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My psychiatrist has just prescribed 50 mg of Pristiq for me.

I am also now on...
My psychiatrist has just prescribed 50 mg of Pristiq for me. I am also now on 40 mg of escitalopram. he wants me to take both together for a while. I am nervous about this amount of anti-depressant. I mentioned it to him and he said not to worry. I just want a second opinion. I also take 150mg of trazadone for sleep at night. What is your opinion?
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Answered in 11 minutes by:
7/18/2013
Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7,664
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Verified
Elliott, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I believe that I can help.

Elliott, LPCC, NCC :

Psychiatrists are free to give you whatever psychotropic medications that they want to.

Elliott, LPCC, NCC :

Sometimes they mix medications that have known contraindications, feeling that they may help the individual client.

Elliott, LPCC, NCC :

He is giving you three medications that are considered to be at high risk when taken together. They may help you, but if I were in your position I would think carefully about taking them.

Elliott, LPCC, NCC :

Here is what the very reputable www.drugs.com says about these three medications combined:

Elliott, LPCC, NCC :

Interactions between your selected drugs



trazodone ↔ escitalopram


Applies to: ***** *****



Talk to your doctor before using escitalopram together with traZODone. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision

, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms while taking the medications. In addition, you may have an increased risk of developing an irregular heart rhythm that may be serious. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or fast or pounding heartbeats while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data



trazodone ↔ desvenlafaxine


Applies to: ***** ***** (desvenlafaxine)



Talk to your doctor before using traZODone together with desvenlafaxine. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp

, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data



escitalopram ↔ desvenlafaxine


Applies to: ***** ***** (desvenlafaxine)



Talk to your doctor before using escitalopram together with desvenlafaxine. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea

. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Elliott, LPCC, NCC :

You can read this from the source that I have prepared at:

Elliott, LPCC, NCC :


http://www.drugs.com/interactions-check.php?drug_list=1013-0,2228-0,2796-12488

Elliott, LPCC, NCC :


I would, at the very least, get a second opinion from another psychiatrist who has seen you face-to-face.

Customer:

But, I did ask him about that and he said he, after 40 years in practice, has never seen a case of serotonin syndrome.

Elliott, LPCC, NCC :

So you are willing to take a chance then?

Customer:

I am not sure. I think I want to talk to him more before I start the Pristiq.

Customer:

I have a long relationship with this Doctor.

Customer:

Do you think it's wise to hold off?

Elliott, LPCC, NCC :

If he monitors you very closely then you will probably be safe. He does have experience but this combination of all THREE flies in the face of conventional wisdom about safety.

Elliott, LPCC, NCC :

Trusting him means a lot, and if he will watch you closely and warn you of all possible symptoms to be aware of then you might want to follow his directions - but with great care.

Customer:

Well, when the Pristiq was filled by the Pharmacy, the computer did not put up any red flags. The Pharmacist said it would if it detected a problem.

Elliott, LPCC, NCC :

If you have treatment resistant depression you might consider the non-invasive and very effective Transcranial Magnetic Stimulation (TMS).

Customer:

What would you think I would look for if there was an issue?

Elliott, LPCC, NCC :

You would look for any of the symptoms listed above.

Elliott, LPCC, NCC :

drugs.com has the following pedigree:

Elliott, LPCC, NCC :

drugs.com Data sources include Micromedex™ (updated June 15th, 2013), Cerner Multum™ (updated June 17th, 2013), Wolters Kluwer™ (updated June 6th, 2013) and others.

Customer:

I was on Effexor for many years, and I was fine, then I went off and I fell into GAD and Depression. He tried lexapro first and it has not worked, so he wants to try Pristiq since it's so much like Effexor

Elliott, LPCC, NCC :

Modern psychiatry is very experimental and the patient is tested for effectiveness. Every patient is different and so no outcomes are ever guaranteed.

Customer:

Yes, that is true.

Customer:

I think I'm going to hold off until I talk to him again - I need more reassurance.

Elliott, LPCC, NCC :

If you take the combination (and the other two without the Pristiq are already risky), then you can look for:

Elliott, LPCC, NCC :

confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp

nausea, vomiting, and diarrhea.


Customer:

Okay, thank you!

Elliott, LPCC, NCC :

I think you are making a wise decision

Elliott, LPCC, NCC :

I shall keep you in my prayers.

Elliott, LPCC, NCC :

Warm regards,

Elliott, LPCC, NCC :

Elliott, MAE, LPCC, NCC, CCMHC

Customer:

Thank you. I will pray for you as well! God bless you!

Customer:

War Regards,

Customer:

Warm Regards, Dan

Elliott, LPCC, NCC :

Thank you. and God bless you too and keep you safe and lift your depression. Amen.

Elliott, LPCC, NCC :

Thank you so much, Dan. :)

Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7,664
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Verified
Elliott, LPCC, NCC and 87 other Mental Health Specialists are ready to help you
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Elliott, LPCC, NCC
Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7,664
7,664 Satisfied Customers
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.

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