
- 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.
340 comments posted
September 13, 2011 12:23 p.m.
I started taking Pristiq after doing alot of reading on the drug. I have tried the others like Celexa and Prozac with no success. This med is amazing for me. I have a normal energy level now and I am happy most of the time. Talk to your Doctor if you feel that your current anti-depressant isn't doing the job. I went through a few months of major depression at the beginning of the year and finally realized that maybe I could feel better with a different med. You must communicate with your Doc.
- karen
September 7, 2011 8:11 p.m.
I started Pristiq about 6 months ago after being on Lexapro for about 5 years. It seemed the Lexapro left me listless and didn't appear to be working as well as it did in the beginning. The only side effects I've experienced since beginning Pristiq are that I sweat profusely but I had that problem with Lexapro too. And, I often cry a bit sometimes during the day when I wouldn't have in the past (i.e. sad movie, difficult world news, small family issues) but the crying doesn't last. I have also found that I have more energy rather than less when compared t Lexapro. To those who take any AD med, track your side effects and discuss them with your doctor BEFORE making any changes to your meds. I'm also in counseling in conjunction with the Pristiq and the combination has been quite dynamic. I have been feeling better and I sometimes wonder if the short crying bouts aren't good for me. I worked in an executive level position for 20+ yrs and was a single mother so I didn't have the luxury of crying when things went south. I have toyed with the idea that perhaps I'm slowly releasing years of pent up emotion with these mini crying bouts as I fight this depression. At any rate, I don't think Pristiq would have been the best med for me if I hadn't combined it with counseling. I hope this provides others with food for thought. Good luck to you all in dealing with an often misunderstood and very difficult disease.
- Deb
September 2, 2011 5:02 a.m.
Pristic is basically Effexor, a very bad drug in many ways (withdrawal, brain tremors, floating head, electrical zaps in limbs, plus the usual side effects (and men, yo may never climax again). Effexor's patent expired, so Wyeth (the company) altered the exact formula enough to get a new patent and called it Pristiq. They say it is improved Effexor with less side effects. I have a different opinion...
- Jordan
August 31, 2011 9:42 a.m.
Taking pristiq in seven weeks Lost half a Kilo, definitely no weight gain. Worth while mentioning
- HAZLE
August 31, 2011 9:31 a.m.
I have suffered depression many years, no medication for 8years just tapping pressure points from a book written by a psychiatrist forgotten title . The last 6months severe depression and panic attacks made me seek help, I was put on Pristiq I cannot say I found any rapid improvement, my panic attacks are very rare now and after now 7weeks I have decided to keep trying it : Side effects I had was as follows: Very shaky and weak feeling, so much so I did not drive for a while, nausea not to bad, ate a lot of grated apple which definitely helped. Dry mouth I nearly stopped taking it due to the shakes now in the 7th week almost disappeared. I explained to my Doctor that taking Tramadol (50MG)for Rheumatoid arthritis it seemed to really lift me. So sticking with 50mg pristiq at night, one only tramadol (50mg) in the morning. I will keep posting as I go along as if it helps one person worth while, unless one suffers from depression they have no idea how awful it is,
- HAZLE
August 19, 2011 11:13 p.m.
I have tried several different antidepressants, none affected me as seriously as pristiq. I became seriously suicidal and did attempt suicide whilst on pristiq. At first, it was great, i was almost normal again, but within four months, i had a knife in my wrist. Be very careful with this drug.
- Danielle
August 18, 2011 12:18 p.m.
Ive been on antidepressents since the 80s on effexor the longest tryed them all!! Finally told my doctor Ive had it! they don't work! he said i wqant u to try Pritiq i've only been on it for 4 days i wamt to tell u i feel like a differant person!! energy energy thank god its a relief!!!!! it works for me i'm so thankful
- camille
August 12, 2011 8:46 a.m.
I have been taking Pristiq for about six months. Over the past 5-6 years, I have tried many other drugs for depression (Cymbalta, Zoloft, Wellbutrin, and others). All had bad side effects, ranging from depersonalization to diarrhea to invisible libido. I tried going off of medication because of the side effects, but fell into depression again within a year. I was jittery with Pristiq for about a month, then it subsided and I have not had any side effects since. I find one tablet (50mg?) per day is enough to put me on an even keel, but I still retain a full range of emotions (including sadness). I have been very happy with Pristiq - the new generation of drugs seems to be much more targeted than the old generation of drugs. I would encourage anyone who has depression, but has been disheartened by the effects of the drugs, to give this a try.
- Karen
August 4, 2011 11:06 p.m.
July 14, 2011 3:46 p.m. I posted a comment and here's follow-up. Here to report that Pristiq was worse for me than Effexor. Within now and my previous posting, I have been taken off Pristiq already. Got real squirrley, depressed like I haven't been in 6 years and was literally ready to jump in front of a moving train. Hope it works for you, this was my experience.
- Andrew
August 4, 2011 1:06 a.m.
Just started this medication today (50MG)I was on 20mg of Cyprilex and 1mg Ativan, the Dr discontinued the Cyprilex due to fatigue ALL day, no emotions or feelings. Being without anything for a few days I cried and felt aweful and depressed. So far this is my first day on Pristiq and i feel pretty good. My hands feel a bit weird when I first took it but they are fine now, I did have the chills and I never got that stoned effect the first time taking it like I usually do with new medication. I think this one could be good for me. So far so Good!
- Getting There
August 1, 2011 2:06 p.m.
Pristiq may decrease your appitite, but it also lowers your metabolisim. I have been taking pristiq for about a year now, 50 mg and have gained 30 lbs. I go to the gym 3 - 4 x's per week, am very active, watch my calories and eat a low fat diet. Dr's have found nothing wrong with me except the meds. I have spoken with many people who say it is a myth that pristiq doesn't cause weight gain. Also, if you miss a dose for any reason the side effects are horrible - dizziness, nausea and it feels like your nerves are on fire. It is worth considering this before starting this medicine as due to the withdrawl it is hard to get off.
- Liz
July 30, 2011 11:24 a.m.
I have been taking Pristiq now for almost a month and the jury is still out. I was on Celexia for 3 yrs but the depression, anxiety and anger got to be too much, hence the switch. I will have a few good days on the Pristiq then something (usually trivial) will set me off and I am back in the pit again. Every day is an internal fight against suicide. A look at my life and there is no outward reason for my depression. Must be chemical, right? So we take the pills and hope for a respite. Time is running out though for me. I hope the Pristiq will do the trick. It has shown signs of helping me it just might take a litte while. I guess it helps to know we are not alone. Keep up the fight.
- Jeff
July 28, 2011 1:51 p.m.
When a large dose of CYMBALTA stopped being effective, my doctor prescribed PRISTIQ several months ago. Then, to combat lethargy Wellbrutin was added to the mix with good effect. My old energy levels have returned somewhat. This bodes well for being able to incorporate better organization and regular exercise.
- Bonnie
July 28, 2011 12:05 p.m.
I have been on PRISTIQ since October 2008 after trying almost every AD drug over a period of 20 years or so and PRISTIQ is the best drug for me. I am on USA Medicare and just tried to refill the RX but now I can not without prior approval. My co-pay has been $225 for 90 pills. Medicare thinks I should take another AD. They just don't understand or don't care that AD drugs are not like other medications; What works best for one person doesn't work for another. The worst side effect for me is as a male I can not reach an orgasm but I take a vacation when I want. I also gain weight on this drug.
- Don
July 20, 2011 8:19 p.m.
I have been diagnosed with depression for 20 years, and have been taking Prestiq for about six months. Here are a few side effects that are not listed on the list: slowed eye blink, eye twitches, decreased energy. Slowed eye blink makes it very difficult to drive. The doctor wanted to add $50 eye drops, which helped the problem, but I'm looking for less co-pays. When adding Ambilify, add shortness of breath and pneumonia to the list.
- Jen
July 14, 2011 3:46 p.m.
My Dr. prescribed me Prestiq, 50mg a few days ago and I tell you now that I'm am somewhat scared and skeptical. I've been on Effexor before, different dosages, and it wasn't good. But I'll try to trust my Dr. I've been on Prozac, Effexor, Lexapro, Paxil, and I think Wellbutrin. I'm so tired of changing meds. Sometimes feel as if I should be locked up in the State Mental Hosptial. Not to sure if the Pristiq is working yet, my brain feels pretty mushy.
- Andrew
July 9, 2011 10:24 a.m.
For 4 weeks I felt good on Pristiq . On the 5th week I had major insomnia, lower back pain. I got off it and went back on Lexapro. I took Lexapro before and was good but I did cry from time to time. I would much rather cry than not sleep for 3 nights.My Dr. wanted me to add Trazadone to stop the insomnia but that would just be adding more addictive meds. I no longer see him.
- don
July 7, 2011 11:55 p.m.
I took Pristiq for about 3 months and felt better emotionally and just thought the side effects were worth it because I kind of felt better. Then, the vertigo got sooooo bad that it was crippling and frequent and then one day, I had a TIA! It also came with bad nightmares after about the 2 month mark. After the TIA, I dumped it quick and went back to the Zoloft. A month later, I had to have a craniotomy because of aneurysms. I really, really think that was due to the Pristiq. I think I'm immune to the Zoloft since I've taken it off and on for years so I am making an appt. to find anything but Pristiq.....the ringing in my ears, but especially the vertigo, nightmares and then the TIA and aneurysms.......NO THANK YOU on the Pristiq!
- Lynda
July 7, 2011 6:21 p.m.
I have been taking Pristiq off and on now for over a year. I sweat terribly from one hour after taking it until about 5 hours later. That is annoying to me. Unfortunately, I have decided to take myself off and on it (without my Dr's consent). I have not been taking it as I should for over a month and a half now. Today, my poor decision caught up with me. I am feeling terribly apathetic (my predecessor to going completely over the edge into a deep depression) Take my advice--from someone who has been suffering over 20 years with Major Depression. STAY ON YOUR MEDICATIONS!!!! IT'S BETTER TO HAVE AN ANNOYING SIDE EFFECT AND BE ABLE TO FUNCTION, THEN TO HAVE YOUR WORLD COME CRASHING DOWN ON YOU AT THE MOST INOPPORTUNE TIME!!
- Ang
June 30, 2011 2:09 p.m.
Well my brother was 50 years old everything in the world to live for and on April 20, 2011 he shot his self. He had been on celexa for 5 years then seroquel for 4 days and Pristiq for 8 days. He left a wonderful wife and 2 girls age 17 and 20, 100 acre farm soon to be paid for, but a sister grasping for answers. My brother definetely shot himself due to the anti depressents, that is the only answer. As I read these remarks I wonder if my brother had not have been on this med if he would still be here. I get angry just thinking that dr prescribe medicines without making people aware of their dangerous side efects. I was around my brother every day and I never saw a reason for him being on anti depcents. My understanding was that he was having trouble sleeping and that was the reason for him being put on these medicines. Please anyone that reads this keep in mind what these medicines can do to a person and his mind. I fully believe I would still have my brother today if this doctor would have been more careful and mindful of his patient. I am heart broke and still crying every day wishing I would have said more about this doctor... Remember the SIDE EFFECTS of medicines are REAL!!!!!!!!
- Linda
June 30, 2011 10:51 a.m.
dear cathy: i 2 suffer from depression & i just started on pristiq yesterday, i thought it was gonna give me some energy, but i was so drowsy, i was sleepin' on the couch all day, gonna take it @ nite, of course now, the pharmacy print-out is different that the side effects that r listed on line, i look @ the results from any of the studies that the manu. has done, these r usually the most reliable, the drug manu. tells u in their info. that u should tell your dr. if ur bpII or have hypo/manic or manic episodes, but it doesn't list anything in the side effects about it in the pharmacy info.?? very confusing, i hope this helped a little bit, good luck to you
- denise
June 28, 2011 5:10 p.m.
Sorry for the typo below. I meant to ask... "...specifically related to the risks of triggering a manic episode" (and thanks to everyone for helpful descriptions of experiences with side effects - it helps to know what to expect ahead of time, at least whenever possible)
- Cathy
June 28, 2011 5:07 p.m.
Does anyone know about the use of Pristiq in patients with bipolar II disorder (especially in cases of BPII w/ predominantly depressive symtpoms), specifically realted to the risks of triggering a manic episode? So far I haven't seen information on whether Pristiq is officially approved for bipolar patients. So I'd even be interested in anecdotal evidence if this is indeed an 'off-label' usage (i.e. prescribing it to bipolar patients). Also, specifically for bipolar patients, I've heard that the combination drugs (serotonin and norepinephrine reuptake inhibitors) may have more risks for triggering a manic episode than do the SSRI's (serotonin-only). I'm having trouble finding hard data on this as well. Any information, or links to good sources, would be appreciated. ...Best wishes.
- Cathy
June 23, 2011 7:10 p.m.
My husband has just recently started taking this antidepressant, he has been having some side effects that are not listed. He is eating more than normal and he is having some acne problems. Has anyone else had these side effects?
- Bellamy
June 18, 2011 7:53 p.m.
I have been on Pristiq for a year. I had nausea and trouble sleeping at first but it gradually subsided. I am the caretaker for my 91 year old mother and 40 year old daughter who is in hospice care and I needed the help. I have lost 51 lbs that I needed to lose, only take Pristiq on Monday, Wednesdays and Fridays and am able to cope now with not only the difficult parts of my life but also the upcoming wedding of my youngest daughter. I think it's great but it's hard at the beginning.
- Vicki

340 comments posted