Lexapro vs. Pristiq
See how Lexapro and Pristiq compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Lexapro is an SSRI approved for both major depressive disorder and generalized anxiety disorder, while Pristiq is an SNRI approved only for major depressive disorder in adults.
Lexapro starts at 10 mg and may increase to 20 mg after two weeks, while Pristiq is prescribed at a single fixed dose of 50 mg from day one.
Pristiq's most common side effects, especially nausea and dry mouth, occur at notably higher rates than Lexapro's most common side effects.
Lexapro vs. Pristiq Drug Summary
Lexapro
Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat major depressive disorder and generalized anxiety disorder. It comes as a tablet or oral solution, taken once daily, usually starting at 10 mg before increasing to 20 mg if needed.
Pristiq
Pristiq (desvenlafaxine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved to treat major depressive disorder in adults. It is taken once daily as an extended-release tablet, typically at the 50 mg dose that is both the starting and therapeutic amount.
Lexapro vs. Pristiq Side Effects
Lexapro
Pristiq
Lexapro vs. Pristiq Dosage
Lexapro
Pristiq
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 20 mg once daily | Week 2 onward |
| Dose changes | 1 increase | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 50 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Lexapro
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 20 mg once daily | Week 2 onward |
| Dose changes | 1 increase | As tolerated |
Pristiq
| STAGE | DOSE | WHEN |
| Starting dose | 50 mg once daily | At the start |
| Maximum dose | 50 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Lexapro vs. Pristiq Indications
Lexapro
Lexapro is FDA-approved for major depressive disorder in adults and adolescents ages 12 to 17, and for generalized anxiety disorder in adults. It is not approved for pediatric anxiety or for depression in children under 12.
Major depressive disorder in adults
Major depressive disorder in adolescents (12-17)
Generalized anxiety disorder in adults
Pristiq
Pristiq is FDA-approved only for major depressive disorder in adults. It is not approved for use in children or adolescents, and its dose must be adjusted for significant kidney impairment.
Major depressive disorder in adults
Not approved for children or teens
Dose adjustment needed with kidney disease
Lexapro vs. Pristiq Pros and Cons
Lexapro
Lexapro's SSRI profile tends to cause fewer gastrointestinal and dizziness-related side effects than SNRIs like Pristiq. It also covers a broader range of approved uses, including generalized anxiety disorder and adolescent depression, which can matter for insurance coverage.
Pros
Approved for generalized anxiety disorder as well as depression
Approved for adolescents with major depressive disorder
Generally lower rates of nausea and dizziness than Pristiq
Cons
Requires a titration step from 10 mg to 20 mg
Not approved for anxiety disorders in children or teens
Ejaculation-related sexual side effects reported in up to 9% of patients
Pristiq
Pristiq's SNRI mechanism can help people who haven't responded well to SSRIs like Lexapro, and its single fixed dose simplifies treatment. However, it carries higher rates of nausea, dry mouth, and dizziness, and it is approved only for major depressive disorder.
Pros
Single fixed effective dose, no titration needed
May help patients who don't respond to SSRIs
Simple once-daily dosing from day one
Cons
Only approved for major depressive disorder in adults
Higher rates of nausea, dry mouth, and dizziness than Lexapro
Requires dose adjustment for kidney impairment
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.