
- 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
June 13, 2011 11:36 a.m.
I find it offensive that these side effects only ever seem to warn of sexual disfunction in men. There is a huge incidence of sexual dysfunction and related side effects in women, but for some reason it is not seen as relevant, or isn't tested for, or perhaps its just plain old sexism...ie the idea that orgasms are optional or don't really matter to women. Feeling numb from the waist down and not being able to orgasm is a pretty major side effect for women too, and is what I always experience on SSRIs, as have any other women I have spoken to who are on these meds.
- Peggy
June 8, 2011 6:09 p.m.
On this medication for two weeks. Experienced bad headaches daily, some lasting 8 hours. Also had trouble sleeping. Stayed awake until four in the morning and then awoke again at eight. Also experienced constipation that caused lack of elimination for three days, and then only partially relieved. Had to eat a lot of fruit, drink a lot of water, and also consumed lots of yogurt in order to empty bowels. The worst of all symptoms were the headaches. Also experienced dizziness and return of vertigo problems previously experienced months before.
- Joan
June 1, 2011 11:20 p.m.
This is not directed at the author. Isn't it typical in a depressed world, given it takes so long for a new drug to get approved, that this is Yet another serotonin and company reuptaker? Given that the biggest problem with current depression treatment is Not that there are too few ssri or snris, but that millions don't get helped enough or at all on them or other existing meds. See, how it goes, when profit, not healing per se, even though they're linked in this case, is the primary driving factor. It mocks the suffering. You'd think that any new drug would be based on groundbreaking experiments and trials. What about ketamine for instance, which yielded previously unseen responses in treatment resistant patients in studies? If healing or curing had been the true motivating factor behind new drugs, any new drug that came out would fill the void, not add to an already over saturated pool of existing drug classes. They do it by choice. And think of a very real concept like 'corporate sociopath, at worst, and how that meshes with medicine and healing. It's crazy. Ultimately, it's no more than a money gamble to them. The pharmaceuticals are corporations, not healers. If/when they come up with drugs that work, obviously it's good for them, since it means more profit. But as long as current drug classes sell in the billions, they have less incentive to focus on alternatives. "why try something different if what we have now line our pockets so well".
- bd
June 1, 2011 9:38 p.m.
I never thought I'd be a person that suffered from depression. And I thought depression was feeling unhappy and sitting in the closet in the dark by yourself. I had no idea "depression" was a blood pressure of 170, an inability to turn one's brain off at night, insomnia, panic attacks, tight burning in the chest, inability to concentrate and emotional instability. I'd been unraveling for close to six months. My doctor hates prescribing medication. His recommendations the first two times I went in for stress and insomnia were caffeine avoidance, exercise and a herb filled capsule that did nothing for me. It's only when he saw my blood pressure at 160 - 170 a few weeks ago, and then again when I came back for the blood tests results (healthy as a horse) coupled with my emotional breakdown in his office that he finally recognized that I needed help. I went on Pristiq that day. It is the first time I have EVER in my life been on ANY type of medication like this. I am now on day 13. The first week I had nausea and a headache for the first couple hours after taking it and I had zero appetite. Now the side effects are minimul. And the emotional/mental/physical symptoms of the depression - GONE. I sleep like a baby because when I close my eyes I'm able to turn my brain off from it's frantic erratic thoughts. My focus at work is back to normal. And my BP? Back to 120. I just feel....good. Not euphoric - just "deep-sigh-sit-in-the-sun" go
- Rose
May 26, 2011 6:08 p.m.
I have struggled with depression off and on since high school. I finally realized a few years ago that no matter how good I was feeling, if I stopped taking my medication, I would eventually fall back into the pit. I have tried just about everything but after gaining 30 lbs on effexor and then zoloft, I refused to take SSRI's anymore. I was taking Wellbuterin daily and Xanax when I needed it and was doing okay. Then my son left for college and I fell deeper in the pit than I have ever been - don't know why - he is perfectly happy at his first choice school, but that is what happened. 6 months after he left, I started taking Pristiq and it was like a miracle drug. I feel like a new person. I even lost a few pounds. I do have the night sweats and memory loss and I don't know if it is because of the Pristiq but my hair is falling out! Has anyone else had that reaction? So far, this is the best drug I have ever taken for my depression and I hope it stays that way. It is so frustrating when the meds stop working!
- Reece
May 26, 2011 2:28 p.m.
I've been on Pristiq for a few months and after a lifetime of "experimenting" with antidepressants, I believe (so far) it to be the most effective of all. I too am experiencing the little sweating attacks (and no, it is not menopause) which are little more than annoying. I have just come through an extended medical leave because I was also taking Geodon; the two meds clashed and I developed very painful eps (extra pyramidal side effects). Reducing the Geodon did not help so Geodon was replaced with Abilify and after two weeks I am stable and feeling good and able to return to work. I also have Lorazepam to take prn; seem to have hit on the right combination. I have had depression since I was 13 and am now 61 so it's been a long haul. Feeling very optimistic and hopeful and "normal" now, looking forward to the future and making plans. I have been professionally employed for over 40 years, the last 18 of which have been spent as a Victim Advocate specializing in Domestic Violence. I returned to work this week after having been out for 5 wks, but I am better than ever and don't anticipate any future trouble that I can't handle - ever. :-)
- Janice
May 22, 2011 7:05 a.m.
Iv'e been on Pristiq for 7 or so months now and besides the ringing in the ears occassionally its the sweating or hot flushes that I find annoying as they are frequent but I have noticed the past few days they seem to be getting less and less, I dont know to be honest as they seem to disappear for a few days then come back. I wonder if the HRT pills arent working anymore or if it is the Pristiqu (100mg tab daily). ?? I am in agreence with others that AD meds can stop working as I have been on maybe 10+ types in the past 20yrs and have found to date Pristiq to be the best (less side affects) and oh yeah, weight loss, 15kg in 3mths I lost so nearly back to my pre-baby wieght lol. I am also on epilim for helping to stabilise moods, high blood pressure tabs, zumenon & Ravolera for HRT. Does anyone know if all these pills are a good mixture as at times I am not sure if doctors at times think of this or even know. I asked mine and he always nods ok but being at times find it hard to understand him. Be nice to be able to share experiences with others about meds etc. I've lived with depression all my life and its not easy finding the right one to suit each person. Its very correct in saying what suits one person wont suit another. Final question, whats best for low sex drive while on pristiq. Its affecting my sex life also. Bye for now Janika
- Janika
May 19, 2011 3:11 p.m.
Alissa, there is a patient assistance program for pristiq available if you go to the website, www.pristiq.com. I think it is called pfizer friends or something of that nature. They will send you a card in the mail which you will present to the pharmacy each time you pick up your prescription. They will cover half of your co-pay as long as you take the medication. Hopefully this will help you. I recently switched to pristiq from effexor and I am doing much better on the pristiq although I still have similar side effects if I am too late with a dose. I have the "brain buzzing" effect that another person posted as well as the headaches. Needless to say I try not to miss a dose. All medications interact with different peoples' body chemistry differently so what works for one may not work for another....pristiq works for me and I think it is worth trying.
- Jessica
May 17, 2011 9:13 a.m.
dear alissa: usually your dr. will have samples in his office, ask him, if he doesn't ask the staff if they ever get samples or if they can call & get samples ? if all that doesn't help, call the company directly, u can get the manufacturer's name off your pres. bottle, u can get there phone no., on-line or from your pharmacist, $80- is way 2 much 2 b paying 4 your pres.!! if you don't get it free the manu. will probably have a discount pres. plan ? good luck 2 u & write back
- denise
May 17, 2011 12:17 a.m.
Pristiq is very expensive-even with insurance it is costing me $80.00 a month.DOES anyone know of a coupon or prescription card you can qualify for to help with the expense? My husband gets Nexium reduced by a card thru the pharmasutical companies?
- ALISSA
May 16, 2011 11:18 p.m.
I have been depressed for about 8 years now, but I had never sought help until last fall. Pristiq is the first antidepressant that I have ever tried so I don't know how to compare it to others. I started with the 50mg, and after 11 days I felt like I was on cloud 9. That only lasted for about 2-3 days though, then I started feeling the blah that I did before. My doctor upped my dose to 100mg and it started working again, but not as strongly as the first time it kicked in. I have been on 100mg for about 3.5 months and the past couple of weeks have started feeling blah again. The 100mg dose seems to have stopped working now, so I don't know where I go from here. :( As far as side effects, I get high blood pressure and very vivid, weird dreams (usually nightmares). It actually increased my sex drive and made me less tired.
- Ashly
May 15, 2011 1:49 p.m.
yes i have been suffering with depression for so many years an had denied my self treatment,my depression was getting in way of my daily functioning and my goal til one day i had enough and sought help and my doctor prescribed pristiq and it really has been a life changer for me
- jake ferruche
May 14, 2011 10:24 a.m.
dear stacy: i'm so glad 4 u that ur doing good !! finding the right med. is "half the battle" as they say, i envy u that u have enough energy to exercise & that u've lost weight-yeah !! enjoy your good experience of feeling NORMAL again !! stay positive, good luck 2 u & keep writing if it helps, let us know how ur counseling goes ? i'm thinking of going & just haven't made the appt. (poor excuse) i know
- denise
May 13, 2011 2:26 p.m.
I am a 32 year old female. I have been on Pristiq for about two weeks. I did have the sweatiness but after 3 days no other side effects. I really couldn't be happier. It has helped me feel balanced and healthy. Once I started taking it, I had enough energy to exercise and I have lost 20lbs. I was scared to go on a anti-depressant because of the change in personality I had seen in my sister and friends on anti-depressants but my Dr assured me we could taper if need be because I needed medication badly for how emotionally incapable I had become. I will start seeing a counselor next week and now I am scared to come off of Pristiq ever because I never want to feel the way I did before.
- Stacy
May 5, 2011 3:34 a.m.
I have been on Prestiq 100 mg. daily since 2009. Prior to that I have been on SSRI/SNRI's since 2000 for depression. Ever since starting on anti-depressants, I have experienced, hypomania, mania, worse depression than when I started out with, suicidal ideation and have been hospitalized 6 times in 3 years. I am currently in the midst of a doctor-supervised medication taper and/or discontinuation of some of my many of my medications and I absolutely love Dr. Peter Breggin's book, "Medication Madness". I am currently in SSRI withdrawals due to reducing Prestiq from 100 mg. to 50 mg. (the tabs are time-released and are not manufactured in smaller dosages so I will in all likelihood have to be crossed over to another SSRI that comes in dosages that are more able to be titrated down to increasingly smaller and customizable dosages during my taper. So far I have been successful in a 25% dose reduction in Klonopin, the 50% reduction in Pristiq (2 days of severe nausea and vertigo), discontinuation of a "sleep dose" of Seroquel (25 mg),the addition of Lunesta 3 mg. for sleep (sleep is getting better as I adjust to the lower dose of Klonopin) discontinuation of Lithium 900 mg. and I just took my last 500 mg. tablet of Depakote ER 500 mg. down from 1500 mg. daily which I was on for only a few days.If you are depressed, see your doctor, but please read the package insert and the Black Box Warnings about increased suicidality when starting, decreasing, or stopp
- laurie
May 2, 2011 3:49 p.m.
Im 21 years old and have had mild to medium depression for about 2.5 years now. At first, I started off with Lexapro which was fine for a while but wasn't the best for me...My mother recommended I take Pristiq because it's what she used to take for depression as well (started off 50 mg but updosed to 100 mg because it depends on ones weight). I've been on it ever since and I function pretty well with it. One thing to note is it is not alaways the medication that makes one feel better, but their environment as well. Also, not every medication works for every person...Pristiq just happens to work for me quite fine with little to no side effects.However, if you skip a day or so you will feel light-headed and you have these little brain zaps so avoid skipping dosages. Other than that, Pristiq has helped me so such and I hope it is able to help others too.
- Carrie
April 17, 2011 4:10 a.m.
I was never depressed but experiencing some mild anxiety and had a couple of panic attacks. Long story short - I started on Lexapro, and I did not agree with me at all, so I was switched to 50mg Pristiq. While on Pristiq I started to experience horrible anxiety 10xworse than I had experience prior to being put on meds.. I ended up on a whopping 150 mg of Pristiq. I become depressed, crying in the streets, isolated myself, suicidal thoughts. I become so irritable and short-tempered I was put on seroquel (used for Bi-Polar, and I am not Bi-Polar) which made me feel like I had been hit with a tranquiliser. I felt this was getting out of hand, seeings I presented with mild anxiety and during my 'treatment' had developed a range of new problems. I decided to take myself to some Counselling. Basically one session did more for me than any tablet. I decided to come off the meds - without knowledge of withdrawals. I have been tapering down for the last 6 weeks and even weaning is tough. I have had an ED admission because one day the withdrawals were so intense I could not relieve the anxiety. The nausea, the body aches, constant head ache, dizziness, irritability, anxiety is just awful. I honestly feel like contacting a newspaper or something like that because people need to be aware of Drs putting people on these medications with with little care considering the side effects and withdrawals. I can't wait to have this poison out of my system. It has destroyed my libido, I am a young w
- amme
April 16, 2011 2:29 p.m.
I've taken Zoloft for years. I've felt depressed lately and tried celexa. It made me moodier. My Dr. told me to try pristiq. I mostly suffer from anxiety/OCD-so the blood pressure thing scared me a little. My dr said not to read the label...as I will obsess over every side effect. I still did though. I believe it helped in some ways...I'm on my 3rd week of it. I decided to take it with food..but I've had weird headaches and muscle aches..which I do not know if are from the flu or this med...all I know is I was sick on Sat/Sun coming back from vacation with severe leg cramps/headache..my 4 kids got sick too..but vomited/sore throat..no leg cramps. I thought I was well..but then Friday I had a sore throat and the terrible leg cramps and muscle aches. So I'm wondering if Pristiq is to blame. I've also had trouble sleeping xanax did not help me sleep with being sick...wide awake with leg/head pain. I hate the sexual side effects of Zoloft..14 years of no satisfaction sucks..I just wish my OCD/depression did not exist so I could function w/o meds. I'm not going to tolerate leg cramps and every nerve aching though!
- Heidi
April 13, 2011 11:19 a.m.
I was diagnosed with depression 4 years ago. Pristiq worked for me like a dream. Like Audrey, I don't feel it is working for me as of lately. I feel the aggitation, irritablility and lack of giving a dare coming back. My husband and I decided that if it continued for more than a month I would return to my doctor for help. It has been a two months now and I have an appointment next week. I know he will have a solution or suggestion for me. Yes for me the sexual side effects suck. Lack of interest as well as difficulty achieving an orgasm. My advise is try a testoseron cream:-)
- Wendy, 39
April 4, 2011 7:52 p.m.
I am a 22 year old female, and ever since I graduated school back in 2006, I have noticed that I am sick...mentally. As everyone does as they get older, I started to get to know myself, and didn't like what I saw. I hate myself. I now realize that even as a child, I didn't like myself. My father killed himself 2 years ago, and my Aunty is bipolar. I was put on Cipralex after I found about about my father. It did not work for me. I stopped taking it without advice from the doctor, and I went on a continuing downward spiral from there on. I've never attempted suicide, but I think about it all the time. It got to the point where I was missing work a lot and didn't talk to anyone. I just slept all day and all night. My mother finally made me go to the doctor again and that's when he gave me samples for Cymbalta and Pristiq, to see which one I liked better. Too me, I thought maybe that wasn't such a good idea, but he's the doctor. I tried Pristiq first for about 6 weeks and I seriously felt almost 80% better, without many side effects except sleeplessness and constipation. Then I went on the cymbalta where it was way too intense for me. I felt out of my body. I felt like a crazy person on that. So out of all antidepressants I have tried so far, my favourite is definitely Pristiq, minus my sleeplessness, ringing in the ears, constipation, and increased sweating. Those don't amount to anything when before all you wanted to do was die.
- Tanechia
March 28, 2011 4:58 p.m.
I am a 30 year old male who has been treated for depression and mood disorder for many years. At first, this worked like a dream come true. I got samples from my pyschiatrist and after 20 days i filled the prescription thinking I had finally found the answer to my depression. I then began to go slightly insane. Mood swings, anger issues, and depression became more prevalant. By 2 months I was having constant suicidal thoughts, I was unable to come to work occasionally because I was so depressed. I finally decided to stop taking this and after 3 days I was feeling better than I had for 2 weeks. This medication is not for everyone. I honestly believe that if i had continued to take this medicine I would be a suicide statistic.
- Christopher
March 9, 2011 9:46 a.m.
I am 58 was diagnosed with major depression two years ago but I also had an horriffic bout with panic during that time as well. As others have said here, I also have a long family history of this debilitating problem, to a greater or lesser degree. Anyone who has been through it knows what I am talking about. It was like being in a horror movie 24 hours a day interrupted by an occassional train wreck. But it can be fought with medication, cognitive behavior therapy, and especially, healthy relationships. Pristiq has been very successful for me with no side effects and I highly recommend it. However, one skipped dose will lead me to dizzyness and what I call a light and momentary "electrical head buzz" until the next dose. Overall a great but pricey medicine.
- John
March 1, 2011 8:40 p.m.
I am a 54 yr old nurse, female. Suffered this illness most of my life. Family HX. Started Pristiq today and with in 30 minutes I did feel calmer. I was on the verge of losing my job for rageing implusive behavior. With in 3 hours of taking I got up out of bed and painted my bathroom which I had been intending on doing for over a year. I just felt like I needed to do something constructive instead of destructive. Yes it appears to work quite that fast. I just felt better. I can't explain it, only that I will certainly give it a shot. There are other areas of my life that I pray it will work that well too. I can only hope that it will continue well for a very long time. A bit nausea but this too shall pass I am sure.
- Rachel
February 28, 2011 10:30 a.m.
On Zoloft felt great - gained weight - no energy - On Wellbutrin - feels like brain is going to jump out of my head - no weight gain- is there a resolution?
- Pat
February 27, 2011 1:56 a.m.
Pristiq stopped having any beneficial effectafter about 16 months. Same story. Now what? And the cost is making a profund impact which sure doesn't help how I feel so why keep taking something that doesn't work?
- Audrey

340 comments posted