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.

If you’re struggling with anxiety or depression and find that your mental health impacts your everyday life, don’t let your symptoms go untreated. At Klarity Health, we connect you with an online licensed healthcare provider who can help you identify the right medication for you, if applicable.

Find a provider online or in person with Klarity Health.

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

	Effexor	Pristiq
Drug class	Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)	Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)
Brand / Generic status	Brand name for venlafaxine	Brand name for desvenlafaxine
Form(s) of the drug	Immediate-release tablets	Extended-release tablets
Standard dosage	Immediate-release tablets: • 25 mg • 75 mg • 225 mg • 350 mg • 375 mg (in 3 divided doses per day)	Extended-release tablets: • 25 mg • 50 mg • 100 mg
Conditions treated	FDA-approved uses: • Major depressive disorder (MDD) • Generalized anxiety disorder (GAD) • Panic disorder • Social anxiety Off-label uses: • Neuropathic pain related to: • Diabetes • Hot flashes • Migraines • Post-traumatic stress disorder (PTSD) • Obsessive-compulsive disorder (OCD) • ADHD • Complex pain syndromes	FDA-approved uses: • Major depressive disorder (MDD) Off-label uses: • Generalized anxiety disorder (GAD) • Panic attacks • Social anxiety disorder • Obsessive-compulsive disorder (OCD) • Vasomotor symptoms associated with menopause, such as hot flashes
Cost	Generic form (venlafaxine): • $1.10 to $22.36 for 30 tablets Brand-name: • $549 for 30 tablets Prices vary depending on insurance coverage and available coupons30 tablets	Generic form (desvenlafaxine): • $13 to $110 for 30 tablets Brand-name: • $470 for 30 tablets
Side-effects	Common side effects: • Sweating • Headache • Nausea • Diarrhea • Dry mouth • Nervousness • Fatigue • Insomnia • Difficulty orgasming • High blood pressure Serious side effects: • Increased heart rate • Low blood pressure • Increased salivation • Irregular menstrual cycle • Weakness • Teeth grinding • Difficulty urinating • Eye pain or vision problems • Serotonin syndrome	Common side effects: • 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 Serious side effects: • Worsening depression or anxiety • Suicidal thoughts or thoughts of self-harm • Severe insomnia • Severe irritability or aggression • Serotonin syndrome • Chest pain • Easy bruising or bleeding • Changes in vision
Warnings for use	Drug interactions: • Adderall (Amphetamine and dextroamphetamine) • Tramadol • Trazodone • Wellbutrin (Bupropion) • Abilify (Aripiprazole) • Ambien (Zolpidem) • Aspirin • Clonazepam • Gabapentin • Klonopin (Clonazepam) • Lamictal (Lamotrigine) • Lyrica (Pregabalin) • Seroquel (Quetiapine) • Xanax (Alprazolam)	Contraindicated conditions: • 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 Drug interactions: • MAOIs • SSRIs and SSNRIs • TCA antidepressants • Lithium • Opioid pain medications • NSAIDs • Blood thinner medications • Certain diuretics • Stimulant medications, such as Adderall

Get anxiety and depression treatment on Klarity Health

Living with symptoms of anxiety or depression is challenging enough. Finding the best medication for you shouldn’t be. With so many different drugs on the market, the process of finding the right treatment plan can be overwhelming. At Klarity Health, we offer access to quality anxiety and depression treatment with licensed, board certified providers.

Find a provider online or in person today and be seen within 24 hours.* If your provider thinks medication is right for you, get a prescription right online.

Frequently asked questions about Effexor vs Pristiq

Does Effexor make you gain weight? Does Pristiq?: While there is a potential for weight gain due to appetite changes when starting any SNRI medication, the risk is quite low. It is more common to experience decreased appetite and weight loss when taking either Effexor or Pristiq.
Is Effexor or Pristiq better for anxiety?: While both medications can help with anxiety symptoms, Effexor is FDA-approved for the treatment of anxiety and has been clinically proven to be effective.
Can I replace Effexor with Pristiq?: Yes, you can easily transition from 1 medication to another, but this should be done under the close supervision of your prescribing healthcare provider. They will help to taper you off one medication and transition to another, as your dose may change.
Is Effexor energizing or sedating? What about Pristiq?: Both Effexor and Pristiq are known to be energizing medications. This is due to the effects of their increasing norepinephrine within the body.
Does Effexor cause brain fog? Does Pristiq?: Neither Effexor nor Pristiq is known to cause brain fog. However, it’s important to remember that everyone reacts differently to each medication. SSRI medications are typically known to be associated with brain fog.
Can I drink alcohol on Effexor? On Pristiq?: Alcohol should be avoided while taking any SNRI medication, including Effexor or Pristiq. Drinking alcohol while taking either medication can cause an increased risk of experiencing adverse effects of the medication, such as nausea, increased anxiety, dizziness, and an increased risk of bleeding.
Can I drink caffeine when I’m on Effexor? How about Pristiq?: It’s considered to be generally safe to drink caffeinated beverages while taking SNRI medications. However, it’s important to remember that caffeine is a drug in itself and can cause its own side effects if taken in high quantities.
What is better for depression — Effexor or Pristiq?: Effexor and Pristiq are highly effective in the treatment of depression. They are equally effective, but some studies show that Pristiq is better tolerated, with fewer side effects than Effexor.

Sources: “Efexor Xr Coupons & Prices” SingleCare. https://www.singlecare.com/prescription/effexor-xr?q=Effexor%20Xr%20(Venlafaxine%20HCl%20ER)

“Desvenlafaxine: Drug Information” UpToDate. https://www.uptodate.com/contents/desvenlafaxine-drug-information?search=pristiq&source=panel_search_result&selectedTitle=1~20&usage_type=panel&kp_tab=drug_general&display_rank=1

“Pristiq Coupons & Prices” SingleCare. https://www.singlecare.com/prescription/pristiq?q=Pristiq%20(Desvenlafaxine%20Succinate%20ER)

“Venlafaxine: Drug Information” UpToDate. https://www.uptodate.com/contents/venlafaxine-drug-information?search=effexor%5C&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1
How we reviewed this article: This article went through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author. Learn more about the editorial and medical review process and standards for the HelloKlarity site.

*Appointments are generally available within 24 hours. Free initial consultations are available only with select providers. Prescriptions, particularly for controlled substances, may require an in-person evaluation depending on the state of residence and current federal regulations.

The information provided in this article is for educational purposes only and should not be construed as medical advice. Controlled substances may not be appropriate for all patients and any mention of these medications is for educational purposes only, not for marketing or encouraging self-diagnosis. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health. Providers on Klarity Health are independent practitioners with clinical autonomy. Nothing in this article is intended to diagnose or treat any condition, including guaranteeing prescription medication of any kind or dosage. Not all providers on Klarity Health prescribe all medications, particularly medications that are controlled substances.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as 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.