Brand & Generic Names; Drug Classes
|US brand name: Effexor|
|Generic name: venlafaxine|
|Primary drug class: Antidepressants|
|Additional drug class(es): Serotonin and Norepinephrine Reuptake Inhibitor (SNRI)|
Approved & Off-Label Uses (Indications)
Effexor’s US FDA Approved Treatment(s)
- Major Depressive Disorder (MDD) - extended release (XR) approved October 1997, immediate-release (IR) approved December 1993
- General Anxiety Disorder (GAD) - XR approved 11 March 1999
- Social Anxiety Disorder (SAnD) - XR approved 11 February 2003
- Panic Disorder - XR approved 18 November 2005
Uses Approved Overseas but not in the US
- In France Effexor is also approved for long-term (maintenance) therapy for MDD .
- In the Netherlands Efexor is also approved for PTSD
Off-Label Uses of Effexor
- Bipolar depression
- Depression in Parkinson’s Disorder
- Hot flashes due to breast cancer therapy (thanks to Betsy!)
- Migraine prevention (prophylaxis)
- Tension-Type Headaches
- Although in this randomized, double-blind trial Effexor didn’t do shit for the pain of fibromyalgia. It was still effective for other fibro symptoms.
- As venlafaxine is an SNRI it’s popular (in Europe at least) as a treatment for chronic nerve pain from conditions such as:
- shingles (post herpetic neuralgia)
- diabetic peripheral neuropathy
- phantom limb syndrome
- Which is both freaking hilarious and disturbing given information about serotonin-reuptake inhibitors and bone fractures (see the comments section below) that’s been collected in Australia.
- Chronic Fatigue , along with every other drug on the planet.
- Adult ADD/ADHD
- Irritable Bowel Syndrome (IBS)
- Which makes too much sense. I don’t understand why SNRIs aren’t used more often for IBS.
- Eating Disorders:
When & If Effexor Will Work
Effexor’s Usual Onset of Action (when it starts working)
Three weeks to a month.
Likelihood of Working
Generally SNRIs are more likely to work than SSRIs for depression and some forms of anxiety. Their biggest advantage being they are far less likely to suddenly stop working (see the SSRI poop-out (tachyphylaxis) page for details). The problem with Effexor is that the reviews from the field don’t form a bell curve or long tail like most stats, but a U, with most people loving it or hating it, as a lot of its efficacy was overshadowed by how bad it was to stop taking it. Fortunately that isn’t as much of a problem today as it was the first 10 years Effexor was on the market. Wyeth finally owned up to the fact that discontinuation syndrome exists and it can be really fucking awful. Doctors realized the same thing. Score another one for Internet-based support groups and sites like Crazymeds, as it sure as hell wasn’t getting published in The Literature all that much before we started making a lot of noise about it.
So, like all SNRIs, Effexor does work. Due to its side effects and the chance of the discontinuation syndrome from hell I can’t suggest it as the first med to try, unless you’re reading this for someone who is too depressed to work up the energy to kill themself - in which case that person should be hospitalized so they don’t do just that when the Effexor or whatever kicks in - or too anxious to look at a computer. If you aren’t quite that bad and your doctor brings it up, ask about something else for the first go. Not Pristiq, which is just predigested Effexor, albeit with a slightly different way of working, but either an SSRI or even Cymbalta. If you want something to work right the fuck now, Lexapro is your best bet.
Let’s see what Science has to say about it…
Effexor for Depression
- Effexor XR for Depressed Slovenes When Laibach isn’t enough. This smallish (161 participants to start, 148 completed. 75% female.) study is notable not only for being the first to evaluate Effexor XR for MDD in Slovenia, but for using more than just the HAM-D to evaluate the results. Not only did Dr. Plesničar use four different rating scales, she also evaluated patients for physical pain, a symptom of depression frequently ignored. The results: Effexor kicked depression’s ass and didn’t suck all that much. As the study lasted only 8 weeks it didn’t have much of a chance to deal with weight gain or discontinuation syndrome. The 3:1 ratio of women to men also downplayed any sexual side effects. Still, I wish she had more money for a larger and longer study.
- Effexor XR for Depressed Women Aged 45-55. The idea of this study was to see if there’s a difference in effect for women before and after menopause. While they tracked the women for a decent amount of time, they used only the HAM-D and there were only 36 participants, so the data are interesting but not all that conclusive. The results: Effexor works better and sucks less for post-menopausal women.
Effexor vs. Other Antidepressants for Depression
- Effexor vs. Prozac vs. Placebo. Which is the most likely to fail after two years? After just one year 73% of the people taking the placebo were severely depressed again. So much for the placebo effect making ADs overpriced, side effects-inducing placebos. Effexor pooped out for 61% of the people taking it, but as this was a double-blind study, the dosages were completely randomized. A participant could have been taking 75 mg a day for a year. Or 300 mg. Or somewhere in between. Prozac randomization was 20–60 mg and the tachyphylaxis rate was 66%. Phase B was even more messed up. This study is pretty bogus. The only thing about it worthwhile is that it shows the placebo effect is equally bogus. Medicine works.
Taking and Discontinuing
How to Take Effexor
Effexor comes in immediate-release (IR) and extended release (XR) flavors, although hardly anyone takes the IR form anymore. Just be sure to check your prescription for that XR to make sure you are getting the extended release form. For the XR flavor, you start at 37.5 to 75 mg a day, taken with food, at either breakfast or dinner, depending on if you’re apt to get wired or tired. Once you get the wired/tired issue straightened out, you take the med all at once at the same time every day. If you start at 37.5mg you can move up to 75mg after a week. As with any serotonergic antidepressant, it may take up to a month to feel any positive effect, so give it a month. Seriously, don’t move up above 75mg a day unless you feel it doing something positive or it’s been about a month. You’ll know if it’s going to do anything then. If you feel nothing, give up and take a med with a much easier discontinuation (i.e. anything that’s not an SNRI). After that you can move up in 37.5–75 mg increments, allowing at least a week between each increase until you reach the maximum of 375 mg once a day for adults with severe MDD. Or 450mg a day if you and your doctor have the balls for it. If the two of you are sure you are a rapid metabolizer of some medications, there are people who take 600mg a day, but roughly 1% of people on the planet, if that many, would metabolize it at a rate fast enough to need 600mg a day, and need to take the XR form twice a day. If you’re reading this site because you take your XR capsule in the morning and feel dizzy, confused, have headaches and feel like you’re wearing an electric eel for a hat after dinner every night, you may need to take a once-a-day pill twice a day.
The older immediate release version is pretty much the same, except that the dose is divided into two or three doses a day.
In some ways Effexor is almost like an AED in that you need to fine-tune its dosage for maximum effect.
How to Stop Taking Effexor (discontinuation / withdrawal)
Unless you need to discontinue the XR flavor at a more rapid rate due to an extremely nasty side effect, your doctor should be recommending that you reduce your dosage by 37.5mg a day every week if you need to stop taking it, if not more slowly than that. You shouldn’t be doing it any faster than that unless it’s an emergency. Yes, that means if you’ve maxed out at 375mg a day it could take up to 10 weeks to get off of it. You can try it faster and hope it works out, and since the odds are actually with you it’s worth doing at the higher dosages and reduce the rate once you’re down to half of what you used to take, but it’s hardly a sure thing. Once you get down to that last 37.5mg a day you have several options:
- If the discontinuation symptoms you’re experiencing are mild, if you’re experiencing any at all, then you may as well stop taking it. You’re in the plurality of people who have taken either version of Effexor who could stop taking it without too much of a hassle.
- If the brain zaps or shivers and other discontinuation symptoms are still bad you can try taking one 37.5mg capsule every other day, or getting a prescription for generic venlafaxine IR and working your way down. As IR comes in a variety of dosages you have all sorts of ways you and your doctor can work out a discontinuation schedule from there.
- If you still can’t stop taking it at a low dosage, you and your doctor may want to try Prozac (fluoxetine) prescription or samples. Generic fluoxetine will even do. 10mg a day is all you should need. Even with the proper discontinuation stopping the last 37.5mg can be hellish. Taking two weeks worth of Prozac (fluoxetine) will make the discontinuation a lot easier. So when you’re off of it and you cannot function, get on the Prozac for a week or two, then stop taking the Prozac. By that time you should find you’ll have either no discontinuation syndrome, or it won’t be nearly as bad.
- If worse comes to worst, there’s always the liquid Prozac. Then you can work your way down from the equivalent of 10mg, or higher if 10mg was too low, to ever-so-slowly try to wean yourself off of the serotonergic part of Effexor that had its claws in you. Unlike most liquid medications of any type, Prozac’s oral solution tastes pretty good3, somewhere between really good mint-flavored mouthwash and so-so peppermint schnapps.