Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Pristiq is an FDA-approved medication that's used to treat major depressive disorder (MDD). The generic version of Pristiq is desvenlafaxine, and we will use these terms interchangeably throughout this article because they refer to the same active drug ingredient.
Is Pristiq more effective than other antidepressants? Does it cause concerning side effects? Does it cause withdrawal symptoms? And how do real users describe how they feel on Pristiq?
In this article we’ll answer all of these questions and more as we review medical studies on Pristiq to determine if it's effective, document the drug's side effects and share real, unsponsored user reviews.
Does Pristiq Improve Depression?
Pristiq has been studied in many clinical trials to see if it's effective for reducing the symptoms of depression.
A clinical trial published in the CNS Spectrums journal found that Pristiq was effective for patients with depression.
Researchers in the trial measured patient symptoms on the Hamilton Depression Rating Scale (HAM-D), which tracks patient responses across a wide variety of symptoms associated with depression, such as insomnia and loss of sex drive.
The depressed patients taking Pristiq had their depression significantly reduced based on the HAM-D scoring. The average score was over 20 at the start of the trial and under 10 at the end of the trial, representing a decrease in depression symptoms of over 50%.
A 2010 meta-study evaluated the efficacy of Pristiq for patients with major depressive disorder.
The study authors concluded that Pristiq was safe, effective and tolerable for depressed patients and improved their condition. Remission rates were around 10% higher in the groups taking Pristiq compared to the groups taking a placebo pill. Remission is defined as an extended period free of any major depressive symptoms.
We will conclude from the available research that Pristiq is effective for treating depression.
Pristiq Side Effects
Pristiq is required by the FDA to publish a “black box” warning on its drug label, shown above, which references an increased risk of suicidal behavior in children, adolescents and young adults.
A medical trial published in the Current Medical Research and Opinion journal provides some more data on the side effects caused by Pristiq.
The most common side effect reported was dizziness, which occurred 8% more often than in those taking placebo, dry mouth which occurred 9% more often and constipation which occurred 7% more often.
Most of the common side effects of Pristiq seem relatively mild and standard for antidepressant drugs, but it may be logical for young adult patients to consider alternative antidepressant drugs that do not increase the risk of suicidal thoughts or actions.
Real, Unsponsored Pristiq Patient Review
One of the most popular YouTube reviews of Pristiq is published by a creator called Anxiously Bri. She shares her experience after using Pristiq for six weeks, including benefits of the drug and side effects:
Should I Take Pristiq Generic?
The generic form of Pristiq is called desvenlafaxine.
A medical review of the comparative effectiveness of generic and branded drugs found that the generic versions were just as effective on average. This suggests that desvenlafaxine should be as effective as Pristiq, but may be much cheaper.
We typically recommend that patients speak with their doctor about generic alternatives to brand-name drugs due to the cost difference.
According to SingleCare, the retail price of Pristiq is over $500 at the time of updating this article, while desvenlafaxine costs $18.30 on Cost Plus Drugs.
Does Pristiq Cause Withdrawals?
Like many pharmaceutical antidepressant medications, Pristiq does have a risk of uncomfortable withdrawal symptoms.
A research review published in 2009 documented these symptoms in order of occurrence. The most common withdrawal symptoms were similar to the most common Pristiq side effects: dizziness, nausea, headache and irritability.
Patients taking higher doses experienced worse withdrawal symptoms. After week 3, patients withdrawing from a 400 milligram (mg) per day dose were still experiencing withdrawal symptoms around 100% more severe than patients withdrawing from a 100 mg per day dose.
Withdrawal symptoms can be mitigated with proper tapering, which means a strategic lowering of dose rather than stopping medication all at once. This is why it’s so important for patients to speak with their doctor prior to discontinuing medication. Even if the patient is set on quitting the medication, their doctor can help them taper off safely based on research standards which reduce the risk of withdrawals.
A YouTube creator named Nicole Grotesca published a video explaining her experience withdrawing from Pristiq:
Pristiq is prescribed at different doses depending on the severity of the patient's depression. The therapeutic dosing range is between 25 mg and 400 mg. The typical starting dose is 50 mg.
A clinical trial compared the efficacy of Pristiq at 50 mg per day and 100 mg per day.
Contrary to what one might expect, the drug was actually more effective at the lower dose. Patients on the 50 mg daily dose experienced greater average reduction in depression scores than patients on the 100 mg daily dose by end of the trial.Typically there is a trade off between efficacy and side effects. The higher the dose, the higher the chance of side effects. Since Pristiq appears to be more effective at a lower dose, at least according to one research trial, this should be a good thing for patients because it lowers the risk of side effects.
Pristiq Vs. Effexor
As we documented in our Effexor reviews article, the antidepressant Effexor is in the same drug class as Pristiq (SNRI). For this reason, patients are often curious about which drug is more effective for depression.
A comparative study published in the CNS Spectrums journal analyzed the effectiveness and safety of the two drugs.
Pristiq reduced depression scores by a small amount more than Effexor in the medical review, but not to a statistically significant degree. Pristiq also caused fewer patients to experience nausea as a side effect.
The active ingredient in Pristiq is a metabolite of the active ingredient in Effexor, so it's unsurprising that the two drugs have very similar effects.
Because the drug appears slightly more effective and seems to have a slightly more favorable side effect profile, we would recommend that patients speak with their doctor about Pristiq over Effexor.
Does Pristiq Reduce Anxiety?
Pristiq is not FDA-approved for the treatment of anxiety, but there have been some clinical trials evaluating the drug's effect on anxiety levels in depressed patients.
A meta-study published in the CNS Spectrums journal analyzed results from 9 clinical trials on Pristiq to examine its effects on anxiety.
Study participants taking Pristiq had significantly reduced anxiety by the end of the trials than at the beginning. Anxiety scores were 14% lower in those taking Pristiq than those taking placebo.
Another medical study found similar results. Depressed patients taking Pristiq had significantly reduced anxiety levels by the end of the trial.
These studies suggest that Pristiq may be an effective option for patients with both depression and anxiety. They don’t prove that Pristiq is effective for non-depressed patients suffering from anxiety, because the patient populations in both studies were depressed.
How Does Pristiq Work?
Pristiq is in a drug class called SNRI, or serotonin and norepinephrine reuptake inhibitor. According to StatPearls, which is one of the largest freely-accessible medical databases, Pristiq is 10 times more selective for serotonin than norepinephrine.
This class of drugs delays the body’s processing of neurotransmitters serotonin and norepinephrine which has significant effects on mood. In Pristiq’s case, it has more of an effect on serotonin than norepinephrine based on the above-linked research review.
By blocking normal processing and clearance of these neurotransmitters, Pristiq causes an artificial increase in their circulating levels in the brain, which can improve mood and relieve symptoms of depression.
It hasn’t been conclusively proven that patients with depression have lower levels of serotonin and norepinephrine than neurotypical patients, but this is the suggested mechanism of action.
Our Mental Wellness Recommendation
We recommend a platform called Brightside to patients on a mental health journey. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.
A medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.
Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.
Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.
The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.
Interested patients can check out Brightside at this link to the brand's website.