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Steven Olsen
Steven Olsen, Therapist
Category: Mental Health
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Experience:  More than twenty years of expertise in counseling, psychological diagnosis and education
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My son is 16 years old. He has been taking pristiq for about

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My son is 16 years old. He has been taking pristiq for about 4 months. He started on 50mg for a month then went up to 100mg
for 2.5 months and then back to 50 mg. He wanted to stop taking pristiq because it has made him agitated. He stopped taking it on
Sunday and Tuesday afternoon he was extremely nnauseous, dizzy,
hot flashes, very uncomfortable feeling, brain zaps. He took 50 mg
that day and about an 1.5 hours feeling less uncomfortable but still he is agitated. Then took another 50 mg same time next day. Now it is 44 hours since. What is the best way to come off this drug?
Also, can you take herbal supplements like st johns wort on days
you are not taking it? (or something else to ease the total discomfort
Submitted: 5 years ago.
Category: Mental Health
Expert:  Steven Olsen replied 5 years ago.

It is unfortunate, but this series of symptoms is a common issue for those on serotonin enhancing medications. Agitation, gastrointestinal symptoms and even the "zaps" (which many pharmaceutical companies deny can occur but in practice often does...) can be symptoms of a too sudden withdrawal.


The drug must be carefully titrated only under the guidance of his doctor. Individual responses to this drug vary widely and your son's titration plan will need to be individualized to his situation and biochemistry. What I can say is that these drugs often take several weeks to be titrated and he should not ever just stop taking them.


Supplements like SJW are never to be used in conjunction with a medication that impacts serotonin levels. A condition called serotonin syndrome can result and its effects can be life threatening. So, do not take SJW with this or any other anti-depressant.


Medications like SJW also take 3-5 weeks to build a response. So, little to no impact will be seen if taken on an as needed basis.


Your son will most likely be given medication to ease the transition from his current medication and to eliminate or reduce the side effects. This can be done safely but he will need face to face planning. No "schedule" can be used as we are all very different neurologically. Steven

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Customer: replied 5 years ago.

His doctor is on vacation and he wants to stop taking the drug.

And to be quite frank after this experience I want him off as well. We do not have an appt until 7/19.

Expert:  Steven Olsen replied 5 years ago.

Best practice would be to have him seen by any qualified physician as soon as possible as this is entirely too long to wait. I do understand you urgency. Your son is in discomfort and needs to feel better. However, the risks of sudden withdrawal are very real. I ethically must recommend that he sees someone face to face to develop a titration plan. He can come off the drug, just not suddenly. And, to give him the standard 3/4 then 1/2 then 1/4 then none plan over two weeks may raise risk for him. Reactions to serotonin medications can be significant.


If this was my son, even though it would cost to do so, I would have him seen on a urgent basis at an ER or similar facility. That is safest and best for his health. His doctor does not have a referral set up? This is the doctor's obligation to his patients in his absence. Steven

Customer: replied 5 years ago.

I have a call placed into my doctors referral

i am waiting for a call back

Expert:  Steven Olsen replied 5 years ago.
That would be ideal as your son's records would be (typically) accessible and a plan can be created to take him off this drug. I will say that in the Children's Institute in Pennsylvania experimented with a regime of natural supplements that has been shown to have some success in adolescents with mild depression: 10 mg Zinc, 100 mg Calcium, 100mg Magnesium Glycinate, daily, showed similar effects to low dose pharmaceutical alternatives. It is worth asking about if he wishes to be pharmaceutical free. Not all physicians agree with more holistic choices, but I have become a believer in the last few years after seeing children respond to the regime. Steven
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