Effexor vs Pristiq: Which one should I take?

Anxiety and depression are the 2 most commonly diagnosed and treated psychological conditions. These 2 disorders often coexist with one another, and there are a number of medications that are useful in treating both anxiety and depression. So, when considering Effexor vs Pristiq, which is best for you?

Specifically, 2 classes of medications are considered first-line treatment for anxiety and depression, called Selective Serotonin Reuptake Inhibitors (SSRIs) & Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Within each class of medications, there are several different drugs that all have their own unique properties and effects on the body. 

In this article, we compare two of the most commonly prescribed SNRI medications, Effexor and Pristiq, so that you can be better informed before discussing treatment options with your healthcare provider. 

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This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

Pristiq vs Effexor: What are the key differences?

Pristiq and Effexor are both SNRIs used to treat various conditions, including anxiety and depression. However, there are some key differences between them.

Conditions treated

Both Pristiq and Effexor are primarily prescribed for major depressive disorder (MDD). Effexor is also approved by the U.S. Food and Drug Administration (FDA) to treat generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder. Pristiq, on the other hand, is specifically indicated for MDD.

Dosages and forms

Effexor is available in immediate-release tablets and extended-release capsules, which allows for flexible dosing options. It can be prescribed in different strengths to tailor the treatment to individual needs. 

Pristiq is only available in an extended-release formulation, which means it releases the medication gradually into the body over time. The dosage strengths for Pristiq are fixed and can’t be easily adjusted.

Side effects

Both Pristiq and Effexor share common side effects, such as nausea, dizziness, dry mouth, and increased sweating. However, individual responses can vary. 

Effexor has been associated with higher rates of discontinuation due to side effects, particularly at higher doses, while Pristiq is generally better tolerated. 

It’s important to consult with a healthcare professional to discuss the potential side effects and determine which medication may be more suitable for you.

What is Effexor and how does it treat depression?

Effexor is the name brand of the generic drug venlafaxine and is an SNRIs. It’s commonly prescribed for the treatment of anxiety and depression.

Common doses and forms of Effexor

Effexor (venlafaxine) is available in both immediate-release and extended-release formulations in tablets and capsules. Your healthcare provider will typically start you at the lowest dose and then titrate up on a weekly basis, depending on your symptoms. 

Effexor immediate-release tablets are available in the following dosage: 

• 75 milligramsmg 
• 100 milligrams 
• 225 milligrams 
• 350 milligrams 
• 375 milligrams (in 3 divided doses per day)

Effexor extended-release 24-hour capsules are available in the following dosage: 

• 37.5 milligrams
• 75 milligrams
• 150 milligrams

Effexor extended-release 24-hour tablets are available in the following dosage:

• 37 milligrams
• 75 milligrams
• 150 milligrams 
• 112.5 milligrams 
• 225 milligrams

Conditions Effexor treats

Effexor is Food and Drug Administration (FDA)-approved for the treatment of GAD, MDD, , panic disorder, and social anxiety disorder. 

Off-label uses for Effexor

The term off-label is used to describe any use for a medication that has not been approved by the FDA. This does not mean that the medication is not effective in the treatment for a given condition but that it has simply not gone through the FDA-approval process for treating that condition. 

Some off-label uses for Effexor include: 

• Narcolepsy 
• Diabetic neuropathic pain 
• OCD
• Premenstrual dysphoric disorder (PMDD) 
• Migraine prevention 
• Vasomotor symptoms associated with menopause, such as hot flashes 
• Fibromyalgia 
• Complex pain syndrome

Effexor costs

The cost of Effexor or generic venlafaxine varies greatly depending on your insurance coverage, dosage, and which pharmacy you use. The average cash price for a 30-day supply of Effexor is around $549, but this cost can be significantly reduced to around $42 with the use of generic forms and coupon codes. 

Effexor is typically covered by most health insurance plans, and coupon codes can be found at the majority of pharmacies. 

Effexor side effects

When starting a new medication, it’s important to weigh the potential risks and benefits of the given drug. Some of these risks include the possibility of developing side effects after starting Effexor. 

Side effects typically appear within the first few weeks of initiating the medication but are also known to decrease or resolve completely after continuous use of the medication. 

If you’re experiencing bothersome side effects that are persistent and interfere with your everyday life, talk to your healthcare provider about discontinuing the drug or finding an alternative. 

Common side effects of Effexor include: 

• Headache 
• Dizziness 
• Drowsiness or increased tiredness 
• Sleep disturbances, including insomnia or strange dreams 
• Changes in appetite, resulting in weight loss or gain 
• Dry mouth 
• Tremors 
• Racing heart rate 
• Gastrointestinal (GI) upset, including abdominal pain, nausea, vomiting, diarrhea or constipation
• Tremors 
• Sexual dysfunction, including lack of desire or libido, and inability to achieve orgasm 

If you begin to experience the following serious side effects, contact your healthcare provider immediately: 

• Changes in vision, including blurred vision
• Abnormal bleeding 
• Seizures 
• Difficulty breathing or chest tightness
• Hyponatremia or low blood sodium

Effexor drug interactions

There are a number of medications to avoid while taking Effexor due to potential interactions. It is important to disclose all medications you are currently taking with your healthcare provider, including all over-the-counter medications and supplements. 

Some common drugs that interact with Effexor include: 

• Non-steroidal anti-inflammatory drugs
• Blood thinner medications, such as Warfarin or even aspirin 
• Monoamine oxidase inhibitor medications – should be discontinued two weeks prior to starting an SNRI
• Opioid pain medications
• Supplements such as St. John’s Wort 
• Recreational drugs that increase serotonin, such as MDMA, aka ecstasy

What is Pristiq and how does it treat depression?

Pristiq (desvenlafaxine) is another SNRI medication that is commonly used in the treatment of anxiety and depression. It can improve your mood, feelings of well-being, and energy levels. 

Common doses and forms of Pristiq 

Pristiq is available in extended-release 24-hour tablets only. Similar to Effexor, the medication is typically started at a low dose and then titrated up on a weekly basis until at the lowest effective dose. 

Pristiq is available in the following dosage forms:

• 25 milligrams 
• 50 milligrams 
• 100 milligrams 

Conditions Pristiq treats

The only FDA-approved use of Pristiq is for major depressive disorder (MDD). Although treating depression is the only FDA-approved use, there are a few different off-label uses for Pristiq. 

Off-label uses for Pristiq

As described above, the term off-label doesn’t mean that the medication is not effective in the treatment for a given condition but that it has simply not gone through the FDA-approval process. 

Some common off-label uses for Pristiq include: 

• GAD
• Panic attacks 
• Social anxiety disorder 
• OCD
• Vasomotor symptoms associated with menopause, such as hot flashes 

Pristiq costs

As with Effexor, the cost of Pristiq or desvenlafaxine can vary depending on insurance coverage, dosing, and which pharmacy you use. Without insurance, a typical 30-day supply of Pristiq is around $470, which can be significantly reduced to between $13-110 with the use of coupon codes and generic formularies. 

Most health insurance plans typically cover Pristiq, and coupon codes are readily available at the majority of large pharmacies. 

Pristiq side effects

As with any medication, there is the potential for developing side effects after starting a new medication. Similar to other SNRI medications, these side effects may begin to appear within the first few weeks of starting a new medication and tend to improve or resolve with continuous use. 

If you experience bothersome adverse effects that impact your everyday life or serious adverse effects, it’s important that you contact your healthcare provider immediately or seek emergency medical care. 

Some of the common side effects associated with Pristiq include: 

• Dry mouth 
• Nausea and vomiting 
• Diarrhea or constipation
• Fatigue or increased tiredness
• Dizziness 
• Reduced appetite 
• Sleep disturbances, including insomnia and increased need for sleep
• Increased anxiety, irritability, or restlessness
• Sexual dysfunction, including reduced libido or sex drive and inability to achieve orgasm 

Serious adverse effects that require immediate medical attention include: 

• Worsening depression or anxiety 
• Suicidal thoughts or thoughts of self-harm 
• Severe insomnia 
• Severe irritability or aggression 
• Signs of serotonin syndrome, including racing heartbeat, sweating, flushing, tremor, muscle stiffness, hallucinations, seizures, or coma 
• Chest pain 
• Easy bruising or bleeding 
• Changes in vision, including blurred vision, seeing halos around lights

Pristiq drug interactions

It’s important to disclose all medications you are currently taking with your healthcare provider, including all over-the-counter medications and supplements. Below is a list of drugs that cause known interactions with Pristiq and should be avoided. 

Common drug interactions with Pristiq: 

• MAOIs should be discontinued two weeks prior to starting an SNRI medication 
• Other SSRIs and SNRIs
• Tricyclic antidepressants 
• Lithium 
• Opioid pain medications
• NSAIDs 
• Blood thinner medications, including warfarin and aspirin
• Certain diuretics 
• Stimulant medications, such as ADHD medication Adderall and diet supplements like Adipex

What are SNRIs and which mental health symptoms can they treat?

Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase serotonin and norepinephrine levels within the brain by blocking their reuptake after neural transmission. Those who suffer from anxiety or depression tend to have lower serotonin and norepinephrine levels, leading to physical and psychological symptoms.

SNRI medications increase the levels of these key neurotransmitters in the brain, which play an important role in numerous bodily functions, such as mood, sleep, and appetite, to name a few. 

It’s important to note that everyone reacts to each medication differently, so although one SNRI medication did not work for you, another drug within the SNRI class may work and be beneficial for managing your symptoms. 

SNRIs can treat symptoms of anxiety and depression

Anxiety and depression can present themselves in many different forms, and these two conditions are commonly seen together. Your symptoms may range from mild to severe in nature and can sometimes disrupt your daily life. 

When talking with your healthcare provider, be sure to explain all of your current symptoms to ensure that they arrive at an accurate diagnosis and proper treatment. 

Some common symptoms of anxiety include: 

• Constant thoughts of worry or fear out of proportional to the situation
• Feelings of panic 
• Catastrophizing 
• Feelings of impending doom 
• Irritability 
• Difficulty concentrating 
• Insomnia 
• Physical symptoms, including increased muscle tension, racing heartbeat, sweating, hot flashes, abdominal pain, headache, or tremor

Some common symptoms of depression include: 

• Constant low or depressed mood 
• Fatigue or decreased energy 
• Loss of interest in pleasurable activities or hobbies 
• Excessive crying 
• Changes in appetite, causing weight loss or gain 
• Feelings of worthlessness, guilt, hopelessness, or helplessness
• Difficulty concentrating
• Sleep disturbances, including sleeping too much or too little 
• Suicidal thoughts or thoughts of self-harm 

Warnings before taking SNRIs

Although SNRIs are considered to be relatively safe medications to take, there are a few warnings that should be considered before starting an SNRI medication for the treatment of anxiety and depression. Below we have listed a few of the major warnings associated with SNRIs, including Effexor and Pristiq. 

If you have any of the following preexisting conditions, SNRI medications may not be the best medication for you. 

• Hypertension or high blood pressure 
• Significant cardiovascular disease
• Bipolar disorder 
• Seizure disorder 
• Certain lung diseases, such as interstitial lung disease 
• Hyponatremia or low blood sodium levels, including SIADH
• Glaucoma 
• Chronic kidney disease 
• Liver disease

Boxed warning 

As with most antidepressant medications, there is a risk of developing suicidal thoughts or thoughts of self-harm shortly after starting a new medication. Studies have found that this only occurred in a small number of patients and was more common in young adults under the age of 24. 

This is a rare side effect of starting an SNRI but should be discussed with your healthcare provider before starting a new medication. It’s important to monitor yourself for signs of increased suicidal thoughts or thoughts of self-harm when starting an SNRI. 

If you’re experiencing suicidal thoughts or thoughts of self-harm, contact your healthcare provider immediately or seek out medical attention at the nearest emergency room. The Suicide and Crisis Lifeline can be reached at 988 and is available 24×7. 

Serotonin syndrome 

Serotonin syndrome is a rare but serious condition that may occur while taking an SNRI medication and is the result of high levels of serotonin built up within the body. This is typically caused when someone is taking more than one medication that causes an increase in serotonin. 

Although this syndrome is fairly uncommon, it is important to seek immediate medical attention because this condition can be fatal if left untreated. 

Some symptoms to look out for include:

• Fast or racing heart rate 
• High blood pressure 
• Severe nausea, vomiting, or diarrhea 
• Fever 
• Dilated pupils 
• Severe dizziness and loss of coordination 
• Twitching or muscle rigidity
• Agitation, restlessness, and inability to sleep
• Confusion or loss of consciousness
• Hallucinations 

Withdrawal or discontinuation syndrome

As always, you should take your medication exactly as prescribed. If you’re experiencing uncomfortable side effects or are thinking of discontinuing your SNRI medication, it’s important to discuss this with your healthcare provider. 

Otherwise, you’re likely to experience withdrawal symptoms or a discontinuation syndrome when abruptly stopping or significantly decreasing your dose. Your healthcare provider will help you taper off your current dose of SNRI safely, so you are less likely to experience adverse effects of withdrawal coming off of your medication. 

Some common symptoms of withdrawal or discontinuation syndrome include: 

• Increased symptoms of anxiety and depression 
• Dizziness 
• Paresthesias or sensations of numbness or tingling throughout your body 
• Nausea or vomiting 
• Increased irritability 
• Headaches 
• Sleep difficulties, including nightmares 

Caution with use in elderly population 

SNRI medication should be used with caution in patients over the age of 65 due to the increased risk of adverse effects, including dangerous changes in blood pressure and low blood sodium levels or hyponatremia. 

Some signs and symptoms of hyponatremia include headaches, confusion, or delirium and may even result in loss of consciousness. Elderly patients are typically started at a lower dose of the medication and closely monitored when starting an SNRI medication. 

Effexor vs Pristiq : Overview 

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