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

Most common
Nausea (up to 15%)
Insomnia (up to 9%)
Ejaculation disorder (up to 9%)
Somnolence (up to 6%)

Pristiq

Most common
Nausea (up to 41%)
Dry mouth (up to 25%)
Dizziness (up to 16%)
Constipation (up to 14%)

Lexapro vs. Pristiq Dosage

Lexapro

Dosage
Dosage Table
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

Dosage
Dosage Table
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.