we need to bring down my stress/cortisol level. My doctor suggested Pristiq - we've tried just about everything else,
What else have you tried? (Besides xanax).
Pristiq is a slightly more refined version of Effexor - it's a metabolite, which in very simple terms means it's what's left over after the molecule is metabolized. In practical terms, it means there's fewer things going on when you take pristine, as opposed to Effexor. It doesn't mean it's more or less effective. it's different on different people.
Pristiq initially sought approval as a drug to treat vasomotor symptoms in menopause - basically, relief from hot-flashes. It was denied FDA approval, but is still sometimes prescribed off-label in low doses for women struggling with hot flashes. There's no great evidence that it works, but apparently, it works for some people.
There's a strong argument that says Pristiq is an example of what's called 'evergreening' - this is when a company seeks to extend its own royalties on a product by taking out an additional patent, or developing a new, slightly different product that they can patent differently. Effexor was a major money-maker for Pfizer pharmaceuticals, and so when it was nearing the end of it's patent and there were no more extensions to be had, pfizer developed pristiq - a drug nearly identical to Effexor, but new, so it could be launched with another marketing campaign, and it would ostensibly be under patent unit 2022. (So the pfizer critics say; I'm inclined to agree with them, though it doesn't mean that pristiq isn't a good drug for some people).
I cannot for the life of me figure out exactly what happened, but the patent was challenged, and maybe (?) there's a generic of pristiq that has made it to the US market? It's really hard to figure out, to be honest. But you should ask your doctor - because if you are considering Pristiq, but it's not available as a generic, you could be looking at an unnecessary cost...especially if your doc is considering it primarily for anxiety. It's an SNRI, and it's not a light-weight drug, even in low doses.
For some reason, the SNRIs all have parallel uses - sometimes off-label, sometimes not - in full-body pain relief. Cymbalta is also prescribed for fibromyalgia, pristiq for menopausal symptoms (off-label), effexor for menopause and fibro (off-label), savella for fibro, and it's analogue fetzima for depression and off-label fibro.
That's all just to say -
@VioletButterfly - have a very comprehensive talk with your doctor about
exactly what you need relief from, and what
all your medication options are. Ask your doctor why they would choose one thing over another. Ask them what they think of other approaches - diet, mindfulness, etc.
Often, doctors become familiar with certain medications, and they prescribe them because they understand them and trust them to work in the majority of cases. That's not a bad thing, it's your doc using their experience. Sometimes, they aren't as familiar in one area or another - they should be willing to admit that, and able to make a case for why they are preferring one drug over another, or they should offer to do more research or send you to a different doc for an outside opinion.
/end world's longest post
