Desvenlafaxine ( Pristiq ) is a novel form of the isolated major active metabolite of venlafaxine, and is categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI). It works by blocking the transporter "reuptake" proteins for key neurotransmitters affecting mood, thereby leaving more active neurotransmitters in the synapse. The neurotransmitters affected are serotonin (5-hydroxytryptamine) and norepinephrine (noradrenaline). It is approximately 10-fold more potent at inhibiting serotonin uptake than norepinephrine uptake
Lorazepam, initially marketed under the brand names Ativan and Temesta, is a benzodiazepine drug with short to medium duration of action. It has all five intrinsic benzodiazepine effects: anxiolytic, amnesic, sedative/hypnotic, anticonvulsant and muscle relaxant It is a powerful anxiolytic. Lorazepam's principal use has been in treating the symptom of anxiety. Among benzodiazepines, lorazepam has a relatively high addictive potential.
Abilify is an anti-psychotic used to treat schizophrenia, Bi-Polar disorder and major depressions.
It's a lot of medication you are taking and some new meds can do wonders at treating both anxiety and depression like the selective serotonin reuptake inhibitor ( SSRI like Cymbalta and Lexapro ) But well if you GP think you need such heavy medication i respect his choice since i don't know you and your condition but you're taking a lot...
And as for the Abilify i don't sugest you change that since you might have a schizophrenia and or bi-polar disorder...
Don't forget to consult your GP if you are worried and ask a lot of question about why so many meds and come back to me. Knowing you diagnosis would be a good thing to.
First, Pristiq isn't novel, it's just Effexor with part of it cut off, as was done with Celexa/Lexapro. Some will say it's just a way to get another drug on patent, but since people do have very different reactions to Celexa vs. Lexapro, there probably are differences here, too. Second, Cymbalta isn't an ssri, it's an snri like Pristiq. Third, snris can be very stimulating because they target norepinephrine. Fourth, you haven't been on the med long enough to get used to it; some are very hard in the beginning. Fifth, you didn't say why you're on these meds. If it's for just anxiety, an snri might not be the best way to go because of its targeting of norepinephrine. That is usually used when the main problem is depression. So is Abilify, which is undergoing a huge advertising campaign right now and I notice posts popping up with people taking it. However, even the ads specify that it's only to be used when all else has failed for depression, and is mainly an augmentation drug, to be used in addition to other meds. So the question would be, were you put on these three meds at once? The step studies that use augmentation, which you'll find on the NIMH website, start with one medication until one if found that works. If it doesn't completely solve the symptoms, then another med is tried. If this doesn't work, then a second med is added for augmentation, and a third if necessary, but they go one by one so the psychiatrist can tell what works and what side effects are caused by what medication. Oh, and I'm not an expert, not a physician, all this is just my opinion, and since I had a bad experience with a medication, you shouldn't listen to me. Medhelp orders.
And hey, that last line is obviously an inside joke, so nobody get bent all out of shape.
I have depression and GAD also some racing thoughts,,,,my dr put me on abilify as a mood stabilzer and to help with some racing thoughts,,,,,,,,,,,,,,i guess i never looked at it as being a bunch of heavy meds,,,i only take 1 mg of abilfy been on it since jan 09 alot od the antidepressnats dont work for me so trying Pristiq,,,,ativan is for my severe anxiety.
Yeah i know cymbalta isnt a SSRI its jus that use both word so often that when im typin fast i might confuse them, you are right and it's a SNRIS ( serotonin-norepinephrine reuptake inhibitor ) sorry for the confusion it may have lead to. But thanks for corecting me it's really important to me to be always right when talking about meds.
Was talking about Lexapro being a SSRI and Cymbalta being the SNRIS.
If your initial therapy was Ativan and Abilify, you were likely targeted for bipolar disorder. In depression, the indication is for add on treatment for resistant depression.
Both pristiq and abilify are expesive therapies. Abilify affects Dopamine by partially stimulating dopamine receptors while also putting the brakes on intrinsic dopamine via affects on certain seratonin receptors.
Effexor, from which pritiq was derived as an isomer ( more potent r configuration of molecule, approximate. 50% of parent compound), is not effective until 150 mg on norepinephrine. It is possible, in that 75 mg of pristiq may be required for norepinephrine release.
The norepinephrine likely has some pro dopamine effects and can be better for negative depression symptoms such as lethargy and poor concentration. Additionally, peripheral pain transmission appears to be decreased with norepinphrine over seratonin agents alone. They both have descending pathways down the spinal cord.
Sleep is critical in mood treatment. Recent studies have demonstrated much more rapid improvement of depression with clonazepam coadministered at night for sleep, with Prozac. Compared to Prozac alone, reversal was evident in a week as compared to 3 weeks.
There may be disagreement but in the absence of sleep apnea, I would focus on the lorazepam for sleep. It is always better to sleep and safer to take a medication to sleep than not sleep.
If mainly anxiety, followed by insomnia, then daytime fatigue, inability to concentrate, increased anxiety and stress from a non focused mind, and a broadening gap between your ideal self and where you are, then reevaluate.
An inexpensive ssri such as celexa, with a longer acting benzodiazapine as clonazepam may save a lot of money.
If daytime hypo arousal is present, get a trial of Nuvigil. Get the 250 and try 1/3 in the am. This is a great medi at ion that can help improve daytime mental energy to keep the concentration circuit activated and reduce the mental background noise that tells u how anxious you are!!
Deeply asleep, deeply awake, quite mind, able to concentrate, perceptive, with limited use of excess calories and limited use of intoxicants. Able to plan and learn from the past but deeply present. Being deeply in life, not always thinking, is the goal.
This is mental health, the medications should be tailored to meet this endpoint. The variation on treatments is high among physicians, many do not look at these problems in mood as having multiple dimensions, nor target the basic symptoms ( I.e. Insomnia, daytime hypersomnia) if these problems are not improved and better, then the problem is not optimally treated.
Very well said! What would you recommend to someone with daytime anxiety, no motivation, unable to concentrate, gets overwhelmed easily, who already takes Klonopin 1mg/day.
I was trying Lexapro but got allergic reaction and it made me extremely sleepy and drowsy during the day. I need to concentrate and stay alert at work!