
- With Mayo Clinic psychiatrist
David Mrazek, M.D.
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David Mrazek, M.D.
David Mrazek, M.D.
Dr. David A. Mrazek is chair of the Department of Psychiatry and Psychology at Mayo Clinic, Rochester, Minn., and a professor of psychiatry at College of Medicine, Mayo Clinic. Dr. Mrazek has developed a federally funded psychiatric pharmacogenomics research program and implemented clinical psychiatric pharmacogenomics services at Mayo Clinic.
He has received numerous awards including the Award for Creativity in Psychiatric Education from the American College of Psychiatrists and the Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry from the American Psychiatric Association. He currently serves as chairman of the board of the American Board of Psychiatry and Neurology.
Dr. Mrazek has focused his current efforts on using pharmacogenomics testing to improve clinical care. One of his specific goals is to decrease the risks of taking psychiatric medications.
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Depression blog
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Jan. 27, 2009
Pristiq: New antidepressant medication approved
By David Mrazek, M.D.
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As I talked about last week, it takes quite a while for a new medication to be approved by the Food and Drug Administration (FDA). Additionally, medications can be granted additional indications (diseases the medication is approved to treat) over time. For instance, Rogaine was first developed for treating high blood pressure. The side effect of hair growth led to the additional indication of treatment for hair loss.
Pristiq (desvenlafaxine) was approved by the FDA in February of 2008 for the treatment of major depressive disorder in adults. Pristiq is not available in generic at this time and will not be for some time.
Pristiq works by preventing the reuptake of the serotonin and norepinephrine in the brain. We know that certain neurotransmitters such as norepinephrine, serotonin and dopamine are not in proper balance when a person is depressed. We don't routinely check neurotransmitter levels because we don't completely know what the levels mean. Someday checking these levels may be part of a depression screening.
Like many antidepressants, Pristiq can have side effects, which may include:
- Nausea
- Dizziness
- Trouble sleeping
- Hyperhidrosis (increased sweating)
- Constipation
- Fatigue
- Decreased appetite
- Anxiety
- Sexual dysfunction in men
If you've been diagnosed with depression, Pristiq might be a good option if other medications haven't worked well. And, if you've taken Pristiq, please share your experiences.
359 comments posted
April 18, 2009 7:41 a.m.
i have been on pristiq for a week now. all week have had diarrhea, nausea, and loss of appetite. i am on a high blood pressure and muscle relaxer at this time too. also, pain meds as needed. while i do feel better - i can't live with these side effects. i am scheduled to see my doc this weds, but am scared of what will happen if i go off the meds.
- jamie
April 10, 2009 10:48 a.m.
I have been on Pristiq for about three weeks at 50 mg. This is how I feel today.I am staring at the page. My back hurts. I do not want to write, but I have to do something to get out of the bed. It feels like nothing is ever going to get better. I am consumed by my head. I am only taking a low dose of my medicine until I get my insurance card to get the rx filled. If the doctor is right, maybe I will feel better when I am at the full dose on my meds. I hope so. Deep sigh. Again. I desperately need to feel a sense of purpose, more than just doing someone's laundry or emptying the dishwasher. I have suffered this depression often in my life of forty nine years. I wish I could articulate my pain better. I feel plugged up. Emotionally. I am hurting. In every way. My back, joints, soul.
- Lucinda R.
April 4, 2009 8:16 p.m.
Please do research on DNA drug reaction testing. Mayo Clinic does this, as well as other places. Your insurance might not cover it, but it was well worth it for me and my family. It will help you and your psychiatrist figure out which drugs are not correct for you.
- ccn
April 3, 2009 12:06 p.m.
Amiee: I just wanted to let you know that you are not alone.. If I have learned one thing, it is there are so many moms and wives out there that are going through the same things we are.. i don't know, is it the age and the children thing.. i am a 36 year old mother of two daughters 3 and 6 and have been married for 9 years this october. My husband is 8 years older then me and is from the old school. When we met we wanted all the same things and shared the same dreams, but now, everything has changed. My depression is contributing heavily to the way our family life and marriage have become. I can't seem to feel like I am a good mother let alone a good wife. I see the way my mood swings are affecting my children and their behavoir and also the way it is contributing to my husbands behavoir towards them. He has to deal with me and the way I am on top of being a full time provider and dad. Most of the time I feel like picking up and leaving cause the girls and my husband would be better without me. I only want the best for my girls and want my husband to be HAPPY... How can i believe it when he says , that i make him happy ... Is he saying it cause he thinks it will make me feel better? I feel the same as you, will it ever be normal again?
- Annie K
April 3, 2009 11:50 a.m.
Ane R: It has never hit me as hard as it is currently. i have always had my "peaks" but this time is the worst.. Like I said, I have been on various SSRI's and they would peak and then not work anymore. Finally, my family dr suggested I see a psychiatrist to regulate the meds. I have been treating with him for about 4 mnths now and our last vist he suggested maybe switching to something different, I was hesitant. Finally, two weeks ago I hit a wall.. The depression got so bad that I decided it was time to try something else.. I do have alot of issues in my life right now that are contributing to my depression BUT i need to get this part under control so I can figure out the rest. I am slowly learning that I am NOT crazy, as I was reassured by my psychiatrist. I am not bi polar either... I am just unsure if I want the life that I am in currently. The one thing that hurts the most is the fact that my husband thinks me seeing a therapist is a joke.. He is always afraid I am going to come home and say, I am done with this life.. Three years ago he had a similar crisis and thinks I am going through the same.. I assured him I am not. Does your husband support you seeing a therapist and pyschiatrist? The life I have is something I thought I wanted years ago, BUT now I am living it, I am unsure. The depression is making it alot worse to try and find the right answers. Do you feel that way? I know one thing, there are so many mom/wives out there that have the same issues.
- Annie K
April 3, 2009 9:33 a.m.
Annie K: Yes, I started off with my family doctor when I didn't know what was happening to me when I couldn't get out of bed for 3 days last summer. He started me on Lexapro, but it wasn't right for me. I decided to hit this head on and see a Psychiatrist who tried Remerol first which helped during the day but really knocked me out at night. I am now on Prozac, and I continue to see my Psychiatrist as well as a wonderful counselor. The worst part is our children seeing their mother this way and not having the ability to control it. I pray someday there will be a "magic pill" to reconnect what I have lost. Unfortunately its something we cannot discuss openly -- it still remains an illness that is unaccepted to talk about in society today. So I guess I'm in for a roller coaster ride that never comes to a stop. Is it safe to assume that? How often has this hit you since it first began?
- Ane R.
April 3, 2009 9:09 a.m.
Ane R. I have had depression problems since my mid 20's but never had taken antidepressants until 1999 or so.. Like i mentioned, it started with celexa cause when it became PMS time i would have crying fits or anger rages. Since marrying and having my first child that's when it got worse... I don't know if the pregnancy caused it to get worse or not.. I was placed on lexapro and it worked, for awhile. Then I became pregnant with baby no 2. That was when it got worse.. I did get my tubes tied and I am not sure if that could be contributing to the depression. I have heard horror stories about women getting their tubes tied and their emotions, etc... The depression was under control for a bit and just in the last 9 months I started to feel the down turn again.. I try my best to be a good mom and be involved with the kids, but I am easily agitated. As for my husband, he has been as understanding as possible and is there for me, BUT i want nothing to do with him sexually or emotionally. I know a big reason is because of my depression and that's why I need to get my emotions intact and have a clear mind.. It's like I said, I want my life back... for almost a year it has been extreme ups and downs, I can't do it to my husband nor my family anymore.. Are you seeing anyone? I have been seeing a therapist for over a year and she has made me realize some things that i have been struggling with. I have just recently been seeing a psychiatrist to regulate the meds.
- Annie K
April 3, 2009 8:40 a.m.
I want to respond to Annie K. I feel your despair - trust me we have 4 young children and its just debilitating with this illness. I am on one of the antidepressants you mentioned for about 8 months, and I'm starting to feel awful again. Waking up in the middle of the night, no appetite, just wanting to sleep my life away. My children and husband are suffering because of it and I don't know what else to do. How long have you been going through this? Will there ever be a state of normalcy for us?
- Ane R.
April 2, 2009 3:25 p.m.
OMG!!!!!!! My doctor has taken me off of my latest SSRI's which included Pristiq. He wants to put me on the MAOI patch. I have to be off of my previous SSRI's for 7-10 days and I haven't been able to move off of the couch because of the nausea, headaches, dizziness, low blood pressure, etc... I never felt so bad in my life.. I am starting to think it isn't goinig to be worth it.. I have been on numerous antidepressants since 1999. I started out with celexa, then went to lexapro, prozac, cymbalta and the most recent being wellbutrin and prestiq. It seems like they work and then they just level off... After reading all the side effects and restrictions that go along with this MAOI I am not sure if this is going to work for me.. I have high blood pressure and heart disease runs in the family.. Like, Aimee, I WANT MY LIFE BACK!!!!!! I too have a wonderful husband and two girls, ages 3 and 6. I want to be HAPPY again.. Can anyone shed some light for me???
- Annie K
April 2, 2009 9:10 a.m.
The aggression mentioned in some of the posts reminds me of what I dealt with when I was on Cymbalta....
- ginger
March 25, 2009 9:24 p.m.
I started on Pristiq about 6 weeks ago after being on Zoloft for over 2 years but decreasing it and becoming depressed again. I felt better at first after a week or two but have had exteme episodes of anger and aggression that are very difficult to control that I feel are related to the norepinephrine reuptake in this drug as opposed to others I have taken. Seeing that others have mentioned increased aggression leads me to believe I am correct and should discontinue after discussion with my doctor.
- Lisa
March 24, 2009 2:28 p.m.
I have been using Pristiq for a month. I love it. I stareted feeling better after three days. It is working much better than the other A.D. meds I have used. I am noticing headaches, but that is likely due to allergy season. It has also eliminated my loose bowel problems. My doctor said he has had a lot of success with this medicine.
- Deanne
March 24, 2009 6:38 a.m.
My doctor started me on Prestiq 2 weeks ago. I faxed him a message on the 3rd day which said "I FEEL GREAT". I still feel great and I have reboundability from incidents that before would have sent me reeling. All of this after 3 doses of 50 mg!!!! I can honestly say, I have never felt this way before in my entire 59 years of life.
- BJ
March 23, 2009 10:19 a.m.
I have taken several different AD in my life but hated side effects. I have been taking Pristiq for 3 months. It has helped moderately with my depression and anxiety. However, I definitely feel sluggish and would rather just sit around which is not like me at all. I am taking the 50 mg and am starting to wean off of them. I have been on a strenuous exercise program for 3 years and while taking Pristiq, I don't have the energy to work out. Therefore, I am gaining weight. I also have cravings and my will power is gone. I guess the bottom line is, I have to face the fact that I can't have it all.
- D.
March 22, 2009 8:25 a.m.
I have been taking pristiq for about 3 weeks now. It was making me very tired all day and falling asleep earlier than ever. I just started adderall too about 1 week ago and it has helped with feeling "more normal" and not making me so tired, but I can tell when it wears off and some difficulty with sleeping now. I don't know what to say about pristiq. I have already been on celexa, cymbalta, welbutrin and remeron. I hope something works. I have never had anxiety and depression before, and this started 7 mos. ago with a panic attack. I still have crying spells and my good days have still never outnumbered my bad. I want my life back and is there hope? So far, adderall has been the closest thing for me with feeling "normal" and having energy. None of the other ADs worked for me and some almost made me worse. Is there hope? What should I do? Please help. I do go to counseling, but no such luck really. Sometimes I feel like I need to go somewhere until we can figure this out. I am a 34 yo female and have a wonderful husband and family (3 kids- 5 and under) and this is killing me to feel so numb, sad, and unhappy. I have never felt this way ever before. Will this all come back, please??
- Aimee
March 21, 2009 11:49 a.m.
I have been on antidepressants for 15 years. Pristique was the worst. I took it ofr 4 months and became very aggressive. When I tried to wean off of this drug, the withdrawl process was horriffic. I have been completely off of it for 1 month and am still feeling the effects of withdraw. I feel uncontrollably angry and agressive and anxious. I feel I need to be on some sort of medication but am afraid to go back on anything after this horror. Mary.
- Mary
March 11, 2009 4:04 p.m.
CDB- Please call the provider that prescribed the medication to you so that person is aware of how you're doing including the irritability, insomnia, etc. MC.Com Staff
- MC.Com Staff
March 11, 2009 4:02 p.m.
Thanks to all for your interest! As you all understand, we cannot reply to all postings. To Becky regarding hair growth problems- check with your health care provider that prescribed the medication (could also call the drug company) as this is not listed as either a common or rare side effect according to the package insert. Good luck.
- Mc.Com Staff
March 11, 2009 11:05 a.m.
I HAVE ONLY BEEN ON PRESTIQ FOR 6 DAYS COMING OFF 225MG OF EFFEXOR XR FOR 4 PLUS YEARS. I AM EXPERIENCING A VERY HIGH MOOD DAY AND NEXT DAY A CRASH DAY OF DOOM. IN THE MORNING BEFORE I TAKE MY MEDICATION I AM SO IRRITABLE I WANT TO PUT MY FIST THRU THE WINDSHIELD OF MY CAR ON THE WAY TO WORK. EXTREME TROUBLE SLEEPING,HEADACHE,MOMENTS OF NAUSEA,THEN EXTREME HUNGER,BUTTTT I AM GOING TO STICK WITH IT FOR A BIT LONGER AND HOPE FOR THE RESULTS I WANT.
- CDB
March 6, 2009 11:56 p.m.
I started taking Pristiq a few months ago, after having taken several others in a 2 year span (under a doctor's supervision). I've had side effects that have been getting worse the longer I'm taking the medication: random/unpredictable nausea, trouble falling asleep, significantly increased appetite (which has lead to a horrible weight gain), and not much improvement in my symptoms. I've taken Effexor, Wellbutrin, Cymbalta, and Prozac. At best, they worked for 6 months and then my symptoms returned. I plan to talk to my doctor about this as soon as I can get an appointment, but I'd like to know if you have any suggestions.
- cms
March 4, 2009 1:03 p.m.
i'm having hair growth problems while using pristiq is it the cause ?
- becky
March 3, 2009 10:50 p.m.
My teenage son took Pristiq for about 6 mos. at 50mg and 100mg. It did not seem to help much. He went back to generic Zoloft. He did not have withdrawal side effects.
- ccn
March 3, 2009 6:54 p.m.
I have been on Pristiq for about three months. At first I thought it was really helping, but now I'm not so sure. My doctor increased my dosage to 100 (mg?)a month ago, and I really haven't felt any better. I tried several other drugs (Lexapro, Cymbalta) before this one. Is there anything else to try?
- Joy
February 21, 2009 9:44 p.m.
To Brandy: It is not surprising you had the relapse after you stopped taking the Pristiq. My understanding (from 15 years of treatment and numerous medications) is that with any anti-depressant, you feel better because they correct the chemical/biological imbalance in your brain. Like insulin and diabetes, you can't stop taking it and stay well; the medication is the reason you are feeling well. I'm surprised your doctor didn't explain this to you, or perhaps you didn't consult him/her before you stopped. I hope you have found an anti-depressant that works, and you will stay on it so you can get on with your life.
- Joan
February 19, 2009 4:11 p.m.
i have been on Pristiq for about 6 months and after my refills have been used up i thought maybe i was better because Pristiq does wonders making you feel better. the downside was the withdrawl. when i was off of it for a while i had stress building up and i ended up haveing a severe mental breakdown from a withdrawl. everything in life sucked again. so it works when your on it but if your on it, stay on it or there are definate consiquinces.
- Brandy
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359 comments posted