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Remeron vs Pristiq

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For individuals with major depressive disorder (MDD) or other forms of depression, specific drugs that adjust the levels of brain compounds related to mood, known as neurotransmitters, can aid in reducing depressive lows and managing symptoms. Remeron and Pristiq are two such medications often prescribed for depression. They both influence different neurotransmitters in the brain but have a common outcome: stabilizing mood in patients dealing with depression.

Remeron, also known as mirtazapine, is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA), primarily affecting norepinephrine and serotonin receptors. This medication works by enhancing the activity of certain chemicals within the nervous system to maintain mental balance.

On the other hand, Pristiq or desvenlafaxine falls under selective serotonin-norepinephrine reuptake inhibitors (SNRI). It functions by restoring equilibrium among serotonin and norepinephrine - two naturally occurring substances found within our brains which help maintain mental health.

Remeron vs Pristiq Side By Side

Brand NameRemeronPristiq
ContraindicationsShould not be taken with or recently after MAO inhibitors.Should not be taken with or recently after MAO inhibitors.
CostFor brand name: around $425 for 30 tablets of 15 mg. Generic: $0.25 to over $1 per day depending on dose.For brand name: about $350 for 30 tablets of 50mg. Generic: $.60 - $.80 per tablet.
Generic NameMirtazapineDesvenlafaxine
Most Serious Side EffectIncreased thoughts about suicide or self-harm, especially in people under 25.Increased suicidal thoughts or behaviors particularly among children and young adults under the age of 24.
Severe Drug InteractionsMAO inhibitors.MAO inhibitors.
Typical Dose15-45 mg/day, starting dose of 15 mg/day at bedtime.50 mg/day, can be increased to a maximum of 400 mg/day based on response and tolerability.

What is Remeron?

Mirtazapine (the generic name for Remeron) was approved by the FDA in 1996 and belongs to a class of antidepressants known as tetracyclic antidepressants. This drug is different from SSRIs, as it increases levels of both serotonin and norepinephrine in the brain. Mirtazapine does this by blocking receptors that when activated, lead to feelings of depression and anxiety.

On the other hand, desvenlafaxine (the generic name for Pristiq) was approved by the FDA in 2008 and belongs to a newer class of antidepressants known as serotonin-norepinephrine reuptake inhibitors (SNRIs). Like Remeron, Pristiq works by increasing levels of both serotonin and norepinephrine in the brain but does so differently - it prevents these neurotransmitters from being reabsorbed into nerve cells.

While both drugs are used for treating major depressive disorder, they have different side effect profiles due to their mechanisms of action. For example, because Remeron increases free levels of norepinephrine along with serotonin — which can stimulate appetite — one common side effect is weight gain. In contrast, Pristiq's more balanced influence on these two neurotransmitters results in fewer effects on appetite or sleep patterns.

What conditions is Remeron approved to treat?

Remeron (mirtazapine) is approved for the treatment of several forms of depression:

  • Major depressive disorder (MDD)
  • Dysthymia, a chronic type of depression where moods are regularly low
  • Mixed anxiety and depressive disorders

On the other hand, Pristiq (desvenlafaxine) is also used to treat:

  • Major Depressive Disorder (MDD)
  • Menopausal symptoms like hot flashes.

How does Remeron help with these illnesses?

Remeron, known generically as mirtazapine, helps manage depression by increasing the availability of norepinephrine and serotonin in your brain. It achieves this by blocking specific adrenergic receptors which results in an increased release of these neurotransmitters into the synapses. Norepinephrine is involved with attention and response actions while serotonin plays a significant role in body temperature, mood, sleep patterns, appetite and more. Like Prozac's relationship with serotonin levels, it's believed that individuals battling depression may have lower levels of norepinephrine and serotonin. Therefore by enhancing their presence through Remeron administration can help mitigate depressive symptoms allowing patients to stabilize their mood better.

What is Pristiq?

Pristiq, also known by its generic name desvenlafaxine, is a serotonin-norepinephrine reuptake inhibitor (SNRI). This means it increases the levels of both serotonin and norepinephrine in your brain by reducing their absorption. It doesn't act on other neurotransmitters like acetylcholine or dopamine. Pristiq was approved by the FDA in 2008 and is commonly used for treating major depressive disorder. Unlike Remeron, which is a noradrenergic antagonist specific serotonergic antidepressant (NaSSA), Pristiq does not block histamine or alpha-1 adrenergic receptors, meaning that patients are less likely to experience side effects such as weight gain or sedation often associated with these kinds of drugs. Furthermore, because it acts on both serotonin and norepinephrine, Pristiq can be beneficial for treating depression symptoms in patients who do not respond well to typical SSRI antidepressants like Prozac.

What conditions is Pristiq approved to treat?

Pristiq is a medication that has been approved for use in treating:

  • Major depressive disorder (MDD)

Although not formally approved for these conditions, it may also be used off-label to treat menopausal symptoms and attention-deficit/hyperactivity disorder. It's important to consult with a healthcare professional before starting or changing any medication regimen.

How does Pristiq help with these illnesses?

Pristiq, like Remeron, is an antidepressant that works by affecting the balance of chemicals in the brain. Specifically, Pristiq targets serotonin and norepinephrine, two neurotransmitters that play significant roles in mood regulation. By blocking their reuptake, Pristiq increases the levels of these key neurotransmitters available in the brain. This can help to alleviate some of the symptoms associated with depression such as sadness, lack of interest in activities once enjoyed or trouble concentrating. Unlike Remeron which also has a notable effect on histamine and alpha-2 receptors leading to increased appetite and sleepiness respectively, Pristiq’s action primarily focuses on serotonin and norepinephrine without significantly influencing other systems. Consequently, it may be chosen when a patient does not respond well to other types of antidepressants or prefers to avoid certain side effects.

How effective are both Remeron and Pristiq?

Both mirtazapine (Remeron) and desvenlafaxine (Pristiq) are well-established in treating depression, with the former approved by the FDA in 1996 and the latter gaining approval more recently in 2008. As they operate on different neurotransmitter systems, their prescription can vary depending on individual patient circumstances. A head-to-head clinical trial comparing both drugs is currently lacking; however, numerous separate studies have shown their effectiveness against major depressive disorder.

A systematic review conducted in 2011 highlighted that mirtazapine starts alleviating symptoms of depression from the first week of treatment, which is sooner than many other antidepressants. Its side effect profile includes sedation, weight gain and increased appetite - factors to consider when prescribing this medication. Despite these potential drawbacks, Remeron remains a widely used option due to its unique mechanism of action involving various neurotransmitter pathways such as serotonin and norepinephrine.

On the other hand, a meta-analysis carried out in 2016 showed Pristiq's efficacy is comparable to that of other commonly used antidepressants including SSRIs and SNRIs. While typically not a first-line therapy like some SSRIs or TCAs might be, it holds importance for patients who do not respond adequately to initial treatments or those who experience severe side effects from them. Most research related to Pristiq involves it being prescribed alone rather than alongside another drug class making its stand-alone efficacy data more robust compared to some alternatives like bupropion.

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At what dose is Remeron typically prescribed?

Oral dosages of Remeron typically range from 15-45 mg/day, but studies have indicated that a starting dose of 15 mg/day at bedtime is sufficient for treating major depressive disorder in most people. Children and adolescents should only take this medication under the direct supervision of a healthcare professional. In either population, dosage can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded in any case is 45 mg/day.

On the other hand, oral dosages of Pristiq usually start at 50 mg once daily, with or without food. Dosage adjustments to levels above 50mg are generally used after several weeks if patients have not responded to lower doses and if they tolerate Pristiq well. In any case, the maximum recommended dose per day should not exceed 400mg.

At what dose is Pristiq typically prescribed?

Pristiq treatment is typically initiated at a dosage of 50 mg/day, taken once daily. The dose can then be increased to a maximum of 400 mg/day based on individual patient response and tolerability. However, it's worth noting that an increase in dose above the recommended starting dose has not been shown to provide additional benefit. Therefore, exceeding the initial dosage should only be considered after several weeks if the patient hasn’t responded adequately to therapy at this level. As always, any alterations in medication doses should be under direct supervision and recommendation from your healthcare provider.

What are the most common side effects for Remeron?

Common side effects of Remeron (mirtazapine) include:

  • Drowsiness, dizziness
  • Increased appetite and weight gain
  • Dry mouth
  • Constipation
  • Joint or muscle pain

On the other hand, Pristiq (desvenlafaxine) can cause:

  • Nausea, vomiting, diarrhea
  • Reduced appetite and weight loss
  • Sweating, hot flashes
  • Insomnia
  • Dizziness, -Anxiety.

Both medications may impact sexual desire or ability. However, individual reactions to each medication will vary. It's important to discuss any concerns with your healthcare provider before switching between these two drugs.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Remeron?

When comparing Remeron to Pristiq, it's important to note that both may carry the risk of certain side effects. For example:

  • Increased thoughts about suicide or self-harm, especially in people under 25
  • Signs of allergic reactions such as hives, difficulty breathing, swelling in your face or throat
  • Vision changes including blurred vision and dilated pupils; this can be accompanied by eye pain/swelling/redness, severe discomfort with bright lights
  • Heart changes such as fast or pounding heartbeats, fluttering sensation in the chest; these symptoms could also be associated with shortness of breath and sudden dizziness
  • Low sodium levels - headache, confusion, slurred speech; other signs might include severe weakness/vomiting/loss of coordination/unsteady feeling
  • Severe nervous system reaction - very stiff (rigid) muscles/cold sweats/confusion/fast/uneven heartbeats/tremors/fainting. In rare cases serotonin syndrome: marked agitation/hallucinations/high fever/sweating/shivering/fast heart rate/muscle stiffness/twitching/loss of coordination/nausea/vomiting/diarrhea.

If you experience any unusual symptom while taking either medication please consult your doctor immediately.

What are the most common side effects for Pristiq?

The side effects of Pristiq may include:

  • Nausea, vomiting, stomach pain, loss of appetite
  • Sleep problems (insomnia) or abnormal dreams
  • Dry mouth or sore throat
  • Sweating more than usual
  • Mild headache, feeling dizzy or drowsy
  • Increased blood pressure resulting in blurred vision and ringing in the ears
  • Constipation and increased urination
  • Weight loss due to decreased appetite -Tremors, feeling anxious or nervous with a higher heartbeat.

Remember these are potential side effects and not everyone who takes Pristiq will experience them. However if they persist longer than expected it is important that you consult your healthcare provider immediately.

Are there any potential serious side effects for Pristiq?

While Pristiq is generally well-tolerated, it can occasionally cause serious side effects. These may include:

  • Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue or throat.
  • Increased suicidal thoughts or behaviors particularly among children and young adults under the age of 24 during initial treatment.
  • Changes in mood or behavior like anxiety, agitation, panic attacks, insomnia, irritability, hostility (aggressiveness), impulsivity or restlessness.
  • Serotonin syndrome: symptoms may include agitation, hallucinations (seeing things that are not there), coma, fast heart rate, slow heartbeat when standing up from sitting down which could lead to fainting
  • Vision problems: eye pain changes in vision including blurred vision
  • Unusual bleeding or bruising under the skin It's important to seek immediate medical attention if you experience any of these symptoms while taking Pristiq. Your health care provider will be able to guide you through the necessary steps for managing these reactions effectively.

Contraindications for Remeron and Pristiq?

Both Remeron and Pristiq, like most other antidepressant medications, may worsen symptoms of depression in some individuals. If you observe your depression intensifying or if there is an escalation in suicidal thoughts or behaviors, it's crucial that you seek immediate medical attention.

Neither Remeron nor Pristiq should be taken if you're currently taking, or have recently stopped taking monoamine oxidase (MAO) inhibitors. It's vital to disclose all medications you are on to your doctor; MAOIs will necessitate a period of about 2 weeks without these drugs for clearance from the system before starting treatment with Remeron or Pristiq to avoid dangerous interactions.

How much do Remeron and Pristiq cost?

For the brand name versions of these drugs:

  • The price of 30 tablets of Remeron (15 mg) averages around $425, which works out to approximately $14/day.
  • The price for a month's supply (30 tablets) of Pristiq (50mg) is about $350, working out to roughly $12/day.

Thus, if you are in the higher dosage range for Remeron (i.e., 45 mg/day or higher), then brand-name Pristiq is less expensive on a per-day treatment basis. Please remember that cost should not be your main consideration when deciding which drug is right for you.

Regarding generic versions, costs get significantly lower:

  • Mirtazapine (generic version of Remeron), at dosages between 15 and 45 mg per day, can cost anywhere from around $0.25 to over a dollar per day depending on the dose and where it’s purchased.
  • Desvenlafaxine ER Tablets - Generic Pristiq ranges from about $.60 - $.80 cents per tablet depending upon pharmacy pricing and insurance coverage.

As always keep in mind that while generics offer substantial savings, their effectiveness may vary slightly due to different inactive ingredients such as fillers or dyes. It's also important to note that prices can fluctuate based on factors like location, pharmacy used and whether or not they accept insurance.

Popularity of Remeron and Pristiq

Mirtazapine, also known by brand names such as Remeron, was estimated to have been prescribed to about 2 million people in the US in 2020. Mirtazapine accounted for approximately 4% of antidepressant prescriptions in the US. It is classified as an atypical antidepressant due to its unique mechanism of action compared to SSRI and other broad classes of antidepressants. Over the past few years, mirtazapine has seen a steady increase in prescription rates.

Desvenlafaxine, including brand versions such as Pristiq, was prescribed to nearly 1 million people in the USA in 2020. In terms of SNRI prescriptions (serotonin-norepinephrine reuptake inhibitors), desvenlafaxine accounts for about 10%. The overall prevalence of desvenlafaxine has remained relatively stable over the last decade.


Both Remeron (mirtazapine) and Pristiq (desvenlafaxine) have proven efficacy in treating depression, supported by numerous clinical studies indicating they are more effective than placebo treatments. They may sometimes be used in combination, but this requires careful consideration by a healthcare provider due to potential interactions. Each drug has a different mechanism of action: Remeron primarily enhances the neurotransmission of norepinephrine and serotonin, while Pristiq is a selective serotonin and norepinephrine reuptake inhibitor.

Remeron is often considered for patients who have trouble sleeping or lack appetite due to its sedative effects and ability to stimulate weight gain. On the other hand, Pristiq might be preferred when these side-effects are not desirable or beneficial.

Both drugs are available as generics which can lead to significant cost savings for patients paying out-of-pocket. Both Remeron and Pristiq also require an adjustment period; immediate effects should not necessarily be expected after first starting treatment.

The side effect profile varies between both drugs with each having unique considerations; however, they're generally well-tolerated overall. Patients must closely monitor their moods when beginning treatment with either drug and seek medical attention immediately if depressive symptoms worsen or suicidal thoughts occur.