Last Updated on May 13, 2024 by
Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD
WARNING: Never abruptly stop taking Pristiq©, as according to the FDA and other regulatory bodies, rapid or abrupt cessation can be extremely difficult to endure, and sometimes life-threatening. Always seek medical assistance for Pristiq withdrawal treatment.5,7-14,17
Pristiq withdrawal symptoms even when reducing the dosage slowly can be extremely hard to tolerate, and therefore need to be closely monitored. Some persons will have an easier time if gradual cessation is done in an inpatient-style program that can offer enough support and adjunctive therapies to significantly reduce the discomfort that can otherwise accompany cessation.
*Brain zaps are known to occur when coming off antidepressants, sometimes even when the withdrawal is done slowly. The phenomenon has been associated with lateral eye movements but remains poorly understood. There is no medical explanation beyond the observation that they occur commonly in antidepressant withdrawal.5
Pristiq (desvenlafaxine) is an FDA-approved SNRI drug in extended-release, oral pill form for treating MDD (major depressive disorder) and various off-label uses. Antidepressants are often prescribed off-label without strong evidence of their benefits relative to risks.6
Because Pristiq (desvenlafaxine) is a timed-release medication, it may be prudent in some cases for the prescribing physician to consider cross-tapering or other strategies to overcome this factor. Clinical expertise is essential for this method of withdrawal to be done correctly, but choosing this option may ultimately prove to be considerably easier for the patient.
Cross-tapering should only be done in an inpatient setting where close monitoring is possible. In this way, one can avoid any risks that can be associated with incorrect dosages, inappropriate drug interactions, or switching medications too abruptly.
It is recommended that a center be chosen that has demonstrated competence and familiarity with how to successfully negotiate through the cessation process so the withdrawals can be significantly mitigated. Done well, a correct and exact Pristiq taper supplemented with neurophysical and social support can be surprisingly mild.
Pristiq is a timed-release SNRI antidepressant. The drug interferes with serotonin and norepinephrine receptors in ways that are not completely understood. Researchers report that Pristiq acts aggressively on blocking serotonergic receptors at a 10:1 ratio over norepinephrine receptors.15 Stopping the drug suddenly carries certain risks to health.
Pristiq (desvenlafaxine) was initially approved for sale by the FDA in 2007 for the treatment of depressive disorders. The US patent expired around 2017, but Pfizer submitted a new drug application for an extended-release version of desvenlafaxine, called “Prism” to replace it, with a patent, once approved, that won’t expire until 2027.20 Pristiq was withdrawn from sale to European markets for undisclosed reasons. Many generic versions are found today.
Because of the statistics relating to suicidality which have been well documented during many clinical trials both before and after the drug was first approved, Pristiq is not approved to be prescribed for children, teens, or young adults under the age of 25. However, recent research has found that antidepressant drugs are ALSO associated with increased suicidality in adults, though this is not mentioned on the black box that accompanies all such drugs.4,19
Other risks are associated with Pristiq and other similar SNRI antidepressant drugs. All serotonergic medications should be monitored for rare but potentially lethal reactions such as serotonin syndrome and Stevens-Johnson Syndrome (see below for more detailed information). These potential health hazards are other reasons one might consider a medically monitored Pristiq withdrawal and transition to natural Pristiq alternatives.
There is a wide range of additional adverse effects associated with Pristiq (desvenlafaxine) which you will find listed further down in this article. Not everyone who takes Pristiq suffers extreme adverse reactions. Some will experience years of ongoing suffering without medical help, and some people will experience none at all. However, some adverse reactions can be life-threatening and would require appropriate medical intervention.
Where lingering and troublesome adverse effects outweigh the benefits, a person may want to stop taking Pristiq. But one should try to inform oneself of the best ways of stopping Pristiq. FDA guidelines are confusingly vague and very brief on Pristiq withdrawal. The guideline on the drug insert recommends that one reduce the drug as rapidly as possible, but not so quickly as to cause intolerable withdrawal symptoms.4 It is no wonder that doctors in the main are not well-prepared in helping their patients to come off drugs because unfortunately there is little to no training given in medical school on Pristiq withdrawal help. If you are seeking help with Pristiq withdrawal, seek inpatient care but if this is not possible, try and find a physician who is familiar with the process and who has confidence in their ability to help.
When a person elects to stop taking an SNRI medication, or any medication, it is always wise to seek as much information as possible before beginning the process. We can provide much information on request which may help greatly in planning a safe and even relatively comfortable Pristiq withdrawal. We urge you to share the information on this page with your prescriber. More information is given below on how to get off Pristiq and other topics related to Pristiq withdrawal help.
Desvenlafaxine is the generic name for Pristiq, which is FDA approved for the treatment of MDD (major depressive disorder) in adults, aged 25 and older.4
The drug is also prescribed off-label for hot flashes associated with menopause, and for women who experience particularly difficult symptoms relating to the menstrual cycle.
Pristiq is considered to be a “non-hormonal” treatment where an alternative hormone treatment is sought to address vasomotor conditions (relating to the muscles and nerves that regulate dilation and constriction of blood vessels) relating to a woman’s menstrual cycle.
Desvenlafaxine is the drug’s generic name. Pristiq is not known to be a popularized street drug but has been found in relatively uncommon pharmaceutical drug diversion cases as with other antidepressants. Sometimes called “poor man’s cocaine,” certain antidepressant prescription drugs are crushed and snorted or injected for a rush similar to other stimulant drugs like cocaine or crack. However, such practices often lead to a trip to the nearest hospital for emergency medical care.
Due to Pristiq’s extended-release structure, it is less subject to abuse than immediate-release antidepressant drugs. Perhaps viewed by some as a deterrent, fillers used in prescription pills may be toxic to the skin when injected, potentially creating very deep abscesses that are prone to infection, especially where neglect and poor hygiene can quickly escalate infection and lead to loss of life if left untreated.
Severe Pristiq adverse effects can occur as with any SNRI drug. These may require immediate medical intervention for the safety of the patient. It is important to be aware of these while taking an SNRI.
Adverse effects can be mild to extremely harsh and will affect different people in different ways.
Some of the most severe adverse reactions from Pristiq to be aware of are:
Serotonin Syndrome: When too much serotonin has been activated in the body this can result in a set of life-threatening symptoms including sudden fever, chills, depressed respiration, coma, unconsciousness, and death.
Stevens-Johnson Syndrome: This is a rare but severe hive-like reaction of the skin caused by certain medications such as Pristiq, which also targets moist tissues of the mouth, eyes, throat, airways, anus, etc. First presents with fever and flu-like symptoms, followed by the skin erupting into blisters that darken and peel away leaving raw painful tissue. Dehydration, sepsis, pneumonia, and multiple organ failure associated with this condition can lead to death.
Increased Suicidality: Pristiq causes an increased risk of suicide in children, teens, and young adults, especially under the age of 25, and is therefore not approved to be prescribed to this age range. However, trials and statistics also show increased suicidality risk in adult populations.1,4,19
Below are some of the most common questions regarding Pristiq (desvenlafaxine).
It is thought that an SNRI drug affects two types of chemicals that act as messengers within the brain and central nervous system. One of these is serotonin, a neurochemical that is responsible for regulating things like mood, sexual function, digestion, memory, and many, many other functions of health. Serotonin is an inhibitory agent that allows us to relax the fight or flight responses so that these activities are possible. The other neurochemical that SNRI drugs affect is norepinephrine, which is a direct precursor to adrenaline, the fight-or-flight response neurotransmitter. Norepinephrine is associated with mental focus and learning, yet too much of it clinically presents as anxiety.
SNRI drugs keep serotonin and norepinephrine suspended in the nerve synapses, instead of allowing them to be reabsorbed into and along the nerve pathway. When these agents accumulate, they act more intensely, sometimes with unpredictable results.
However, these natural chemicals will eventually degrade and become waste products, instead of being reabsorbed and recycled ready to be used again. This may result in a deficiency as Pristiq does not create more serotonin or norepinephrine, only a healthy body can do that. This mechanism explains how drugs develop diminished efficacy over time.2
If the Pristiq withdrawal is too fast, there is a high risk of relapse, and lengthening the overall process. If the process is too difficult, even if slowly done, and no other guidance or support of any kind is offered, it can be extremely hard to escape relapse as the symptoms of Pristiq withdrawal can be intolerable. There are many beneficial actions that can ease the discomforts that are commonly experienced when trying to stop taking Pristiq.
However, Pristiq withdrawal can be made much easier to tolerate by choosing inpatient treatment, where constant monitoring is routine, and minute changes to dosage may be helpful within a withdrawal schedule designed to fit the urgent and most pressing needs of an individual.
Alternative to Meds Center uses lab testing to help prepare the body for the withdrawal process. If vitamin or mineral deficiencies are present, these can be corrected through supplementation and a carefully planned diet for maximizing the body’s ability to normalize neurochemistry after prescription drugs have created changes that altered or compromised it.
The presence of neurotoxic materials can have a detrimental effect on the central nervous system. Such symptoms as insomnia, depression, and anxiety are linked to certain toxic substances like heavy metals, pesticides, chemicals in foods, cleaners, and many other sources. These toxic accumulations, however prevalent in our modern lifestyles, can be isolated and gently purged, as a very effective way to prepare for and ease a smooth cessation process.
Alternative to Meds Center can provide much more information on request about our center’s safe methods, holistic therapies, diet, nutrition, removal of toxic burden, and many more helpful techniques that can significantly ease Pristiq withdrawal treatment.
1. NAMI authors, “Desvenlafaxine (Pristiq)” National Alliance on Mental Illness [online publication] December 2018 [cited 2022 July 27]
2. Zhang, G., Gao, Z., Guan, S. et al. “Upregulation of excitatory neurons and downregulation of inhibitory neurons in barrel cortex are associated with loss of whisker inputs.” Mol Brain6,&2 (2013). https://doi.org/10.1186/1756-6606-6-2 [cited 2022 July 27]
3. Guzman F MD “Venlafaxine and Desvenlafaxine: Differences and Similarities” Psychopharmacology Institute, 2019 Jun 27 [cited 2022 July 27]
4. FDA drug label Pristiq (desvenlafaxine) 2008 [cited 2022 July 27]
5. Papp A, Onton JA. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. Prim Care Companion CNS Disord. 2018 Dec 20;20(6):18m02311. doi: 10.4088/PCC.18m02311. PMID: 30605268. [cited 2022 July 27]
6. Wong J, Motulsky A, Abrahamowicz M, Eguale T, Buckeridge DL, Tamblyn R. Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system. BMJ. 2017;356:j603. Published 2017 Feb 21. doi:10.1136/bmj.j603 [cited 2022 July 27]
7. Rosenbaum JF, Zajecka J. Clinical management of antidepressant discontinuation. J Clin Psychiatry. 1997;58 Suppl 7:37-40. PMID: 9219493. [cited 2022 July 27]
8. Henssler J, Heinz A, Brandt L, Bschor T. Antidepressant Withdrawal and Rebound Phenomena. Dtsch Arztebl Int. 2019;116(20):355-361. doi:10.3238/arztebl.2019.0355 [cited 2021 Jun 14]
9. Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017;189(21):E747. doi:10.1503/cmaj.160991 [cited 2022 July 27]
10. Berber MJ. FINISH: remembering the discontinuation syndrome. Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory disturbances, and Hyperarousal (anxiety/agitation). J Clin Psychiatry. 1998 May;59(5):255. PMID: 9632038. [cited 2022 July 27]
11. Dilsaver SC, Greden JF. Antidepressant withdrawal phenomena. Biol Psychiatry. 1984 Feb;19(2):237-56. PMID: 6324897. [cited 2022 July 27]
12. Dilsaver SC, Kronfol Z, Sackellares JC, Greden JF. Antidepressant withdrawal syndromes: evidence supporting the cholinergic overdrive hypothesis. J Clin Psychopharmacol. 1983 Jun;3(3):157-64. PMID: 6348107. [cited 2021 Jun 14]
13. Wolfe RM. Antidepressant withdrawal reactions. Am Fam Physician. 1997 Aug;56(2):455-62. Erratum in: Am Fam Physician 1998 Feb 15;57(4):646. PMID: 9262526. [cited 2022 July 27]
14. Howland RH. Potential adverse effects of discontinuing psychotropic drugs: part 2: antidepressant drugs. J Psychosoc Nurs Ment Health Serv. 2010 Jul;48(7):9-12. doi: 10.3928/02793695-20100527-98. Epub 2010 Jun 22. PMID: 20608581. [cited 2022 July 27]
15. Naseeruddin R, Rosani A, Marwaha R. Desvenlafaxine. [Updated 2021 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534829/ [cited 2022 July 27]
16. Skanland S, Cieslar Pobuda A, “Off-label uses of drugs for depression.” European Journal of Pharmacology Vol 865, 15 December 2019, 172732 as published in Science Direct [cited 2022 July 27]
17. Liebowitz MR, Tourian KA. Efficacy, safety, and tolerability of Desvenlafaxine 50 mg/d for the treatment of major depressive disorder:a systematic review of clinical trials. Prim Care Companion J Clin Psychiatry. 2010;12(3):PCC.09r00845. doi:10.4088/PCC.09r00845blu [cited 2022 July 27]
18. Thase ME, Fayyad R, Cheng RF, Guico-Pabia CJ, Sporn J, Boucher M, Tourian KA. Effects of desvenlafaxine on blood pressure in patients treated for major depressive disorder: a pooled analysis. Curr Med Res Opin. 2015 Apr;31(4):809-20. doi: 10.1185/03007995.2015.1020365. Epub 2015 Mar 26. PMID: 25758058. [cited 2022 July 27]
19. Hengartner M, Ploderl M, Newer-generation Antidepressants and Suicide Risk …. published in the Journal of Psychotherapy Psychosomatics [published June 4, 2019] [cited 2024 April 29]
20. Pristiq US Patents Patent 8269040 Expiry published online (ND) [cited 2024 April 29]
Originally Published Sep 13, 2018 by Diane Ridaeus
Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona. He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine. Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
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