Cymbalta vs. Pristiq

Finding the proper anti-anxiety medication can be a daunting task. With so many treatment options available in today’s market, it can be difficult to understand the differences between medications and which one may work best for you. 

Cymbalta and Pristiq are two commonly prescribed SNRI medications used to treat anxiety and depression. In this article, we will discuss the key similarities and differences between these two medications so that you can be better informed when discussing anxiety treatment options with your healthcare provider. 

If you are suffering from anxiety or depression, Klarity can help. The providers on Klarity are compassionate and experienced in providing diagnosis and treatment. Schedule an appointment today, and we’ll connect you to a licensed provider in your state to be seen within 48 hours. 

What are SNRIs?

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are a large class of medications that work by blocking the reuptake of serotonin and norepinephrine, increasing the levels of these two neurotransmitters in the brain.  

Serotonin and norepinephrine are two important neurotransmitters that are involved in numerous important bodily functions, including mood and energy levels.  

SNRIs Can Treat Symptoms of Anxiety and Depression

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are considered the first-line treatment for anxiety and depression. This class of medications is highly effective and considered to be relatively safe, with minimal serious adverse effects. 

Anxiety and depression are two of the most commonly diagnosed mental health conditions and often coexist with one another. Below we have listed some of the most common symptoms associated with both anxiety and depression. 

Symptoms of depression: 

• Persistent feelings of sadness, helplessness, or hopelessness 
• Loss of interest in pleasurable activities or hobbies 
• Changes in sleep patterns
• Changes in appetite
• Difficulty concentrating 
• Severe depression can be associated with thoughts of self-harm or suicidal ideation

Symptoms of anxiety:

• Exaggerated feelings of fear or worry 
• Feeling restless or inability to sit still 
• Irritability 
• Muscle tension 
• Sleep disturbances 
• Fatigue 
• Difficulty concentrating
• Physical symptoms of panic, including racing heart rate, sweating, tremors, upset stomach 

What is Cymbalta?

Cymbalta is the brand name for the generic drug duloxetine, an SNRI medication that is commonly used for the treatment of anxiety and depression. SNRIs work by increasing levels of serotonin and norepinephrine in the brain, improving mood and energy levels.  

Common Doses and Forms of Cymbalta

Cymbalta is available in a delayed-release capsule in 3 forms: 20 mg, 30 mg, and 60 mg. Dosing of Cymbalta varies based on the individual’s symptoms and response to the medication. The average dose ranges from 30 mg to a maximum dose of 120 mg per day. 

Conditions Cymbalta Treats

Cymbalta is FDA-approved for treating major depressive disorder and generalized anxiety disorder. In addition, Cymbalta is used to treat diabetic peripheral neuropathy or nerve pain associated with uncontrolled diabetes, fibromyalgia, and chronic musculoskeletal pain. 

Off-Label Uses for Cymbalta

The term “off-label” is used to describe any medication that has not undergone the formal FDA-approval process. To get a drug approved by the FDA for a given condition, there is a lengthy and expensive research process, which often presents as a barrier for drug manufacturers to gain FDA approval for every condition a medication effectively treats. 

Some off-label uses for Cymbalta include stress urinary incontinence and peripheral neuropathy induced by chemotherapy. 

Cymbalta Costs

Cymbalta is available in its generic equivalent, duloxetine, and is a relatively inexpensive medication. The price of your medication will depend on the dosage, your insurance coverage, and which pharmacy you use. 

This medication is typically covered by the majority of insurance plans and for those who are uninsured, the price can be significantly reduced with the use of a generic formulary and coupon codes. The cost of a 30-day supply of Cymbalta is as low as $6 with the use of coupons, which are found at most large pharmacies. 

Cymbalta Side Effects

As with any medication, there are side effects that should be taken into consideration before you start treatment. Most of the adverse effects are mild and lessen or resolve after continuous use of the medication. If you experience serious or bothersome adverse effects after starting Cymbalta, contact your healthcare provider immediately.  

Common side effects with Cymbalta include: 

• Dizziness 
• Fatigue 
• Orthostatic hypotension or drop in blood pressure upon standing 
• GI upset, including nausea, vomiting, diarrhea, or constipation 
• Blurry vision 
• Dry mouth 
• Headache 
• Loss of appetite 
• Sexual dysfunction, including decreased sex drive or inability to achieve orgasm 

Serious adverse effects associated with Cymbalta include: 

• Hallucinations 
• Worsening depression or anxiety 
• Thoughts of self-harm or suicidal ideation
• Severe restlessness or irritability 
• Constant or severe headaches 
• Easy bruising or bleeding 
• Changes in vision or pain in the eye 
• Yellowing of skin or eyes 

Cymbalta Drug Interactions

Certain medications should be avoided when taking Cymbalta. It is important to disclose all medications you currently take with your healthcare provider, including all over-the-counter medications and supplements. 

Medications to avoid while taking Cymbalta: 

•  MAO inhibitors should be discontinued 14 days before starting any SNRI medication 
• Other drugs that increase serotonin levels, including SSRIs or ADHD medications 
• NSAIDs
• Certain blood pressure medications 
• Antipsychotics 
• Anticoagulants or antiplatelet medications 
• Other antidepressants, such as SSRIs, TCAs, and atypical antidepressants 
• St. John’s Wort

What is Pristiq?

Pristiq is the brand name of the generic drug desvenlafaxine and belongs to the SNRI class of medications. Pristiq is commonly used to treat anxiety and depression and is known to be well tolerated or associated with a good side effect profile. 

Common Doses and Forms of Pristiq 

Pristiq is available in extended-release tablets, with doses of 25 mg, 50 mg, and 100 mg. The initial starting dose is typically 25 mg and can be titrated up to a maximum daily dose of 400 mg. The amount may be adjusted based on symptom severity and how the individual responds and tolerates the medication. 

Conditions Pristiq Treats

Pristiq is FDA-approved for treating major depressive disorder (MDD) only. This medication is also prescribed for a few off-label uses listed below. 

Off-Label Uses for Pristiq

As previously mentioned, the term “off-label” does not mean that the medication is not effective at treating the given condition but that the drug has not undergone the extensive FDA-approval process. 

Some common off-label uses for Pristiq include generalized anxiety disorder, social anxiety, and panic attacks, as well as obsessive-compulsive disorder (OCD) and the vasomotor symptoms associated with menopause.  

Pristiq Costs

The cost of Pristiq will differ based on your insurance coverage, dosage, and which pharmacy you use. For those who are uninsured, there are coupon codes available at large pharmacies that can significantly lower the cost of your monthly prescription. 

For example, the cost of a 30-day supply of Pristiq can be lowered from its retail price of $516 to around $13 with the use of generic formulas and coupon codes. 

Pristiq Side Effects

As with the majority of medications, there is a risk of developing certain adverse effects once starting Pristiq. If you begin to experience serious or bothersome adverse effects, you should contact your healthcare provider immediately. 

Common side effects of Pristiq include: 

• Dizziness 
• Fatigue 
• Dry mouth 
• GI upset, including nausea, vomiting, diarrhea, or constipation 
• Reduced appetite
• Increased anxiety, irritability, or restlessness
• Sleep disturbances, including insomnia or increased need for sleep 
• Sexual dysfunction, including loss of libido or inability to achieve orgasm 

Serious side effects associated with Pristiq: 

• Worsening depression or anxiety 
• Suicidal thoughts or thoughts of self-harm
• Severe insomnia 
• Severe irritability or aggression 
• Chest pain 
• Easy bruising or bleeding 
• Serotonin syndrome 
• Changes in vision 

Pristiq Drug Interactions

Whenever starting a new medication, it is important to disclose all current medications you are taking with your healthcare provider, including all over-the-counter medications and supplements. Pristiq has similar drug interactions as Cymbalta, which are listed below. 

Common drugs interactions with Pristiq include: 

• MAO inhibitors should be discontinued two weeks before starting an SNRI medication 
• Other medications that increase serotonin levels, including SSRIs and ADHD medications 
• NSAIDs
• Anticoagulants 
• Opioid pain medications 
• TCA antidepressants 
• Certain diuretics and blood pressure medications 

SNRI Warnings 

Before starting an SNRI medication, there are a few cautions that should be considered. We have described some of the most important warnings that are associated with taking an SNRI  medication. 

Black Box Warning 

Most antidepressant medications are associated with a black box warning of the potential risk of worsening anxiety and depression, which can lead to thoughts of self-harm or suicidal ideation. 

Of note, this is a rare adverse effect associated with SNRI medications and has only been found in a small number of patients. This was most commonly found in teenagers and young adults under the age of 24. 

Increased Risk of Bleeding 

SNRIs are associated with an increased risk of bleeding, and therefore, you should always disclose all medications you are currently taking with your provider, including all over-the-counter medications and supplements. 

You should avoid all blood-thinning medications, such as aspirin and warfarin. NSAIDs should also be avoided, as they can increase the risk of bleeding. 

Signs and symptoms of bleeding include: 

• Blood in urine or stool 
• Black or tarry stools 
• Severe or persistent abdominal pain 
• Easy bruising 
• Bleeding gums with teeth brushing 

Serotonin Syndrome

Serotonin syndrome is a rare but serious condition that is caused by increased levels of serotonin in the body. This most commonly occurs when someone is taking more than one medication that increases the level of serotonin. 

If you begin to experience any of the following symptoms, contact your health provider or seek immediate medical attention: 

• Increased heartbeat 
• High blood pressure
• Restlessness 
• Nausea, vomiting, diarrhea 
• Increased body temperature and sweating 
• Tremor 
• Loss of coordination or balance 
• Muscle spasms 

Discontinuation or Withdrawal Syndrome 

It is important not to abruptly discontinue your medication, as this can result in withdrawal syndrome. Symptoms of withdrawal include headache, nausea, diarrhea, dizziness, and insomnia. If you are unhappy with your SNRI medication, inform your healthcare provider, and they will safely taper you off of your medication. 

Caution With Use in Elderly Population 

SNRI medications should be used with caution in those over 65 years of age. This is because of an increased risk of adverse effects in the elderly population and can result in dangerous changes in blood pressure or low sodium levels in the blood, which can result in injury from falls. 

Get Anxiety and Depression Treatment With Klarity

Living with symptoms of anxiety or depression can be difficult, but finding the best medication for you shouldn’t be. With so many different drugs available in the treatment of anxiety and depression, it may seem impossible to find the right treatment plan for you, but the providers on Klarity can help. 

At Klarity, we believe everyone should have access to quality mental health care at an affordable cost. Klarity offers a unique telehealth platform with easy scheduling and access to experienced providers, all from the comfort of your own home. 

Start by taking our free brief self-evaluation, and we will connect you with a licensed healthcare professional in your state to be seen within 48 hours. 

Frequently Asked Questions About Cymbalta and Pristiq

It can be confusing to compare two medications that belong to the same class of medications, and it is normal to have additional questions. Below we have included some of the most commonly asked questions about Cymbalta and Pristiq.

Does Cymbalta Make You Gain Weight? Does Pristiq?

Both Cymbalta and Pristiq are associated with the possibility of experiencing decreased appetite, which may lead to weight loss. This is common among most SNRI medications but does not occur in everyone taking an SNRI medication.  

Is Cymbalta or Pristiq Better for Anxiety?

Cymbalta is FDA-approved for the treatment of anxiety and is typically a better choice when compared to Pristiq. Although it is not FDA-approved for anxiety, Pristiq can also be prescribed to treat anxiety as an off-label use. It is important to remember that everyone reacts differently to medications, and Pristiq may be a better option for some. 

Can I Replace Cymbalta with Pristiq?

Yes, Cymbalta and Pristiq can be replaced with one another under the close supervision of your healthcare provider. Your dosage will likely change depending on which medication you are switching to. It is important to talk to your healthcare provider if you are unhappy with your current medication regimen and would like to switch medications. 

Is Cymbalta Energizing or Sedating? What About Pristiq?

Both Cymbalta and Pristiq are considered to be energizing medications.

Does Cymbalta Cause Brain Fog? Does Pristiq?

Brain fog is a potential side effect of any psychiatric medication, although it is considered to be far more common when experiencing SNRI withdrawal. When abruptly discontinuing or lowering your dose, there is a risk of developing symptoms of withdrawal, including brain fog, headache, dizziness, nausea, insomnia, or flu-like symptoms. 

Can I Drink Alcohol On Cymbalta? On Pristiq?

Generally, it is advised to avoid drinking alcohol while taking either Cymbalta or Pristiq due to an increased risk of experiencing side effects or enhancing the effects of alcohol. 

Can I Drink Caffeine When I’m on Cymbalta? How About Pristiq?

It is considered safe to drink caffeinated beverages while taking either medication, but it is important to remember that caffeine is a drug in itself, and combining the two may produce undesirable effects. 

What Is Better For Depression—Cymbalta or Pristiq?

While both medications are FDA-approved and are equally effective in treating depression, Pristiq is typically tolerated better and has a mild side effect profile.