Pristiq (desvenlafaxine) Withdrawal Symptoms, Safety Tips

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

What Is Pristiq?

Pristiq is a timed-release SNRI antidepressant. The generic version is desvenlafaxine. The drug targets serotonin and norepinephrine receptors in ways that are not completely understood. Researchers report that Pristiq acts aggressively on blocking serotonergic receptors at a 10:1 ratio over norepinephrine receptors.¹⁵ Research shows that stopping the drug quickly or all at once does not allow the central nervous system enough time to recalibrate, and can carry certain risks to health.

Pristiq (desvenlafaxine) was initially approved for sale by the FDA in 2007 for the treatment of depressive disorders. The US patent expired around 2017, but Pfizer submitted a new drug application for a future extended-release version of desvenlafaxine, “Prism,” to replace Pristiq — however there is no evidence currently that the application has been approved.²⁰ Pristiq was withdrawn from sale to European markets for undisclosed reasons but generic versions are available in the US.

Pristiq (desvenlafaxine) Withdrawal Symptoms

FDA WARNING:  Never abruptly stop taking Pristiq©, as rapid or abrupt cessation is associated with withdrawal symptoms that can be severe, and sometimes life-threatening. Always seek competent medical assistance for Pristiq withdrawal treatment.^5,7-14,17

For some, Pristiq withdrawal symptoms even when reducing the dosage slowly may be difficult to tolerate. In these cases, close monitoring by medical caregivers throughout the process is recommended. Some persons may choose closely monitored withdrawal done in an inpatient-style program with strong support and care close at hand.

Pristiq withdrawals can include:

• Suicidality ^4,8
• Hyperarousal, anxiety, agitation ¹⁰
• Dizziness, vertigo, imbalance, lightheadedness ^7-9
• Mania, hypomania ^4,12,14
• Psychosis, visual and audio hallucinations ¹⁰
• Amnesia ¹¹
• Insomnia, disturbed sleep, vivid dreams, nightmares ^7-9
• Seizures ⁴
• Brain zaps, shivers, jolts, “head shock” sensations* ⁵
• Weakness, myalgia, headache, chills, and other flu-like symptoms ^4,8
• Mood swings, i.e., crying spells, depression, irritability ^4-8
• Nausea, vomiting ^4,6-10
• Diarrhea, gastrointestinal discomfort, constipation, abdominal pain ^10,15
• Paresthesia, burning or prickling sensations on the skin ⁸
• Movement disorder ^11,13

*Brain zaps are known to occur when coming off antidepressants, sometimes even when the withdrawal is done slowly. The phenomenon has been associated with lateral eye movements but remains poorly understood. There is no medical explanation beyond the observation that they occur commonly in antidepressant withdrawal.⁵

Safety Tips, Special Notes on Quitting Pristiq

Because Pristiq (desvenlafaxine) is a timed-release medication, it may be necessary for the prescribing physician to consider cross-tapering or other strategies to overcome this factor. Clinical expertise is essential for these methods of withdrawal to be done correctly, making the process considerably easier for the patient.

Cross-tapering should only be done in an inpatient setting where close monitoring is possible. In this way, one can avoid any risks that can be associated with incorrect dosages, inappropriate drug interactions, or switching medications too abruptly.

Done well, a correct and exact Pristiq taper supplemented with counseling and other social supports can be surprisingly mild.

Risks and Side Effects Associated with Pristiq

Because of the statistics relating to suicidality which have been well documented during many clinical trials both before and after the drug was first approved, Pristiq is not approved to be prescribed for children, teens, or young adults under the age of 25. However, recent research has found that antidepressant drugs are ALSO associated with increased suicidality in adults, though this is not mentioned on the black box that accompanies all such drugs.^4,19

Other risks are associated with Pristiq and other similar SNRI antidepressant drugs. All serotonergic medications should be monitored for rare but potentially lethal reactions such as serotonin syndrome or Stevens-Johnson Syndrome. (See below for more detailed information on these side effects). These potential health hazards are other reasons one might consider a medically monitored Pristiq withdrawal and eventual transition to natural Pristiq alternatives.

A wide range of additional adverse effects have been associated with Pristiq (desvenlafaxine) which you will find listed further down in this article. Not everyone who takes Pristiq suffers extreme adverse reactions. Some will experience years of ongoing suffering, and some people will experience minor reactions or none at all. However, some adverse reactions can be life-threatening and would require the appropriate medical intervention.

Make a Plan to Safely Discontinue Pristiq

Where lingering and troublesome adverse effects outweigh the benefits, a person may want to stop taking Pristiq. But one should try to inform oneself of the best ways of stopping Pristiq. FDA guidelines are confusingly vague and very brief on Pristiq withdrawal. The guideline on the drug insert recommends that one reduce the drug as rapidly as possible, but not so quickly as to cause intolerable withdrawal symptoms.⁴ It is no wonder that doctors in the main are not well-prepared in helping their patients to come off drugs because unfortunately there is little to no training given in medical school on Pristiq withdrawal help. If you are seeking help with Pristiq withdrawal, seek inpatient care but if this is not possible, try and find a physician who is familiar with the process and who has confidence in their ability to help.

When a person elects to stop taking an SNRI medication, or any medication, it is always wise to seek as much information as possible before beginning the process. We can provide much information on request which may help greatly in planning a safe and relatively comfortable Pristiq withdrawal. We urge you to share the information on this page with your prescriber. More information is given below on how to get off Pristiq with addition information related to Pristiq withdrawal help.

What Is Pristiq (desvenlafaxine) Used For?

Desvenlafaxine is the generic name for Pristiq, which is FDA approved for the treatment of MDD (major depressive disorder) in adults, aged 25 and older.⁴

The drug is also prescribed off-label for hot flashes associated with menopause, and for women who experience particularly difficult symptoms relating to the menstrual cycle.

Pristiq is considered to be a “non-hormonal” treatment where an alternative hormone treatment is sought to address vasomotor conditions (relating to the muscles and nerves that regulate dilation and constriction of blood vessels) relating to a woman’s menstrual cycle.

Pristiq (desvenlafaxine) Alternative Names and Slang

Desvenlafaxine is the drug’s generic name. Pristiq is not known to be a popularized street drug but has been found in relatively uncommon pharmaceutical drug diversion cases as with other antidepressants. Sometimes called “poor man’s cocaine,” certain antidepressant prescription drugs are crushed and snorted or injected for a rush similar to other stimulant drugs like cocaine or crack. However, such practices often lead to a trip to the nearest hospital for emergency medical care.

Due to Pristiq’s extended-release structure, it is less subject to abuse than immediate-release antidepressant drugs. Perhaps viewed by some as a deterrent, fillers used in prescription pills may be toxic to the skin when injected, potentially creating very deep abscesses that are prone to infection, especially where neglect and poor hygiene can quickly escalate infection and lead to loss of life if left untreated.

Pristiq is one of many brand names for desvenlafaxine (extended release) including:

• Ellefore©
• Khedezla©
• Defaxin ER©
• Deslafax©
• Dvenjoy XR©
• Zyven OD©
• Ventab©

Common and Severe Pristiq Side Effects

Severe Pristiq side effects can occur as with any SNRI drug. These may require immediate medical intervention for the safety of the patient. It is important to be aware of these while taking an SNRI.

Adverse side effects can be mild to extremely harsh and will affect different people in different ways.

Pristiq side effects may include:

• Suicidality ¹⁹
• Mania, hypomania ^1,4
• Seizures ⁴
• Cardiac arrest ¹
• Severe muscle tightness ¹
• Hyponatremia (abnormally low level of sodium in the blood) ⁴
• Weight gain ¹⁵
• Interstitial lung disease, eosinophilic pneumonia ⁴
• Increased depression or other worsening symptoms ^1,4
• Thoughts of self-harm ¹
• Unusual bleeding or bruising ^1,4
• Abnormal menstrual cycle ¹
• Cholesterol and triglyceride elevation ⁴
• Elevated blood pressure ^18,21
• Glaucoma, mydriasis, eye pain, blurred vision, swelling, or redness around eyes ^1,4,17
• Renal impairment, frequent urination, difficulty urinating ^1,4
• Teeth grinding ¹
• Headache ^1,15,17
• Tachycardia (rapid heart rate at rest), increased blood pressure ^4,15
• Decreased appetite ¹⁷
• Trouble speaking clearly ¹
• Chills, shivering, cold sweats ¹
• Cognitive impairment, confusion ¹
• Swelling ¹
• Numbness ¹
• Shaking, tremors ¹
• Nausea, vomiting ^1,15,17
• Headache ^1,15,17
• Fatigue, drowsiness ^1,17
• Insomnia, abnormal dreams ^1,17
• Sexual dysfunction ^1,15,17
• Anxiety, agitation, irritability, aggressiveness, restlessness ¹
• Hyperhidrosis (excessive sweating) ^1,17
• Constipation ^15,17
• Xerostomia (dry mouth due to dysfunctional saliva glands) ¹
• Cough ¹⁵

Additional Severe Pristiq Side Effects

Some of the most severe adverse reactions from Pristiq to be aware of are:

• Serotonin Syndrome
• Stevens-Johnson Syndrome
• Suicidality
• DRESS (rashes, hypersensitivity, allergic reactions)

Serotonin Syndrome:  When too much serotonin has been activated in the body this can result in a set of life-threatening symptoms including sudden fever, chills, depressed respiration, coma, unconsciousness, and death.

Stevens-Johnson Syndrome:  This is a rare but severe hive-like reaction of the skin caused by certain medications such as Pristiq, which also targets moist tissues of the mouth, eyes, throat, airways, anus, etc. First presents with fever and flu-like symptoms, followed by the skin erupting into blisters that darken and peel away leaving raw painful tissue. Dehydration, sepsis, pneumonia, and multiple organ failure associated with this condition can lead to death.

Increased Suicidality:  Pristiq was shown to cause an increased risk of suicide in children, teens, and young adults, especially under the age of 25, and is therefore not approved to be prescribed to this age range. However, trials and statistics also show increased suicidality risk in adult populations.

DRESS (drug induced rashes, hypersensitivity):   DRESS stands for Drug Reaction with Eosinophilia and Systemic Symptoms. Eosinophils are a specific type of white blood cell which supports the immune system.”DRESS” means a severe immune system/allergic reaction that affects the skin and other organs in severe and life-threatening ways. Manifestations include fever, painful rash that spreads and blisters, facial edema, fatigue, body aches, and other symptoms. It is a class of reactions of this type (such as Stevens-Johnson, TEN, and others) and these require immediate medical treatment.^1,4,19,22,23

Strategies to Manage Risks for Pristiq Withdrawal

Coming off an SNRI must be done precisely and gradually. As mentioned earlier, Pristiq or desvenlafaxine is a time-release medication that requires special consideration in how it is safely reduced in dosage. Work with a trusted medical team or caregiver who can help with either cross-tapering, converting to an equivalent non-timed-release drug, or other risk-management strategy.

Prepare for the discontinuation process. Diet, exercise, resolving nutritional deficiencies, adequate sleep, all play significant role in health and are important supports in medication management.

Above all, don’t try it on your own. Seek help and be patient with yourself. Network with peer groups or close friends who most likely will be more than willing to help you through the process. Consider learning relaxation techniques, therapeutic massage, and other healthful activities. And, give yourself the space and time to work through this sometimes challenging task. You can call us for more information on strategies that may be useful for Pristiq withdrawal success.

Pristiq (desvenlafaxine) Withdrawal FAQs

Below are some of the most common questions regarding Pristiq (desvenlafaxine).

Are there Pristiq Alternatives?

Medical research has documented many Pristiq alternatives that are available and used in recovery from prescription drug dependence. These are modalities that involve natural neurotransmitter rejuvenation and other important restorative functions that can help address issues that Pristiq was not able to fix.

Here is some further reading to explore:

• Alternatives to Antidepressant Medications
• Holistic Drug and Toxin Detox

If you have other questions, more information is freely available from Alternative to Meds Center on request if you need further knowledge on these or other topics.

What does Pristiq do to your brain?

It is thought that an SNRI drug affects two types of chemicals that act as messengers within the brain and central nervous system. One of these is serotonin, a neurochemical that is responsible for regulating things like mood, sexual function, digestion, memory, and many, many other functions of health. Serotonin is an inhibitory agent that allows us to relax the fight or flight responses so that these activities are possible. The other neurochemical that SNRI drugs affect is norepinephrine, which is a direct precursor to adrenaline, the fight-or-flight response neurotransmitter. Norepinephrine is associated with mental focus and learning, yet too much of it clinically presents as anxiety.

SNRI drugs keep serotonin and norepinephrine suspended in the nerve synapses, instead of allowing them to be reabsorbed into and along the nerve pathway. When these agents accumulate, they act more intensely, sometimes with unpredictable results.

However, these natural chemicals will eventually degrade and become waste products, instead of being reabsorbed and recycled ready to be used again. This may eventually result in a deficiency as Pristiq does not create more serotonin or norepinephrine, only a healthy body can do that. This mechanism explains, at least in part, how drugs develop diminished efficacy over time.²

Is Pristiq Different Than Effexor?

Pristiq and Effexor are similar drugs but are not exactly the same.

Similarities:  Pristiq is a time-release drug, and Effexor XR is also a time-release drug. Both drugs share similar reactions. Both drugs have a black box warning regarding suicide and other risks. Because they are both SNRI drugs they share the mechanism of action on serotonin and norepinephrine, almost identically. Effexor immediate-release is no longer marketed in the US but is available in some other countries. Stopping Pristiq can be difficult, similar to stopping Effexor XR or other prescription drugs.

Like Effexor, Pristiq is not generally viewed as an addictive drug, whereas dependence is seen as a more likely outcome.

Differences:  Pristiq is prescribed for MDD (major depression disorder); Effexor is prescribed for various depression disorders as well as anxiety disorders such as SAD (social anxiety disorder), PD (panic disorder), and anxiety GAD (generalized anxiety disorder). Another difference is that at a lower than 75mg dose, Effexor acts more primarily as an SSRI. Pristiq has no similar dose-response relationship and acts as an SNRI whether taken in 50mg or 100mg doses.³

Does Pristiq Increase Blood Pressure?

Yes. Pristiq (desvenlafaxine) can increase blood pressure. If you already have high blood pressure, you should make sure it is well under control before you start taking a prescription of desvenlafaxine. Symptoms of high blood pressure can be completely non-existent, even though the condition exists. So it is wise to have this checked especially before taking medications that can increase hypertension.^18,21

Where symptoms of HBP are noticeable, they can include severe headaches, pounding in the chest, ears, or around the neck, confusion, shortness of breath, fatigue, irregular heartbeat, blood in urine, vision problems, and pain in the chest area. Uncontrolled high blood pressure can lead to serious health risks such as internal tissue damage, stroke, or kidney failure. Seek medical help if you experience high blood pressure symptoms to avoid these health risks.

Treatment for Pristiq Withdrawal, Dependence, and Abuse

When deciding to come off a drug such as Pristiq, one would be well-advised to choose to work with medical professionals who are familiar with methods and procedures which can mitigate withdrawal adverse effects to have the best chance of success with cessation. While Pristiq addictive behaviors (i.e., pleasure-seeking behavior despite negative consequences) are less frequently seen, a dependence develops easily once the drug begins to alter the chemistry of the brain and CNS.

If the Pristiq withdrawal is too fast, there is a high risk of relapse, and lengthening the overall process. If the process is too difficult, even if slowly done, and no other guidance or support of any kind is offered, it can be extremely hard to escape relapse as the symptoms of Pristiq withdrawal can be intolerable. There are many beneficial actions that can ease the discomforts that are commonly experienced when trying to stop taking Pristiq.

However, Pristiq withdrawal can be made much easier to tolerate by choosing inpatient treatment, where constant monitoring is routine, and minute changes to dosage may be helpful within a withdrawal schedule designed to fit the urgent and most pressing needs of an individual.

Alternative to Meds Center uses lab testing to help prepare the body for the withdrawal process. If vitamin or mineral deficiencies are present, these can be corrected through supplementation and a carefully planned diet for maximizing the body’s ability to normalize neurochemistry after prescription drugs have created changes that altered or compromised it.

The presence of neurotoxic materials can have a detrimental effect on the central nervous system. Such symptoms as insomnia, depression, and anxiety are linked to certain toxic substances like heavy metals, pesticides, chemicals in foods, cleaners, and many other sources. These toxic accumulations, however prevalent in our modern lifestyles, can be isolated and gently purged, as a very effective way to prepare for and ease a smooth cessation process.

Alternative to Meds Center can provide much more information on request about our center’s safe methods, holistic therapies, diet, nutrition, removal of toxic burden, and many more helpful techniques that can significantly ease Pristiq withdrawal treatment.

for Pristiq Withdrawal Help

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15. Naseeruddin R, Rosani A, Marwaha R. Desvenlafaxine. [Updated 2021 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534829/ [cited 2026 June 5]

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21. Nabeel Aslam, Sobia Memon, Hani Wadei, Shehzad Niazi, P0150
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Originally Published Sep 13, 2018 by Diane Ridaeus

This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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Diane Ridaeus

Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.