
- With Mayo Clinic psychiatrist
David Mrazek, M.D.
read biographyclose windowBiography of
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
December 22, 2009 8:48 a.m.
This is in reply to Jenn's comment on Dec. 8th re: "unexplained aggression". Jenn, your comment stopped me in my tracks because I think I am experiencing the same symptom. I have been on Effexor XR for over 10 years but my libido on it is non exixtent. I have been on Pristiq for 2 weeks now and have realized I seem to be on the attack all the time. Everything pisses me off. I thought it was just due to Christmas stresses but your comment made me realize I had been wondering if it was the medication. I see my family Doctor tomorrow and will bring this to his attention. Thank you for voicing your concern and making me more aware of my symptoms too.
- Debby
December 18, 2009 12:18 p.m.
I'm on my second week of Pristiq and love it! I've been on Lexapro 10mg for several years, but had gotten to where I slept all the time and started gaining weight, could not stop eating. I was feeling very depressed. Within 2 days, I felt better.I'm up bright and early every morning and able to stay up until 9pm or 10 and I'm not craving food all of the time. Hope it stays this way!
- Karen
December 16, 2009 1:38 p.m.
I just started the Pristiq due to menopausal symptoms and I am wondering if anyone else has tried Pristiq along with progesterone pills? the progesterone alone was not doing anything for my lowness and so I started the pristiq not even a week ago.
- mj
December 11, 2009 12:59 p.m.
Been on Prisiq for 3 months: Side effects: no appatiete, erectile disfuction, delay in orgasm....I quit cold turkey 5 days ago (I know Im not suppose to) but other than brain buzz and being a bit spacey and tired I feel good, the symptoms are going away and I am ready to be off the phsycoactive drugs for good.
- L
December 8, 2009 4:44 p.m.
has anybody experienced an unexplained aggression after they started taking Pristiq?
- jenn
December 3, 2009 1:34 a.m.
I was on Effexor at first and it was brilliant, went off it withdrawal was o.k. The a few years later symtoms returned Effexor didnt help, Aropax was o.k. but the worse horrible withdrawal ever. Then Effexor but still not the same good results a first time. Zoloft, was o.k. but I felt too vague, back to Effexor which is o.k. but the side effects seems to be bad this time, which before I have never had with any anit depressant. Next I'll try Escitalpram. But in my opinion Aropax is just cruel.
- Sharon-Aust
November 30, 2009 3:12 p.m.
I have suffered major depressive disorder for the last 12 years. About a year ago, I was diagnosed with bi-polar II disorder. I have been on just about every antidepressant made and have been hospitalized and underwest shock therapy, to no avail. New meds work for a few months, then stop working. I can totally relate to so many on this blog. I am on Zyprexa and Effexor. The Effexor is losing it's effect, and I've had this experience before. Added 100 mg. Elavil today, and feel better. When I see my doctor this week, I will ask to try the Pristiq. The hell of this disease is sometimes completely unbearable, and I feel for all of you who have to endure it. My heart goes out to us all.
- Diane
November 28, 2009 12:31 a.m.
Can anyone tell me how to wean myself off Pristiq. I have been taking it for just over a month now and I hate it. It will be another month before I can see my Dr and I do not want to wait that long. Help!! Irene
- Irene
November 27, 2009 10:16 a.m.
Hi I've been on Luvox CR 100mg then 150mg for about 3 months now. i have been feeling a little bit better but I have been so fatigued it has been difficult to do much of anything. I was thinking about asking my Dr. to add something for a bit more pep, like Wellbutrin. Does anyone have any ideas?? This fatigue is too much.
- John
November 25, 2009 10:51 a.m.
I'm not sure what to do. I've been taking Zoloft for 10 years and It doesn't seem to be working as well anymore. My Doctor is recommending Pristiq. I'm afraid it might make me feel worse. When I first starting taking Zoloft it made me feel so much better. Your opinion would be greatly appreciated.
- Vicky
November 25, 2009 1:49 a.m.
I've been on Cymbalta 60mg for a couple of years. Lately I have been sleepy, weepy and not interested in my normal activities. So it seems it has stopped working. I had similar experiences with Effexor and Celexa. I'm interested in trying Pristiq. The weight loss effect would be nice as I've gained 50 pounds after starting antidepressants about 7 years ago. I've read most of the comments and the side effects of starting Pristiq sound similar to what I've experienced before. What should I expect upon changing to Pristiq from Cymbalta?
- Patricia
November 24, 2009 10:27 a.m.
Been on Pristiq for a little bit over a month. I have been off from Pristiq for 6 days now. I used to take Cymbalta for about 4 years. Worse experience of all antidepresants I tried before. High blood pressure Ringing in the ears -- still have it Pain in my joints - especially ankles and fingers. Headaches - awful never had headaches before Dizzines Hot flashes Forgetful On the positive side: It allowed me to go to sleep and stay asleep all night. I made the decision to take myself off of all antidepressants. I rather live the depression than the side effects some of these medications give you. I did start taking B12, Gingo Biloba, & Omega-3. I hope this works. I asked the insurance if they would pay for a vacation to Puerto Rico - it will surely get rid of my depression!! Well, it was denied, ha ha ha. Lisa
- Lisa
November 19, 2009 10:35 a.m.
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November 19, 2009 2:48 a.m.
I have been reading and really appreciate all you ppl have taken time to share. I have fibromyalgia and depression for 20 yrs now, tried everything, not exagerating. I am looking for something that will work to alleviate pain, without knocking me out cold with fatigue, and lift the incredible sadness I cannot seem to escape. I do not understand why more researchers do not try to find cures for these devastating illnesses. Sometimes I feel like I am "walking but dead", laying thinking of what I could do, should do, would give anything to do with my children, my family, my job, my friends. Fibro and Depression also are similar in that you look great, so people cannot understand why you cannot produce, work, smile, whatever. I am not bitter. I am just an old soul at this tour and maybe been on it too long. I am thinking of trying one more thing ... Pristiq, to see how it goes. Thanks for all your info and candor.
- Denise
November 18, 2009 11:31 a.m.
I am on Pristiq, I have been now for 6 months. I have fairly bad depression rated by my doctor at 75/100 (back in June). These were the first antidepressants I have ever taken and I can say they work absolute wonders. To start with I was feeling drowsy and tired alot (more than normal) but after a few weeks it dissipated and I now wake up early every morning feeling bright and refreshed. Haven't had any other side effects, apart from when I forget to take one, then its bad, with the nausea, and head spinning/rushes. But then thats my own fault for forgetting to take them lol. For everyone saying that they crashed when they stopped taking them it seems no one is consulting their doctors about easing off the drugs, you cant just stop and expect everything to be ok. I have spoke in length with my doctor about the process and I'm on 50mg at the moment but that will have to increase next month to 100mg, as thats the way the process goes. It's like this: You start on what they prescribe then go up one. Then you start easing off but going back down the chain( for me it goes, 50-100-50-25-10). And it makes perfect sense that it goes like that.
- Nick
November 12, 2009 12:26 p.m.
My husband just suffered a memory loss of 20 years. He has been depressed for 2 years and had tried to commit suicide in2007. He has not been on medication for 9 months or so. The other morning, he woke up and did not know where he was. He knew who he was, but thought I was very old. The following morning, when he looked in the mirro, he was back in the present. They have put him on Pristiq. I was wondering if anyone else had a similar experience and if they had a diagnosis.
- Tinker
November 10, 2009 5:13 p.m.
I have taken Prozac for 21 years (first 20 mg. then 40 mg.). The drug seems to have stopped working a few months ago. I just started taking Pristiq last week and I am wondering how long it will be before I start to feel better. I also wonder why nobody has invented an anti depressant medication which works FASTER than any of these other drugs do.....you would think some brilliant person would have managed to figure out how to do it....I have dealt with serious Depression for over 30 years and am glad that we have these drugs available....we don't need to end up like Sylvia Plath or her son Nicholas......
- Cynthia
November 8, 2009 1:25 p.m.
I took Zoloft and then Lexapro for many years. I did not experience any intestinal side effects. After having a 2005 knee surgery in which I contracted C-diff (intestinal infection) in the hospital, I developed a chronic IBS condition that doctors say will probably stay with me. Now, every SSRI (I have tried almost all of them) will put me into a severe IBS attack. When a new med arrives on the scene, I get my hopes up that maybe I might tolerate it. Has anyone out there with a similar problem had better luck with Pristiq?
- Patrice
November 7, 2009 10:25 p.m.
"We know that certain neurotransmitters such as norepinephrine, serotonin and dopamine are not in proper balance when a person is depressed." We don't actually *know* that. Let's not oversimplify the science until it becomes meaningless. Taking an antidepressant is thought to increase or inhibit various neurotransmitters, but that doesn't mean that an "out of balance" state is the cause of or even associated with depression. If I have a headache and take aspirin, relieving the headache, that does not mean that my headache was caused by an aspirin imbalance. "We don't routinely check neurotransmitter levels because we don't completely know what the levels mean." Right. Because we don't know what actually constitutes "in balance" for neurotransmitters.
- Tim
November 5, 2009 12:16 a.m.
I HAVE BEEN ON THE PRISTIQ FOR OVER A YEAR, I REALLY BELIEVE THAT IT IS WORKING VERY WELL. I WAS ON EFFEXOR XR FOR 4 YEARS PRIOR. IT DOES HAVE GOD AWLFUL SIDE EFFECTS IF YOU MISS A DOSE. I DO HAVE NAUSEA AT TIMES, BUT THE NAUSEA, DIZZINESS AND JUST TOTAL FEELING OF AGITATION IF YOU GO MORE THAN 24HRS BETWEEN DOSES. I HAVE HAD NO WEIGHT GAIN WITH THE PRISTIQ. I DID HAVE WEIGHT GAIN WITH THE EFFEXOR . THE BIGGEST DOWNFALL IS THE COST OF THE PRISTIQ WITHOUT INSURANCE. I KNOW MY FAMILY IS VERY HAPPY WITH THE PRISTIQ.
- Era
November 3, 2009 10:14 p.m.
I've been taking Prestiq for almost 11 months now. I am an alcoholic and it was prescribed during my early recovery. I had previously been taking Celexa and the Dr. felt I needed a little more to help with my depression. For me Prestiq has been a Godsend. I do experience nausea if I miss a dose, and occasional loss of appetite. I do take it with Trazadone (50mg) to help with sleep at night. Overall, I'm very pleased with the medication. The Celexa offered wild mood swings and anxiety attacks.
- Chris
November 3, 2009 8:23 a.m.
I am 44 and have been dealing with depression of and on since I was a teenager. I have now been on a combination of Wellsbutrin SR 300 mg a day, Pristique 50 mg a day, and zoloft 100 mg a day for my depression and atavan as needed for anxiety, for over a year. When I first started taking the Pristique I told my doc about the sweating,and wanting to sleep all of the time, he refused to take me off of any of the meds. Is there anybody else that is on the same combo of meds as I am??? I heave been wanting to gradually go off of the pristique but now I am not sure after reading some of these blogs. When I say something to doc about my sleepiness he tells me that I am depressed and need to exercise, how do you exercise when you have NO energy??? I have experienced weight gain, no energy,sweating profusely, major night sweats,(never had before the pristique) talking in my sleep, and weird dreams. I want to go back to school in Jan and am afraid that I will fall asleep during classes does anyone have any suggestions as to what to do for the energy? We have now even tried a shot of B12 and that didn't work for more that 2 days.
- Denise
November 3, 2009 12:54 a.m.
I am 49, and I have taken Zoloft 25-50-and then 100mg threw-out the past 18 year. It worked great, but now have problems, as it isn't working very well now, so My Dr. put me on Pristiq 50mg, and zoloft 50 for 7 days, then I will take Pristiq 50mg, and 50mg of zoloft every other day for 7 days, then it will be just Pristiq 50mgs a day... So far I have been on Pristiq for a week now, and I have already noticed a definite difference.. More alert, less sleepy, and better attitude, and way more happiness..I think Pristiq has been a great benifit to me, and I hope that as time goes by, it continues working great for me....It is nice to know that there is alternatives that one can rely on... Thanks to the makers of Pristiq!!!!!!!!!!!!!!
- Pamela
November 1, 2009 11:39 a.m.
I took my first Pristiq bill yesterday morning. An hour after I took it went to store.I was find going to store,on way back home totally blacked out,ended up in this neighborhood I have never been in before. It was awful. I have been to that store hundreds of times. Very easy to get to.After that panic attacks started. I was going to take Pristiq for a short time to help me thru things. After reading about the withdrawals have decided not to take them anymore. I am not that depressed to go thru black outs,panic attacks and just feeling sick. This was all after just one pill.
- gayle
October 28, 2009 8:50 p.m.
I switched to Pristiq one month ago from Celexa and am beyond happy. The need for a depression fix was obvious after taking Celexa for a few months but the symptoms were not out-weighing the benefits: horrible sweating at all hours of the day, no sexual gratification no matter how hard my poor husband worked, and hormonal imbalances seemed to knock the pill progress off. The Pristiq response was pretty obvious within a week. My happy husband agreed. I don't think any drug will be side-effect free when dealing with a major depressive incident. Each person needs to look for balance, not an instant fix. But Pristiq for me is pretty close. My sleep patterns are not like they were but my doctor suggested taking the pill in the evening. It acts like a sleeping pill and I have been sleeping fairly well. The urinary side effects cause some middle of the night bathroom visits, but the sleepyness puts me right back to bed. I was never one to wake up before these issues so sleep was and is a major concern for me. Over all: this SNRI if far and away more appropriate for me, balancing the side effects, current hormonal problems, and the obvious benefits received. I am lucky to have a doctor who listens to all this and talks and walks me through it and then partners with the decisions. If your side effects are bothersom problems talk to your doctor! Or get a new one like I did. She's the reason this drug works for me.
- Pam
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359 comments posted