# Pristiq, anyone?



## Dane (Jul 27, 2009)

I've been on Paxil for years with good results, but it hasn't quite "cured" me. My doctor is suggesting I try Pristiq, which is about to be approved for treating SA, according to him. He says some of his other patients have tried it with good results. Aparently it inhibits the reuptake of one more chemical then paxil does. (Too lazy to look up the exact technical data right now, sorry). Anyway, does anyone have experience/opinions on this option?


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## jim_morrison (Aug 17, 2008)

Pristiq is the succesor and active metabolite of Effexor, and acts as a serotonin-norepinephrine reuptake inhibitor, in contrast with paxil which primarily acts as a selective serotonin reuptake inhibitor, so your right, it does inhibit the reuptake of more neurotransmitters than paxil. 
As indeed Effexor is approved to treat depression, generalized anxiety disorder, social anxiety disorder and panic disorder, I assume pristiq would be similarly prescribed to treat these disorders.


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## RockiNToM (Jun 15, 2009)

Pristiq I heard was made because Effexor had too short of a half-life and there were so many complaints.


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## jim_morrison (Aug 17, 2008)

Effexor does the double metabolism trick, so its half-lives are 3-7 hours and then 9-13 hours for the active metabolite, since pristiq is only the active metabolite part, I assume it would partly deal with this problem, though it's still a damn short half life.


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## RockiNToM (Jun 15, 2009)

Yeah which was always my complaint with Effexor; you forget to take your dose and you WILL feel awful. Plus when you want to finally come off and try something else, the withdrawals are pretty fierce. Hopefully there isn't that problem with Pristiq and is a whole lot nicer.


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## jim_morrison (Aug 17, 2008)

Yeah it doesnt seem uncommon for people to border on nervous breakdown if they miss a dose of effexor, as the withdrawl starts to kick in so early. Must suck trying to get off it once and for all. Probly one of its biggest dowsides, albiet it does seem to be one of the more effective newer antidepressants, atleast for depression.


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## robotaffliction (Jul 24, 2009)

the problem with effexor is that both the venlafaxine and "pristiq" metabolite are active, so you got twice a withdrawal problem. the pristiq appears to be effective at a lower dose (although i'm not sure the relative strengths), but i'm not sure what percentage of venlafaxine is metabolized to desmethylvenlafaxine and what percentage is excreted directly by the kidneys as unchanged venlafaxine or converted into some minor metabolite.. but my guess is that venlafaxine withdrawal is actually withdrawal to both the two active in vivo components, as well as the reuptake of both serotonin and norepinephrine. so hopefully pristiq does have an easier withdrawal since the shorter half-life active component is gone.


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## jim_morrison (Aug 17, 2008)

Yes, effexor withdrawl is withdrawl to both active components. There is also some speculation that effexor may have another unknown mechanism of action, including possiblity of acting as a serotonin releaser and/or an opioid agonist. Both of these however are highly disputed.

See here for more details

http://www.psychotropical.com/Antidepressants_Venlafaxine.shtml

"It is concerning that venlafaxine has a close structural similarity to tramadol (a new narcotic analgesic). There is a suggestion that venlafaxine has analgesic effects that are blocked by naloxone; so could it be acting partly as an opioid drug? However, latest data suggests it may not bind to any opiate receptor sub-types.

Indications are that venlafaxine, and tramadol, are particularly prone to interact with MAOIs and thus be implicated in severe and fatal serotonin toxicity (serotonin syndrome). More so, it seems, than the other SSRIs: that suggests an extra different mechanism of action."


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## CopadoMexicano (Aug 21, 2004)

Ive taken prestiq for about five months and didnt do anything for me.


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## euphoria (Jan 21, 2009)

jim_morrison said:


> Effexor does the double metabolism trick, so its half-lives are 3-7 hours and then 9-13 hours for the active metabolite, since pristiq is only the active metabolite part, I assume it would partly deal with this problem, though it's still a damn short half life.


If these are the facts, then surely Pristiq would actually have a _shorter_ duration of action than Effexor, since Effexor would convert to Pristiq over those 3-7 hours then have the additional 9-13 hour half-life of Pristiq. I suppose it'd depend how much ends up as the latter though.

I'm guessing the point of Pristiq is the take variable rates of Effexor metabolism to Pristiq (due to genetics/drug interactions/whatever) out of the equation. Well the real point of it is to make more money, but yeah .


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## AliBaba (Nov 16, 2005)

My doctor has me on Pristiq while I await the arrival of my 6 month supply of Effexor XR. Her thinking being this would help to avoid withdrawal symptoms while I waited and this has indeed been the case. Really I can only comment on Effexor with any authority, but since their chemistry is so similar, here you go:

Effexor XR(in a higher dose) has effectively killed my social anxiety in addition to noticeably putting me in a better mood. I'd say within 3 months I lost what I call my "hesitation to speak up". This drug has also nearly eliminated physical manifestations of SA. Especially blushing & excessive sweating. 

It works that well for me. On the other hand, I had to fight through about 8 to 12 weeks of EXTREME nightmares in addition to the usual serious orgasm difficulty. As the above experts have so eloquently pointed out, you will feel it if you miss one dose (mainly "brain zaps" for me). However, this simply resulted in me eventually not forgetting to take it 

The benefits by far have outweighed the costs for me. It really has been a wonder drug for me for both SA & atypical depression. The point of this new version is to eliminate the above side effects in addition to making money because the drug company's patent has expired. So until I find out in about 5 years that these drugs cause brain tumors, it's all good.

I say go for it!! What have you got to lose.


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## ShawnnyK (Aug 18, 2009)

Just posted for the first time on this board, good to see a positive review, Seems like the people who are probably doing good, are not posting? 

Anyway I start my first dosage tomorrow.... I hate medication for one, and two I hate switching medication....


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## jim_morrison (Aug 17, 2008)

euphoria said:


> I'm guessing the point of Pristiq is the take variable rates of Effexor metabolism to Pristiq (due to genetics/drug interactions/whatever) out of the equation. Well the real point of it is to make more money, but yeah .


Ofcourse the point is to make more money, this is big pharma where talking about


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## Kelly401 (Aug 20, 2009)

Pristiq is a wonder drug for my teen daughter. Rough initially but kicked in after 8th week. She is now social and happy. Takes one day for her to feel a skipped dose. She'll get a headache. I hope it lasts. She's been on it 3 months.


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## BearFan (Mar 22, 2008)

Isn't Pristiq less effective theoretically, since it's removing the parent compound which has efficacy?


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## jim_morrison (Aug 17, 2008)

BearFan said:


> Isn't Pristiq less effective theoretically, since it's removing the parent compound which has efficacy?


Yeah pretty much, since the parent compound venlafaxine (effexor) has an ascending dose response curve. Pristiq has a more flat dose response curve, which means that it's highest dose is only about as effective as a low-to-moderate dose of effexor.


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