Here is an article about Pristiq talking about how since it's a metabolite of Effexor, that it has sort of gotten overlooked, especially if cost is a factor.

The person who told me that she thought it was very good was a nurse practitioner that I used to see for meds management. I haven't discussed it with any other meds providers.

My impression from what she said about it is that it's a bit "gentler" than Effexor. If Effexor works for a person, it can be a really "big gun" for dealing with depression and suicidal thoughts.

Of course, that usually also comes with some pretty big side effects and a withdrawal syndrome.

It will be interesting to see if Pristiq gets used more widely when a generic version becomes available.