Prozac vs. Pristiq
See how Prozac and Pristiq compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Prozac (an SSRI) treats depression, OCD, bulimia, and panic disorder, while Pristiq (an SNRI) is FDA-approved only for major depressive disorder in adults.
Pristiq uses one fixed 50 mg daily dose, while Prozac requires titration and offers multiple formulations, including a once-weekly capsule.
Nausea is the most common side effect for both drugs, but Pristiq's rate (up to 41%) is notably higher than Prozac's (up to 21%).
Prozac vs. Pristiq Drug Summary
Prozac
Prozac is a selective serotonin reuptake inhibitor (SSRI) approved for major depression, OCD, bulimia nervosa, and panic disorder. It comes as a capsule, delayed-release weekly capsule, tablet, or liquid, typically starting at 20 mg once daily.
Pristiq
Pristiq is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved for major depressive disorder in adults. It is taken as a single extended-release tablet once daily, with 50 mg serving as both the starting and target dose.
Prozac vs. Pristiq Side Effects
Prozac
Pristiq
Prozac vs. Pristiq Dosage
Prozac
Pristiq
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 2 increases | 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 |
Prozac
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 90 mg once weekly | If needed |
| Dose changes | 2 increases | 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 |
Prozac vs. Pristiq Indications
Prozac
Prozac carries the broadest set of FDA approvals among SSRIs, covering major depression, OCD, bulimia nervosa, and panic disorder. It is also the only SSRI approved alongside olanzapine for bipolar depression and treatment-resistant depression.
Major depressive disorder
Obsessive-compulsive disorder (OCD)
Bulimia nervosa
Panic disorder
Pristiq
Pristiq is FDA-approved only for treating major depressive disorder in adults. It does not have additional approvals for anxiety disorders, OCD, or other conditions that broader-spectrum antidepressants sometimes treat off-label.
Major depressive disorder (MDD) in adults
Only FDA-approved indication for this drug
Not approved for children or teens
Same 50 mg dose used for most patients
Prozac vs. Pristiq Pros and Cons
Prozac
Prozac has one of the longest track records of any antidepressant, with FDA approvals spanning depression, OCD, bulimia, and panic disorder. Its long-acting active metabolite makes withdrawal symptoms less likely if a dose is missed, though the same property means it stays in the body longer if side effects need to resolve.
Pros
Approved for OCD, bulimia, and panic disorder, not just depression
Long half-life lowers withdrawal risk if a dose is missed
Available as capsule, tablet, liquid, and once-weekly capsule
Cons
Insomnia and anxiety are common and can feel activating early on
Cannot be combined with MAOIs, pimozide, or thioridazine
Not approved for generalized anxiety disorder as monotherapy
Pristiq
Pristiq is approved only for major depression in adults, with a simple one-dose regimen that skips the need for titration. As an SNRI, it also affects norepinephrine, which can produce side effects like sweating and dry mouth that differ from a typical SSRI profile.
Pros
Fixed 50 mg dose from day one, no titration schedule needed
Simple once-daily extended-release tablet
Higher doses showed no added benefit, simplifying dosing decisions
Cons
Approved only for MDD, a narrower range of uses than Prozac
Higher reported rates of nausea, dry mouth, and dizziness
Typically costs $400 to $543 a month, far more than generic Prozac
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