducing MDD-associated anxiety symptoms warrants more extensive study of desvenlafaxine in
    treating a broad array of anxiety symptoms within
    a wide range of severity. CNS
    Here is the whole pdf.
    http://mbldownloads.com/0310CNS_Tourian.pdf



    As far as common side effects, tolerability, etc.

    Efficacy, safety, and tolerability of fixed-dose desvenlafaxine 50 and 100 mg/day for major depressive disorder in a placebo-controlled trial.
    Boyer P, Montgomery S, Lepola U, Germain JM, Brisard C, Ganguly R, Padmanabhan SK, Tourian KA.
    Source
    University of Ottawa, Institute of Mental Health Research, Ottawa, Ontario, Canada. pboyer@rohcg.on.ca

    Abstract
    The objective of this study was to assess the efficacy, safety, and tolerability of desvenlafaxine (administered as desvenlafaxine succinate) 50 and 100 mg/day for major depressive disorder (MDD). A multicenter, randomized, double-blind, placebo-controlled trial was conducted in Europe and South Africa. Outpatients with MDD received fixed-dose desvenlafaxine (50 or 100 mg/day) or placebo for 8 weeks. The primary efficacy variable was the 17-item Hamilton Rating Scale for Depression total score; secondary measures included Clinical Global Impressions-Improvement scores. The intent-to-treat population included 483 patients: desvenlafaxine 50 mg (n=164), desvenlafaxine 100 mg (n=15, and placebo (n=161). At the last-observation-carried-forward analysis (final evaluation) using analysis of covariance, adjusted mean changes from baseline on the Hamilton Rating Scale for Depression were significantly greater for both desvenlafaxine 50 mg (-13.2; P=0.002) and 100 mg (-13.7; P<0.001) versus placebo (-10.7). Significant differences on the Clinical Global Impressions-Improvement scores were observed for desvenlafaxine 50 mg (P=0.002) and 100 mg (P<0.001) versus placebo. Both doses of desvenlafaxine were generally well tolerated. The most common treatment-emergent adverse events were nausea, dizziness, insomnia, constipation, fatigue, anxiety, and decreased appetite. Fixed doses of desvenlafaxine 50 and 100 mg/day are safe, generally well tolerated, and effective at a clinically relevant level for the treatment of MDD.
    An integrated analysis of the efficacy of desvenlafaxine compared with placebo in patients with major depressive disorder.

    Thase ME, Kornstein SG, Germain JM, Jiang Q, Guico-Pabia C, Ninan PT.
    Source


    Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. thase@mail.med.upenn.edu
    Abstract
    INTRODUCTION:
    To assess the efficacy of desvenlafaxine (administered as desvenlafaxine succinate) in outpatients with major depressive disorder.
    METHODS:
    A meta-analysis of individual patient data was performed on the complete set of registration trials (nine randomized, double-blind, placebo-controlled 8-week studies) of desvenlafaxine. Patients received fixed (50, 100, 200, or 400 mg/day; n=1,342) or flexible doses (100-400 mg/day; n=463) of desvenlafaxine or placebo (n=1,10. The primary efficacy variable was the 17-item Hamilton Rating Scale for Depression (HAM-D(17)); the primary intent to treat analyses used the last-observation-carried-forward method.
    RESULTS:
    Significantly greater improvement with desvenlafaxine versus placebo on the HAM-D(17) total score was observed for the full data set (difference in adjusted means: -1.9; P<.001), each fixed-dose group (all P<.001), and the flexible-dose group (P=.024). Overall rates of HAM-D1(17) response (> or =150% decrease from baseline score: 53% vs 41 and remission (HAM-D(17) < or =7: 32% vs 23 were significantly greater for desvenlafaxine versus placebo (all P<.001). Discontinuation rates due to adverse events increased with dose (4% to 18%; placebo: 3.
    CONCLUSION:
    Desvenlafaxine demonstrated short-term efficacy for treating major depressive disorder across the range of doses studied. No evidence of greater efficacy was observed with doses >50 mg/day; a strong dose-response effect on tolerability was observed.
    PMID: 19407711 [PubMed - indexed for MEDLINE]
    I have some samples of it but have never used them . So, I have no first hand experience.
    Here are some anecdotal reports:
    http://www.askapatient.com/searchres...hField=pristiq

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    metamorphosis's Avatar
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    ^
    Let me also say that while a large pool of first person accounts can be very insightful and invaluable. The odds are more apt, that more people who are dissatisfied with a medication, will post on an anecdotal forum than many who are having good results with their meds. Askapatient can be very informative just by the sheer # of those posting and you will see certain side-effects and result % that appear more frequently. So, those will help paint a part of the picture concerning med. reactions.
    I mean the only psychotropics that I have seen above the 4.0 mark (askapatient) are the MAOI's, Parnate and Nardil. And their side effects, possible dangers, and lifestyle changes can be monumental or unbearable for many.

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    Examination raises

    Always provide type arguments when you use a generic type. Levitra Soft The method might be a pre-Java-5.0 method that was defined before generic and parameterized types had been available in Java.
    White House In other words, we would not even be capable of expressing that we intend to refer to an enum value belonging to a particular instantiation of the generic enum type. impotence Early ejaculation (Premature ejaculation) is a kind of male erectile trouble. Impotence - http://loppholaibet.edublogs.org/2014/04/05/impotence/ I talked to my doctor, who proposed a month of 5 mg, followed by a month of 5mg every other day and then a revisit to see how things are going. I am just entered the 5 mg every other day phase, having made it through one month of 5 mg.

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