Per data, Pristiq and Effexor have more side effects than SSRIs such as Lexapro and Citalopram. While Lexapro is a tradename med it's actually relatively cheap though Citalopram is way way way cheaper.
Citalopram: $4 a month for 30 pills.
Lexapro: 5 mg (30 ea): $107.99 10 mg (30 ea): $118.99 20 mg (30 ea): $118.99
Effexor XR: 37.5 mg (30 ea): $129.99 75 mg (90 ea): $409.99 150 mg (30 ea): $159.99
Venlafaxine ER: 225 mg (30 ea): $256.98
Pristiq: 50 mg (30 ea): $141.99 100 mg (30 ea): $146.99
Now that said, I haven't had any cases, at least so far, where Pristiq seemed to reveal anything special to the degree where it was preferrable over Effexor.
Oddly, I've had cases where a patient was able to tolerate Lexapro or Citalopram but not the other. IMHO the only thing that can explain this is the medium holding the med in the pill was somehow causing a problem.
I find little reason to give Effexor or Pristiq as a firstline med. There is no cheap version of it and it has more side effects to a population vs. Citalopram.
Many of my attendings use them but I don't understand why.
Some doctors I've noticed don't seem to give a damn about the price. This is a shame because if all doctors gave out cheaper alternatives that worked just as well, we could put a huge dent in the cost of medical care. Others are just plain idiots or sold to the drug reps.
I got a bunch of the residents under me, when I was a chief resident, to give out Citalopram instead of Lexapro. An attending mentioned that he was somewhat upset with this because I must have been somehow converted by a Citalopram drug rep. Hmm, it's a $4 generic. There are no reps for it. It was saving the system a heck of a lot more money vs. giving out something > 20x the price. He didn't know that. He was completely oblivious to the price of meds (among several other things). All he saw was a bunch of residents give out one med.
Not suprisingly, whenever he got a patient that stopped Lexapro because they couldn't afford it, he just put them right back on it in the hospital and discharged them on it.