Lexapro vs Pristiq

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For patients diagnosed with major depressive disorder (MDD) or other forms of depression, certain medications such as Lexapro and Pristiq can be effective in managing symptoms. These drugs influence the levels of specific neurotransmitters in the brain associated with mood regulation, thus helping to stabilize emotional lows. Lexapro is classified as a selective serotonin reuptake inhibitor (SSRI), primarily affecting serotonin levels. In contrast, Pristiq belongs to a class called serotonin-norepinephrine reuptake inhibitors (SNRIs), impacting both serotonin and norepinephrine levels within the brain. Both medications are intended to balance these neurotransmitters and help alleviate depressive symptoms; however, their different mechanisms of action may make one more suitable than the other depending upon individual patient circumstances.

What is Lexapro?

Escitalopram (the generic name for Lexapro) is an SSRI antidepressant, which was a significant development from the first class of antidepressant drugs known as tricyclic antidepressants (TCAs). Escitalopram was first approved by the FDA in 2002. Similar to Prozac, Lexapro increases levels of free serotonin by preventing its reuptake, effectively keeping it within the brain's synaptic spaces for longer durations. It is typically prescribed for treating different forms of depression and generalized anxiety disorder. With a selective influence on serotonin and minimal impact on dopamine or norepinephrine neurotransmitters, Lexapro tends to have fewer side effects than other antidepressants with stronger influences on these two additional neurotransmitters.

On the other hand, Desvenlafaxine (the generic name for Pristiq), an SNRI-type antidepressant medication that not only affects levels of serotonin but also has significant impacts on norepinephrine levels in the brain. This dual action can lead to more effective treatment outcomes in certain individuals; however, it may also come with increased potential side effects due to broader neurochemical influence.

What conditions is Lexapro approved to treat?

Lexapro is approved for the treatment of several psychological conditions:

  • Major depressive disorder, often referred to as unipolar depression
  • Generalized anxiety disorder (GAD)

On the other hand, Pristiq is also used for treating a couple of mental health issues:

  • Major depressive disorder
  • Social anxiety disorder (off-label)

How does Lexapro help with these illnesses?

Lexapro, also known as escitalopram, helps manage depression by increasing the amount of serotonin in the brain. It does this by inhibiting its reabsorption into neurons, thus keeping levels consistently higher for longer periods. Serotonin is a neurotransmitter involved in various physiological functions such as mood regulation, cognition, memory processing, appetite control and sleep patterns among others. Lower levels of serotonin have been linked to depressive states in individuals. By enhancing serotonin presence in synapses, Lexapro can mitigate depressive symptoms and aid patients in managing their condition.

Pristiq or desvenlafaxine operates similarly but with a slight difference: it increases both norepinephrine and serotonin levels - two vital neurotransmitters involved in mood regulation. This dual action on two separate chemicals enhances its effect on lifting moods compared to drugs that only increase serotonin levels.

What is Pristiq?

Pristiq, a brand name for desvenlafaxine, is a serotonin-norepinephrine reuptake inhibitor (SNRI), which means it increases the levels of serotonin and norepinephrine in the brain by reducing their reabsorption. Desvenlafaxine was first approved by the FDA in 2008 as an antidepressant medication. Unlike Lexapro, which is an SSRI (Selective Serotonin Reuptake Inhibitor) and mainly focuses on regulating serotonin levels, Pristiq impacts both serotonin and norepinephrine neurotransmitters leading to its unique side-effect profile. Specifically, Pristiq does not tend to cause sedation or weight gain commonly associated with SSRIs like Lexapro but can sometimes lead to increased blood pressure or cholesterol levels due to its effects on norepinephrine. Its dual action on two different neurotransmitters can make it more effective for patients who do not respond well to traditional SSRI treatments such as Lexapro.

What conditions is Pristiq approved to treat?

Pristiq is a medication that has been approved by the FDA for use in treating major depressive disorder (MDD). It's an SNRI, or serotonin and norepinephrine reuptake inhibitor, which works by affecting chemicals in the brain that may be unbalanced in people with depression. Pristiq can help alleviate symptoms of depression such as feelings of sadness, worthlessness or guilt, loss of interest in activities, fatigue and trouble concentrating.

How does Pristiq help with these illnesses?

Pristiq, like Lexapro, is an antidepressant medication but it works by interacting with both serotonin and norepinephrine in the brain. Serotonin and norepinephrine are neurotransmitters that play vital roles in regulating mood, anxiety, fear response, and overall mental wellbeing. Low levels of these chemicals have been associated with depression. Pristiq functions by preventing the reabsorption of these chemicals into your nerve cells after they've communicated their message to other nerve cells. This leaves more active neurotransmitters available for use within your brain's communication system which can help alleviate symptoms of depression.

The way Pristiq affects not only serotonin but also norepinephrine differentiates it from typical SSRI (Selective Serotonin Reuptake Inhibitor) medications such as Lexapro which primarily targets serotonin reuptake only. Therefore, patients who do not respond well to typical SSRIs or need additional symptom management may be prescribed Pristiq either alone or alongside their existing treatment regimen.

How effective are both Lexapro and Pristiq?

Both escitalopram (Lexapro) and desvenlafaxine (Pristiq) have established histories of success in treating patients with depression, and they were initially approved by the FDA within a few years of each other. As they act on different neurotransmitters, they may be prescribed under different circumstances. The effectiveness of escitalopram and desvenlafaxine was directly studied in a double-blind clinical trial in 2009; the two drugs exhibited similar efficacy in managing symptoms of depression as well as similar safety profiles.

A 2012 review showed that Lexapro is effective at reducing symptoms starting from the first week onwards, has fewer side effects compared to many antidepressants, and is generally well-tolerated even among elderly populations. This study also indicated that Lexapro has become one of the most commonly prescribed antidepressant drugs worldwide due to its favorable efficacy-to-safety ratio.

On another note, Pristiq had been subject to numerous studies indicating its effectiveness against placebo for treating major depressive disorder but is typically considered an alternative treatment option after SSRIs or SNRIs like lexapro are ineffective. Much research involves Pristiq being co-prescribed alongside another SSRI or SNRI such as Lexapro itself so data confirming its standalone efficiency isn't quite robust yet. Still, because it uniquely acts on both serotonin and norepinephrine receptors instead of just serotonin alone like most SSRIs do including Escitalopram (Lexapro), Desvenlafaxine could be more suitable for those not responding adequately to typical SSRIs or those wanting avoid some common side effects associated with them.

abstract image of a researcher studying a bottle of drug.

At what dose is Lexapro typically prescribed?

Oral dosages of Lexapro range from 10-20 mg/day, but research has shown that a daily dose of 10 mg is typically adequate for treating generalized anxiety disorder and depression in most adults. Adolescents (12-17 years) and the elderly may be started on a smaller dosage of 5 mg/day. In either population, the dosage can be increased after three weeks if there is no response. The maximum dosage should not exceed 20 mg/day under any circumstances. On the other hand, Pristiq is generally prescribed at a standard initial dose of 50mg per day for adults with major depressive disorder. Dosage increases are generally considered after several weeks if patients have not achieved an optimal response, with a maximum recommended dose set at 400mg per day.

At what dose is Pristiq typically prescribed?

Pristiq treatment is typically initiated at a dosage of 50 mg/day. For some patients, it may be desirable to start at 25 mg for the first week, before increasing to 50 mg per day. Dose can then be increased up to 400 mg/day based on clinical response and tolerability. Unlike many other antidepressants, there is no necessity to divide Pristiq into multiple doses throughout the day; it can be taken once daily with or without food. It should be noted that if there's no sign of improvement in symptomology after several weeks of treatment at the initial dose level, consult your healthcare provider as they may consider an increase in dosage.

What are the most common side effects for Lexapro?

Common side effects of Lexapro and Pristiq may include:

  • Anxiety or nervousness
  • Difficulty sleeping (insomnia) or unusual sleepiness/drowsiness (somnolence)
  • General weakness or lack of energy (asthenia)
  • Tremors
  • Decreased appetite
  • Nausea, stomach discomfort, or digestive issues (dyspepsia)
  • Diarrhea
  • Dry mouth
  • Changes in sexual desire and function including decreased libido, abnormal ejaculation, and impotence.

For some individuals taking these medications, they might also experience:

  • Sweating
  • Abnormal dreams
  • Symptoms similar to the flu such as fever, chills, body aches

In addition to the above-listed symptoms; throat inflammation leading to a sore throat (pharyngitis), sinus congestion due to inflamed sinuses (sinusitis), yawning more than usual are other potential side effects you may notice. Always consult your healthcare provider if any new concerning symptoms arise while on these medications.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Lexapro?

When comparing Lexapro to Pristiq, there are several potential side effects to consider:

  • An increase in suicidal thoughts or tendencies, particularly in those under 24 years old
  • Signs of an allergic reaction such as hives, difficulty breathing, and swelling of the face or throat. Severe skin reactions may also occur with symptoms including fever, sore throat, burning eyes, skin pain and a red or purple rash that blisters and peels
  • Vision changes such as blurred vision or tunnel vision. You might notice pain or swelling in your eye area along with seeing halos around lights
  • Cardiovascular issues can manifest through fast heartbeats that pound/flutter within your chest - this could be followed by shortness of breath and sudden dizziness which makes you feel like you might pass out
  • Low sodium levels (hyponatremia) can result in confusion accompanied by headaches. Slurred speech becomes common alongside severe weakness leading to vomiting. Coordination may become impaired making one feel unsteady.
  • Nervous system overreactions resulting in rigid muscles coupled with high fevers and excessive sweating. Confusion is another symptom along with irregular heartbeat patterns causing tremors leaving one feeling faint.

If any signs of serotonin syndrome begin appearing: agitation sets off hallucinations while body temperatures rise triggering bouts of sweating/shivering; fast heart rates occur simultaneously with muscle stiffness/twitching impairing coordination hence nausea/vomiting/diarrhea occurs - medical attention should be sought immediately.

What are the most common side effects for Pristiq?

Pristiq, another commonly used antidepressant, comes with its own set of potential side effects. These may include:

  • Dry mouth and throat
  • Nausea, vomiting, stomach discomfort or loss of appetite
  • Constipation or other changes in bowel habits
  • Insomnia or other sleep disturbances
  • Increased sweating
  • A feeling of restlessness or nervousness
  • Elevated heart rate
  • Mood changes such as agitation or hostility
  • Skin rash
  • Weight fluctuations, either gain or loss
  • An increase in urination frequency
    -Nervous system effects like headaches and dizziness
    -Possible muscular discomfort or joint pain

It's important to remember that these aren't guaranteed but rather possible side effects based on reported cases from those taking Pristiq. Always consult your healthcare provider for advice tailored to your specific circumstances when considering medication options.

Are there any potential serious side effects for Pristiq?

Pristiq, like any medication, can cause potential side effects. It is vital to be aware of these and seek medical attention if they occur:

  • Indications of an allergic reaction or severe skin response: hives, itching, fever, swollen glands in the neck, difficulty breathing or swallowing, facial swelling particularly around the mouth or throat area
  • Heightened feelings of depression and suicidal thoughts
  • Seizures (convulsions)
  • Unusual changes in mood or behavior including confusion and agitation
  • Blurred vision or eye pain
  • Fast heartbeat and high blood pressure; abnormal bleeding or bruising
  • Symptoms associated with serotonin syndrome: agitation, hallucinations, fast heart rate; sudden numbness/weakness on one side of the body.

If you experience any such symptoms while taking Pristiq consult your doctor immediately.

Contraindications for Lexapro and Pristiq?

Both Lexapro and Pristiq, like many other antidepressants, can potentially worsen symptoms of depression in some individuals. If you notice your depressive symptoms intensifying or an increase in suicidal thoughts or behaviors, it's crucial to seek immediate medical attention.

Neither Lexapro nor Pristiq should be taken if you are currently taking or have recently taken monoamine oxidase inhibitors (MAOIs). Always inform your healthcare provider about all the medications you're using; this is particularly important with MAOIs as they require approximately 14 days for clearance from the body before starting a new medication such as Lexapro or Pristiq to avoid hazardous drug interactions.

How much do Lexapro and Pristiq cost?

For the brand name versions of these drugs:

  • The price of 30 tablets of Lexapro (10 mg) averages around $350, which works out to about $12/day.
  • The price for 30 tablets of Pristiq (50 mg) is approximately $400, working out to roughly $13/day.

Thus, if you are on a standard dosage range for Lexapro (i.e., 10–20 mg/day), then brand-name Pristiq is slightly more expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.

For the generic versions, Escitalopram (Lexapro) and Desvenlafaxine ER (Pristiq), costs are significantly lower:

  • Escitalopram can be purchased in packs ranging from 5 up to 500 tablets with dosages varying from 5mg -20mg. Costs start as low as around $0.25 per day with larger pack sizes reducing this cost further.

  • Desvenlafaxine ER does not have many options regarding pack size but still offers significant savings over its branded counterpart at approximately between $1 and $2 per day depending on your prescribed dose.

Popularity of Lexapro and Pristiq

Escitalopram, also known by the brand name Lexapro, was estimated to have been prescribed to about 25.6 million people in the US in 2020. Escitalopram accounted for a substantial percentage of SSRI (Selective Serotonin Reuptake Inhibitor) prescriptions in the US, given its efficacy and tolerability profile. It has seen an increase in prevalence since its introduction.

Desvenlafaxine, including brand versions such as Pristiq, was prescribed to around 2.8 million people in the USA during the same period. As a serotonin-norepinephrine reuptake inhibitor (SNRI), desvenlafaxine accounts for a smaller proportion of overall antidepressant prescriptions compared to SSRIs like escitalopram due to it being used often as a second-line treatment after SSRI failure or intolerance. The prescription rate for desvenlafaxine has been relatively stable over recent years.


Both Lexapro (escitalopram) and Pristiq (desvenlafaxine) have an established history of use in treating depression, supported by numerous clinical trials showing them to be more effective than placebo. In some cases, these medications may be used together under careful physician supervision. The two drugs work differently: Lexapro is a selective serotonin reuptake inhibitor (SSRI), primarily affecting the neurotransmitter serotonin, while Pristiq is a serotonin-norepinephrine reuptake inhibitor (SNRI), impacting both serotonin and norepinephrine levels.

Lexapro is often considered as a first-line treatment for depression due to its efficacy and tolerability profile, whereas Pristiq may be prescribed when patients don't respond well to other antidepressants or if there's a need to avoid certain side effects associated with SSRIs such as sexual dysfunction.

Both drugs are available in generic form which can provide significant cost savings especially for those paying out-of-pocket. Both Lexapro and Pristiq might require some time before their full effect becomes noticeable.

The side-effects profile for both drugs is somewhat similar; they're generally well-tolerated but can cause nausea, dry mouth and sweating among others. However, sexual dysfunction tends to be less common with SNRIs like Pristiq compared with SSRIs such as Lexapro. Patients should closely monitor their mood changes while on medication therapy since any worsening of depression or suicidal thoughts should warrant immediate medical attention.