Pristiq for Anxiety: How It Works & Comparisons to Other Medications

What Is Pristiq?

Pristiq (desvenlafaxine) is a serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat depression in adults. It is chemically related to another SNRI antidepressant called venlafaxine. Pristiq comes as a tablet made specifically to slowly release medication throughout the day. This allows the medication to be taken just once daily, but care should also be taken to not chew or crush the tablet. This would release a large amount of medication all at once and may cause unpredictable intensity and timing of effects.¹

Pristiq and other SNRI drugs work in the nervous system to increase the activity of serotonin and norepinephrine. These chemicals are responsible for activities in the body related to stress, mood, and other emotions. Studies have shown that this action can help improve symptoms of depression.¹

How Effective is Pristiq for Anxiety?

Pristiq, or desvenlafaxine, is chemically related to venlafaxine, which is FDA-approved for the treatment of anxiety. In a review of multiple studies of desvenlafaxine, patients who reported ‘anxious depression’, significantly improved symptoms over 8 weeks of treatment. This showed that desvenlafaxine, taken at 50mg once daily, can improve clinically relevant anxiety symptoms.²

In another study, patients with depression and high levels of anxiety were treated with either Lexapro, vortioxetine, or Pristiq. After 6 weeks of treatment, patients in all three groups showed clinical improvement in symptoms.³

A study of 63 people specifically assessed the use of Pristiq as an anti-anxiety medication. After 12 weeks of treatment, the group that took Pristiq showed significant improvement in depression and anxiety symptoms.⁴ While these studies are promising, they are relatively small. Further research is necessary to better understand the use of Pristiq in anxiety treatment.

How Does Pristiq Help Anxiety?

Pristiq is not an FDA-approved medication for anxiety. It is instead used as an off-label treatment for anxiety. An off-label use of a medication is a use that is not FDA-approved. Your doctor may decide to use Pristiq as an anxiety treatment if, in their professional judgment, they believe it may offer you clinical benefit.

Pristiq for Anxiety

Pristiq is an SNRI medication that works in the body to increase the activity of serotonin and norepinephrine. These chemicals act in the central nervous system to regulate emotions, mood, the fight or flight response, and other bodily functions. It is thought that the increased activity of these chemicals helps to reduce symptoms of anxiety disorders.¹

Pristiq for Panic Disorder

Panic disorder is often treated with a combination of benzodiazepines, antidepressants, and cognitive behavioral therapy (CBT). Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants commonly used to help reduce symptoms of panic disorder. Work with your doctor to determine if adding an SNRI like Pristiq to your panic disorder treatment plan is right for you.⁵

Pristiq Side Effects

Taking Pristiq can cause many unwanted side effects, ranging from mild and inconvenient to severe and life-threatening. Pristiq’s side effects can occur at the beginning of treatment or after taking the medication for a long period of time. Knowing how to identify a side effect and when a side effect requires immediate medical attention is essential.

Common Pristiq side effects include:

• Nausea
• Fatigue
• Dizziness
• Sweating
• Feeling sleepy
• Anxiety
• Nausea
• Problems sleeping
• Constipation
• Decreased appetite
• Sexual function problems

Severe side effects that require immediate medical attention include:

• Seizures
• Ringing in your ears
• Electric shock sensation
• Increase in blood pressure
• Hypomania
• Changes in eyesight
• Confusion
• Aggressiveness
• Serotonin syndrome

The risk of side effects can increase depending on your specific health history, including anxiety. Review with your doctor which side effects may be more likely based on your health history. Also, it is important to have treatment plans for specific side effects. Your doctor may recommend additional medications or other lifestyle techniques to help treat side effects if they arise.

How Long Does Pristiq Take to Work?

Pristiq, along with most other anxiety medications, take time to work. The full effects of the medication take up to 4 to 6 weeks.¹ This makes Pristiq different from other anti-anxiety medications that are taken on an as-needed basis. Your Pristiq prescription should be taken every day even when symptoms of anxiety are well controlled by the medication.

Pristiq Dosage for Anxiety

Pristiq dosage comes as an extended-release tablet intended to be taken once per day. The specific dose for each person can vary based on age, kidney function, and liver function. Your doctor may increase or decrease the dose based on your response and tolerability of the medication.¹

Here are the available dosages for Pristiq:¹

• 25mg extended-release tablet
• 50mg extended-release tablet
• 100mg extended-release tablet

Following your prescriber’s specific dosing instructions is crucial especially when changing doses. If a dose is changed too quickly, unwanted side effects may occur. The medication is meant to be taken once daily as it is an extended-release tablet. The medication will slowly release into the body over time. It is important not to chew or crush the tablet as this can lead to large amounts of the drug being absorbed all at once.¹

Can You Overdose on Pristiq?

It is possible to overdose on Pristiq if too much is taken at one time or with high doses of other SSRI and SNRI medications. Overdosing on Pristiq can cause dangerous side effects like arrhythmias and seizures.¹ If you or someone you know is suspected of Pristiq overdose, call 911 immediately.¹

Pristiq Warnings & Precautions

Taking Pristiq comes with risks that each person should be aware of. Discuss your medical history before taking any Pristiq so you can better understand the risks and know what to do if any occur.

Warnings and precautions for taking Pristiq include:

• Serotonin syndrome: This is a potentially life-threatening syndrome that can occur when taking any medications that affect serotonin, including Pristiq. Symptoms may include hallucinations, delirium, dizziness, incoordination seizures, and vomiting or diarrhea.
• Increased blood pressure: Any history of high blood pressure should be controlled prior to starting Pristiq. Pristiq can cause blood pressure to rise and your doctor may recommend routine monitoring of blood pressure.
• Suicide risk: Taking Pristiq as a young adult causes an increased risk of suicidal ideation. If you are having thoughts of self-harm you should call 911 immediately.
• Pregnancy: Deciding to take Pristiq or any anxiety medication while pregnant is a serious decision. Be sure to talk to your healthcare team about risks and benefits before starting.
• Activation of mania/hypomania: A small percentage of patients taking Pristiq have reported activation of mania. Those with a history or family history of mania or hypomania should discuss the risk with their doctor.

Pristiq Withdrawal Symptoms

When the time comes to stop taking Pristiq, it is important to have a discontinuation plan. Stopping Pristiq too quickly can put you at risk of experiencing withdrawal symptoms. Slowly decrease your dose at the direction of your doctor.¹

Symptoms of Pristiq withdrawal can vary based on the dose and the length of time you have been taking the drug. As with most side effects, some will be mild and go away on their own while others are serious and may require immediate medical attention. Speak with your doctor before stopping Pristiq to reduce the risk of withdrawal symptoms.

Drug Interactions With Pristiq

Disclaimer: Taking certain medications, herbs, or supplements alongside SNRIs can change how SNRIs work in your body or increase the risk for serious side effects. This article does not consider all the possible interactions. Please let your doctor, psychiatrists, and pharmacists know about all the products you currently use, such as prescription medication, nonprescription drugs, and herbal supplements. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Many medications taken along with Pristiq have the potential to cause unwanted and dangerous side effects. Avoid taking any medication that can negatively interact with Pristiq. In addition, Pristiq may affect other medications you are already taking. Be sure to update all your healthcare providers with your current medication list, including any new medications that you start to take. This should include all medications, including supplements and over-the-counter products as well.

Medications that can negatively interact with Pristiq include.¹

• Anticoagulants: Taking Pristiq with medications that affect blood clotting, can increase your risk for bleeding. Examples include NSAIDs, aspirin and warfarin.
• Monoamine oxidase inhibitors (MAOIs): Taking Pristiq together with MAOIs can increase your risk of experiencing serotonin syndrome. This includes not taking Pristiq within 2 weeks of any MAOIs.
• Serotonergic medications: Taking Pristiq along with other medications that affect serotonin, called serotonergic medications, also increases your risk for serotonin syndrome. This includes other SNRIs, SSRIs, triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, amphetamines, tryptophan, and St. John’s Wort.
• Drugs metabolized by CYP2D6: Pristiq can increase the amount of certain other drugs in the body. The dose of other drugs metabolized by CYP2D6 may need to be reduced in dose.

How to Get a Prescription for Pristiq

Obtaining and using a medication like Pristiq requires a prescription, for both approved FDA uses and off-label uses. The first step should always be a consultation with a licensed healthcare provider. There are many health providers that can prescribe medications and finding the right fit is important. Utilizing an online psychiatry service may be helpful for some people. Expect your prescriber to require follow-up appointments for continued use of Pristiq. This is to monitor your progress and make adjustments if necessary.

Alternative Treatments for Anxiety

Anxiety is a complex health condition that can be effectively treated with a variety of approaches. Medications like Pristiq are one of many options that include lifestyle changes, self-help strategies, and therapy. Understanding the differences between SSRIs vs SNRIs is important. Talk with your doctor to decide the best fit for you.

Some may prefer non-medication treatments for anxiety like online group therapy or support groups. This type of treatment can be very effective and help reduce the stigma around feelings of anxiety. Additionally, some may respond well to exposure therapy, especially when done under the care of a professional.

Finally, having a skilled therapist to work with throughout treatment is crucial. They can provide as much or as little as you would like including cognitive behavioral therapy (CBT), specifically for anxiety.

Questions to Ask Your Healthcare Provider About Pristiq for Anxiety

Taking the time to review all aspects of Pristiq for anxiety is important. This allows you to understand your treatment plan and prevent any unnecessary risk. Being open and honest with your healthcare providers is important to your health. Whether you use a doctor, psychiatrist, and therapist, ask questions and feel comfortable with your treatment.

Questions to ask your care team when considering the side effects of Pristiq may include:

• Pristiq is not approved by the FDA to treat anxiety, how do I know it is safe for use?
• Can I use Pristiq along with therapy to treat anxiety?
• How long will it take for me to adjust to taking Pristiq?
• Am I at risk for more severe symptoms if I am already taking other anxiety /depression medications?
• Will a previous history of addiction make me more susceptible to dependency?
• What is the best dosage to ensure fewer side effects?
• Is it possible to overdose on Pristiq and what should I do if this occurs?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?

In My Experience

In my experience, treatments for anxiety are not one-size-fits-all. You may need to try a few different medications including one like Pristiq used off-label. As with any medication, it is important to fully understand its risks and benefits. Take the time to talk with your doctor to familiarize yourself with treatment.