From the Guidelines
Transitioning from Lexapro to Pristiq should be done under medical supervision with a gradual tapering of Lexapro while introducing Pristiq to minimize withdrawal symptoms and ensure effective treatment continuation. When considering the switch, it's essential to note that low-quality evidence from studies, such as 1, shows no significant difference in remission or depression severity when switching from one serotonin-norepinephrine reuptake inhibitor (SNRI) or selective serotonin reuptake inhibitor (SSRI) to another, including venlafaxine, which is closely related to Pristiq.
Key considerations for the transition include:
- Tapering off Lexapro to minimize withdrawal symptoms, which can include dizziness, headaches, and irritability.
- Introducing Pristiq at a therapeutic dose, typically starting at 50mg daily, and adjusting as necessary based on patient response and side effects.
- Monitoring for side effects such as increased blood pressure, sweating, or sleep disturbances during the transition period.
- Maintaining regular contact with a healthcare provider to adjust the transition schedule if needed, ensuring the patient's safety and the effectiveness of the treatment.
The transition from Lexapro, an SSRI, to Pristiq, an SNRI, is based on the different mechanisms of action of these medications, with Pristiq affecting both serotonin and norepinephrine neurotransmitters. Given the low-quality evidence regarding the safety and efficacy of switching between these classes of medications, as noted in 1, the decision to transition should be made cautiously and under close medical supervision, prioritizing the patient's morbidity, mortality, and quality of life.
From the FDA Drug Label
- 6 Switching Patients From Other Antidepressants to Desvenlafaxine
Discontinuation symptoms have been reported when switching patients from other antidepressants, including venlafaxine, to desvenlafaxine. Tapering of the initial antidepressant may be necessary to minimize discontinuation symptoms.
The recommended approach for transitioning from Lexapro to Pristiq is to taper the initial antidepressant, in this case Lexapro, to minimize discontinuation symptoms. However, the provided drug labels do not specify the exact tapering schedule for Lexapro.
- Key considerations:
- Tapering the initial antidepressant may be necessary.
- Discontinuation symptoms have been reported when switching patients from other antidepressants to desvenlafaxine.
- The drug labels do not provide specific guidance on tapering Lexapro. 2
From the Research
Transitioning from Lexapro to Pristiq
- Lexapro (escitalopram) is a selective serotonin reuptake inhibitor (SSRI), while Pristiq (desvenlafaxine) is a serotonin-norepinephrine reuptake inhibitor (SNRI) 3, 4, 5, 6.
- When transitioning from an SSRI like Lexapro to an SNRI like Pristiq, it's essential to consider the differences in their mechanisms of action and potential effects on patients 3, 4.
- Studies have compared the efficacy and tolerability of escitalopram and SNRIs, such as desvenlafaxine, in patients with major depressive disorder (MDD) 4, 5, 6.
- A pooled analysis of four double-blind, randomized clinical trials found that escitalopram was at least as effective as SNRIs (venlafaxine XR and duloxetine) in treating MDD, with better tolerability 5.
- Another study found that escitalopram was associated with a better efficacy and tolerability profile than SNRIs (duloxetine and venlafaxine) when used as a second-step treatment in patients with MDD 4.
- A randomized rater-blinded 6-week clinical trial compared the efficacy and safety of escitalopram, desvenlafaxine, and vortioxetine in the acute treatment of anxious depression, finding no significant differences in efficacy and tolerability among the three treatments 6.
- When transitioning from Lexapro to Pristiq, patients should be closely monitored for potential changes in their condition, and the dosage of Pristiq should be adjusted accordingly 3.
Key Considerations
- The primary outcomes of interest when transitioning from an SSRI to an SNRI include all-cause mortality, hospitalization, depression relapse, and suicide attempts 3.
- Patients with treatment-resistant depression (TRD) may benefit from the combination of esketamine with an SNRI, which has shown lower incidence of mortality, hospitalizations, and depressive relapses compared to the combination of esketamine with an SSRI 3.