"this medication can&#039;t be rated hastily.  it can take up to 6 weeks to level off.  my first days of pristiq 50mg were terrible.  my first dose at night caused insomnia, jitteriness and dizziness, dilated pupils, nausea, sweaty, and a racing pulse.  the following week i felt great with no anxiety!  i still felt nauseous however, ate very little(lost 7 lbs), and had a headache daily.  the following week my side effects continued (  insomnia &amp; tmj flare up), but my benefits diminished. my doctor then increased my dose to 100mg.  since then most of my side effects are gone except the dilated pupils &amp; tmj issues.  i&#039;ve taken zoloft(ok) &amp; lexapro(zombie) in the past.  please give this medicine time before you decide you hate it!"