Panic Disorder Treatment Pristiq (Desvenlafaxine) for Anxiety and Panic Disorder Timeline, Side Effects, and Risks By Katharina Star, PhD Katharina Star, PhD Facebook LinkedIn Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. Learn about our editorial process Updated on December 15, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Tom Varco / Wikimedia Commons Table of Contents View All Table of Contents Overview Uses Side Effects Timeline Dosage Precautions Withdrawal Antidepressant medications are frequently prescribed to help manage the symptoms of anxiety and panic disorder. One such option is Pristiq. Learn how Pristiq can help these conditions, along with its potential side effects, the timeline for working, dosage amount, precautions, and the capacity for withdrawal. What Is Pristiq? Pristiq (desvenlafaxine) belongs to a class of antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications reduce the absorption of serotonin and norepinephrine in the brain and were first used to treat mood disorders, such as major depressive disorder (MDD). SNRIs were later found to be an effective treatment for a variety of mental health conditions. Today, in addition to being used to help treat MDD, they are also prescribed for anxiety disorders, panic disorder, and social phobia. Some SNRIs have also been found beneficial in the treatment of medical conditions such as diabetic peripheral neuropathy, chronic musculoskeletal pain, stress urinary continence, and hot flushes from menopause and breast cancer. Pristiq for Anxiety and Panic Disorder The U.S. Food and Drug Administration (FDA) has approved Pristiq for the treatment of MDD. However, it also has a few off-label uses, of which anxiety and panic disorder are two. Anxiety Nearly one in five people in the U.S. have an anxiety disorder, making this the most common mental health disorder nationwide. Anti-anxiety medications (anxiolytics) are one pharmacological treatment option. But research has found that desvenlafaxine—known by the brand name Pristiq—provides benefits as well. For example, in a 12-week double-blind study, desvenlafaxine was found effective for easing generalized social anxiety disorder. In this case, the group receiving the drug had a 9.7-point greater reduction in their anxiety scores than those receiving a placebo. A 2019 study compared the effects of desvenlafaxine with escitalopram, a generic drug with the trademark name Lexapro, for postmenopausal women with anxiety and depression. While escitalopram was more effective for treating depressive symptoms, the drugs were equally able to reduce anxiety. Panic Disorder Naturally occurring chemicals in the brain, known as neurotransmitters, are responsible for various bodily functions. These chemical messengers are believed to be imbalanced for those with mental health conditions. Antidepressants work to restabilize certain neurotransmitters. Pristiq, specifically, impacts the neurotransmitters serotonin and norepinephrine, both of which are thought to be dysregulated in people with panic disorder. Serotonin influences many functions, including mood and sleep regulation. Norepinephrine is connected to the fight-or-flight response, which is the way we react to stress and anxiety. Pristiq can help bring equilibrium to both, leading to reduced anxiety, less severe panic attacks, and enhanced mood. Taking SNRIs for Treating Panic Disorder Potential Side Effects of Pristiq As with any prescribed medication, there are potential side effects of taking Pristiq. Common Side Effects Some of Pristiq's most common side effects include: ConstipationDecreased appetiteDiarrheaDry mouthFatigueHeadacheIncreased sweatingInsomniaNauseaNervousnessRestlessnessTremorsVomiting You may experience some, all, or none of these effects. If you do, they typically diminish or become more manageable within a week or two of starting this medication. If they persist or worsen, consult your healthcare provider. If you experience sexual side effects or your blood pressure increases when taking Pristiq, these typically won't improve with time. Serious Side Effects Other Pristiq side effects can be more serious, making it important to contact your healthcare provider or seek emergency medical attention if any of these occur. Some of the rare but also more serious side effects of Pristiq include: Angle-closure glaucoma Changes in taste Heart attack Increased heart rate or severely elevated blood pressure Increased salivation Increased urination frequency or trouble urinating Irregular menstrual cycle Low blood pressure Low sodium Rash Serotonin syndrome Teeth grinding If the patient has an allergic reaction to this medication, this can also be serious. Signs of an allergic reaction include hives, swelling of the face or tongue, and difficulty breathing. If any of these occur, seek medical treatment immediately. How Long It Takes Pristiq to Work You probably won't notice an immediate improvement in your anxiety or panic disorder when taking Pristiq. This is because it takes approximately four to five days to reach a steady state of this drug in the blood. After one to two weeks, you may notice that you are sleeping better, have more energy, or that your appetite is improved. Mmood-related effects generally take a bit longer, or up to eight weeks to improve fully. Pristiq Dosage Information Pristiq is delivered via extended-release tablets that come in one of three doses: 25 mg: A square tan tablet with "W 25" imprinted on it50 mg: A square light pink tablet with "W 50" imprinted on it100 mg: A square orange tablet with "W 100" imprinted on it The recommended dosage is 50 mg, taken once daily; although, more may be needed to provide the desired effect. The 25 mg tablets are generally used to reduce the drug slowly when discontinuing treatment. If you are prescribed Pristiq for anxiety or panic disorder, the tablets should be taken whole (don't crush or cut them), and you can take them with or without food. Pristiq Overdose Pristiq overdose is rare but can occur if this drug is taken in high amounts. One study found 182 cases of desvenlafaxine overdose over a six-year period, 75 of which involved taking this medication only and 107 involving the use of this drug and at least one other. Symptoms associated with Pristiq overdose included mild hypertension (high blood pressure) and tachycardia (heart rate over 100 beats per minute). None of the overdoses studied required intensive care treatment or resulted in death, and the risk of having seizures or developing serotonin toxicity was low. If a Pristiq overdose is suspected, contact the person's healthcare provider or call the Poison Control Center at 1-800-222-1222 for guidance. Precautions for Pristiq Some of the precautions to be aware of when taking Pristiq for anxiety or panic disorder include: Black box warning: In 2007, Pristiq and other antidepressants were given what's called a “black box warning.” This label was prompted by the FDA after it was determined that these medications could potentially increase the user’s risk of suicidal thoughts and behaviors. Adolescents and young adults can be especially impacted by this possible side effect. Any young person taking Pristiq must be closely monitored for mood alterations and suicidal thoughts. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Alcohol consumption: Drinking alcohol is not recommended while taking Pristiq as doing so may increase the toxicity of this medication. Mixing alcohol with Pristiq can also lead to the drug being ineffective.Pregnancy/nursing: It's possible to pass Pristiq to a child during pregnancy or through breast milk. If you're pregnant or nursing, consult your practitioner about the possible risks of taking Pristiq.Children and teens: Studies have found that 25 mg to 50 mg of desvenlafaxine per day is generally considered safe for pediatric patients. However, the FDA does say that safety has not been established for this demographic, so the potential risks must be balanced with clinical need. The child's healthcare provider can help decide if Pristiq should be used.Older adults: The cardiovascular side effects of Pristiq can be more intense for older adults. Monitoring and, if needed, reducing the dosage amount can help reduce these potential effects. Interactions Pristiq can interact with certain medications, potentially increasing or decreasing the drug's response. Drugs that can negatively interact with Pristiq include: Antiplatelet or anticoagulant drugs Monoamine oxidase inhibitors (MAOIs) Other serotonergic drugs MAOIs should not be taken within 14 days of stopping or starting Pristiq. Withdrawal From Pristiq When discontinuing Pristiq, your healthcare provider will likely reduce your dosage slowly to help reduce any unwanted effects. If Pristiq is stopped abruptly, withdrawal may occur, creating symptoms such as: Abnormal dreamsAnxietyDiarrheaDizzinessFatigueHeadacheHyperhidrosis (excessive sweating)InsomniaIrritabilityNausea These withdrawal symptoms can also occur in people who have been taking Pristiq for a long period of time. A Word From Verywell Pristiq can help with anxiety and panic disorder symptoms, though this drug isn't without its potential side effects and isn't safe for everyone. Always consult your medical provider or pharmacist with any questions or concerns you may have about your Pristiq prescription. Medications for Treating Panic Disorder 14 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialog Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelow Bighelli I, Castellazzi M, Cipriani A, et al. Antidepressants versus placebo for panic disorder in adults. Cochrane Database Syst Rev. 2018;4:CD010676. doi:10.1002/14651858.CD010676.pub2 Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: A pharmacological comparison. Innov Clin Neurosci. 2014;11(3-4):37-42. Mental and Behavioral Health. Serotonin norepinephrine reuptake inhibitors (SNRIs). Anxiety & Depression Association of America. Anxiety disorders - Facts & statistics. Liebowitz MR, Salmán E, Johnso A, Hanover R. A 12-week double-blind placebo-controlled, flexible-dose trial of desvenlafaxine extended-release tablets in generalized social anxiety disorder. J Depress Anxiety. 2015:S1. doi:10.4172/2167-1044.S1-014 Shinde Mahajan S, Tandon VR, Arora M, Mahajan A, Kotwal S. Comparative efficacy and safety of escitalopram versus desvenlafaxine in postmenopausal women with depression and anxiety: A randomized, open-label, comparative trial. J Midlife Health. 2019;10(3):141-146. doi:10.4103/jmh.JMH_139_18 National Alliance on Mental Illness. Desvenlafaxine (Pristiq). U.S. Food and Drug Administration. Pristiq (desvenlafaxine) extended-release tablets, oral. Pfizer. Pristiq dosage and administration. Cooper JM, Brown JA, Cairns R, Isbister GK. Desvenlafaxine overdose and the occurrence of serotonin toxicity, seizures and cardiovascular effects. Clin Toxicol. 2017;55(1):18-24. doi:10.1080/15563650.2016.1223847 Friedman RA. Antidepressants' black-box warning—10 years later. NE J Med. 2014;371:1666-1668. doi:10.1056/NEJMp1408480 Atkinson S, Lubaczewski S, Ramaker S, et al. Desvenlafaxine versus placebo in the treatment of children and adolescents with major depressive disorder. J Child Adolesc Psychopharmacol. 2018;28(1):55-65. doi:10.1089/cap.2017.0099 Behlke LM, Lenze EJ, Carney RM. The cardiovascular effects of newer antidepressants in older adults and those with or at high risk for cardiovascular diseases. CNS Drugs. 2020;34:1133-1147. doi:10.1007/s40263-020-00763-z Additional Reading Dell'Osso B, Buoli M, Baldwin DS, Altamura A. Serotonin norepinephrine reuptake inhibitors (SNRIs) in anxiety disorders: a comprehensive review of their clinical efficacy. Human Psychopharmacol Clin Exper. 2009;25(1):17-29. doi:10.1002/hup.1074 Silverman HM. The Pill Book. By Katharina Star, PhD Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. 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