How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Kaushik Your Own Question

Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4050
Experience:  MD Psychiatry
9385906
Type Your Mental Health Question Here...
Dr. Kaushik is online now
A new question is answered every 9 seconds

for a psychiatrist only please. I am taking pristiq 100mg .

Customer Question

for a psychiatrist only please. I am taking pristiq 100mg . I have been on this for 1 week now after being on 50mg for 3 weeks. 1 week ago i stopped zoloft after being on it for 15 years. I was not getting the same response with zoloft as i used to. I got suicidal on saturday so I restarted zoloft and am now at 100mg of zoloft and feeling better. I am also taking the 100mg of pristiq. the problem is is that I am having coordination problems and severe muscle twitches. when i was started on pristiq 50mg 1 month ago and started the taper down from 250mg zoloft i had the same twitches...as i got to a lower zoloft level and while still being on 50mg pristiq the twitches got much better. So my question is what i should do? I talked to my psychiatrist a couple of days ago and she said keep taking zoloft and pristiq together and i will taper the zoloft slower when i see her in 2 weeks. the problem is the tremors and twitches have gotten much worse over the past 2 days. can i take a higher dose of pristiq? what is the max? i can't function taking the two right now because of the twitches.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 1 year ago.

Greetings !

 

Welcome to the site.

 

I am Dr. Kaushik and i believe i can help you with your problem.

 

I am sorry to learn about your condition and i empathize with you.

 

Well the lack of coordination and muscle twitching that you have been experiencing and which have been worsening are signs of a potentially serious condition called as Serotonin syndrome which tends to develop when two drugs which increase serotonin levels in the body are taken together and in your case you are in fact taking two such drugs -- Zoloft and pristiq which are not supposed to be taken together.

 

Kindly see the link below to know more about Serotonin syndrome and see the symptoms involved.

 

http://www.mayoclinic.com/health/serotonin-syndrome/DS00860/DSECTION=symptoms

 

Now since this condition is serious one , so i will suggest that you meet up with your treating doctor as soon as possible for supervised treatment of this impending disorder ( if it already has not developed) or rush to emergency. Other than this stop these drugs immediately after reporting these symptoms to the doctor concerned as the drugs need to wash out of your system to resurrect your condition.

 

I hope this helps.

 

Wish you all the best.

 

Please kindly leave a Positive rating if you are satisfied with the answer.

 

If there is any further assistance needed please feel free to ask using the reply button.

 

Regards.

Customer: replied 1 year ago.

well my dr is aware and said i should continue to take the two together until i see her. i lowered zoloft to 50mg and left the pristiq at 100. why would my dr tell me to do it this way if this is toxic. i have had flu like symptoms too. uncontrollable shaking and hot cold feelings. this did not start right after i took zoloft with pristiq it took 3 days to develpp which is why i didnt think it was anything. usually ss starts right away. so this has not caused permanent brain damage?

Expert:  Dr. Kaushik replied 1 year ago.

Well I am not doubting your doctor's credibility but sometimes one cannot predict the drug reactions at the molecular level and so one ends up with the side effects when it is least expected.

 

You said 3 days it took to develop these symptoms after taking the two drugs together , if this is not early then what is. You see the drug needs some time to reach some sort of steady level in the serum to produce any effect on your system be it a positive effect or a negative , so the fact that the symptoms developed within 3 days after taking the combination makes it more likely the sign of an impending / developing serotonin syndrome , at least an evaluation is a must in this case scenario as a precautionary measure.

 

Serotonin syndrome is not about permanent brain damage but about excessive serotonin levels in the brain causing serious side effects , so permanent brain damage is not that we are looking into or concerned with as it is a rare possibility here in this situation , i am here concerned about possibility of serotonin syndrome.

 

I hope this helps.

 

Regards..

Customer: replied 1 year ago.

i also took 15mg remeron for sleep. started 1 week ago. i was only supposed to take 7.5 but i was so depressed and a little suicidal. i couldnt cope...the shaking has subsided and i didnt have a fever cause i took tylenol....please say i dont have permanent damage...if this is true

Expert:  Dr. Kaushik replied 1 year ago.

No brain damage is there, so stop worrying about that. Brain damage does not happen in such a case scenario, rest assured of that.

 

So relax and stop jumping to hasty conclusions.

 

I hope this helps.

 

Wish you all the best.

 

Take care.

 

Regards...

Expert:  Dr. Kaushik replied 1 year ago.

Please kindly leave a Positive rating if you are satisfied with the answer !

 

If there is any further assistance needed please feel free to ask using the reply button.

 

Regards..

Customer: replied 1 year ago.

i will push accept but i wanted to ask if i can wait 1 day to see my doctor

Expert:  Dr. Kaushik replied 1 year ago.

Sure. Why not. Take your time.

 

Regards..

Customer: replied 1 year ago.

sorry what i meant was should i go to emerg or see my dr tommorow? and i will push accept

Expert:  Dr. Kaushik replied 1 year ago.
Based on the recent positive developments of your symptoms you can wait till tomorrow but if symptoms begin to deteriorate then do not waste any time and rush to emergency.
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4050
Experience: MD Psychiatry
Dr. Kaushik and 3 other Mental Health Specialists are ready to help you
Customer: replied 1 year ago.

can i a sk what the max dose of pristiq is. the litetature says 100mg but i read people take much more

Expert:  Dr. Kaushik replied 1 year ago.

Yes the maximum recommended dose of pristiq is 100 mg / day.

 

Well some people go beyond this maximum dose thinking that it will provide them with more benefits but it does not happen that way since maximum recommended dose is established in such a way where the drug works at it's maximum potential. Any dose higher than this maximum dose shall not provide any extra benefit or improvement, on the contrary to this false belief it may lead to an overdose thereby producing adverse effects and compromising the condition even more.

 

So if you are not finding desired benefits with 100 mg pristiq then instead of increasing the dose any further better will be to add an augmenting agent like lamictal ( lamotrigine ) at moderate dose of 50-100 mg / day or Buspar ( Buspirone) at dose of 10 mg two times a day. This addition shall potentate the action of pristiq and make it more effective than before.

 

I hope this helps.

 

Wish you all the best.

 

Regards..

Customer: replied 1 year ago.

thanks. do you knowwhy pristiq doesnt seem to work as well as zoloft both at yheir max doses? is it because i have ocd anxiety and ocd usually responds best to the most powerful effector of serotonin?

Expert:  Dr. Kaushik replied 1 year ago.

Yes you got it right , ocd responds much better to ssri anti depressants such as Zoloft as compared to SNRI anti depressants because ssri's are more powerful serotonin balancing drugs.

 

I hope this helps.

 

Regards..

Customer: replied 1 year ago.

can i ask one last thing?when i think about it , it is likely that i had varying degreed of serotonin syndrome the past month while cross tapering antideprrssants. could prolonged exposure to high levels of serotonin cause brain damage?

Expert:  Dr. Kaushik replied 1 year ago.

No, there is all or none rule for serotonin syndrome , either it develops or it does not there is no variation in it's occurrence.

 

Excessive levels of serotonin exposure can produce some side effects ( which can be reversed ) but permanent brain damage is unlikely to occur.

 

Regards..

 

Customer: replied 1 year ago.

if permanent damage were to occur it would be because of a fever? or the serotonin storm itself causing damage in the nerve cells?

Expert:  Dr. Kaushik replied 1 year ago.

Well you seem to have good cognitive functioning as is evident from your intricate and valid questions so there is no question here about you having any sort of brain damage. And fever is a sign which the body gives to warn us about something going wrong within the body so it cannot be equated as a cause for brain damage and as far as excessive serotonin is concerned well that too does not lead to permanent brain damage.

 

I hope this helps to clear your dilemma about this.

 

Wish you all the best.

 

Regards..

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr.Keane/2013-8-20_204325_drkeane.64x64.jpg Dr. Keane's Avatar

    Dr. Keane

    Therapist

    Satisfied Customers:

    1262
    Clinical Psychology PhD, Licensed Professional Counselor with experience in marriage/family, teens and child psychology.
  • http://ww2.justanswer.com/uploads/RE/resolutions66/2011-1-17_05728_IMG8202smilingeditedforJustAnswer.64x64.jpg Elliott, LPCC, NCC's Avatar

    Elliott, LPCC, NCC

    Psychotherapist

    Satisfied Customers:

    5024
    35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
  • http://ww2.justanswer.com/uploads/formybunch/2010-12-06_191055_img_0975.jpg Kate McCoy, M.Ed, NBCC, LPC's Avatar

    Kate McCoy, M.Ed, NBCC, LPC

    Therapist

    Satisfied Customers:

    3733
    Over 20 years experience specializing in anxiety, depression, drug and alcohol, and relationship issues.
  • http://ww2.justanswer.com/uploads/DR/DrAkiraOlsen/2012-2-20_746_AkiraADpicmain.64x64.jpg Dr. Olsen's Avatar

    Dr. Olsen

    Psychologist

    Satisfied Customers:

    2336
    PsyD Psychologist
  • http://ww2.justanswer.com/uploads/norriem/2009-5-27_134249_nm.jpg Norman M.'s Avatar

    Norman M.

    Psychotherapist

    Satisfied Customers:

    2193
    UK trained in hypnotherapy, counselling and psychotherapy and have been in private practice. ADHP(NC), DEHP(NC), UKCP Registered and ECP.
  • http://ww2.justanswer.com/uploads/PsychologyProf/2010-07-15_171248_logos060400409.jpg Dr. Michael's Avatar

    Dr. Michael

    Psychologist

    Satisfied Customers:

    2177
    Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
  • http://ww2.justanswer.com/uploads/KURTEMMERLING/2010-07-23_215531_just_ask_picture1.jpg Steven Olsen's Avatar

    Steven Olsen

    Therapist

    Satisfied Customers:

    1727
    More than twenty years of expertise in counseling, psychological diagnosis and education