It has taken the medical profession a very long time to acknowledge that many of the most popular drugs in the pharmacy can cause a kind of dependence. By that we mean such drugs can precipitate serious withdrawal symptoms when stopped suddenly. The FDA and the drug companies have come up with a sanitized term for this reaction. They call it “discontinuation syndrome.” What they do not tell people is how to stop venlafaxine. If this or other antidepressants need to be halted, it must be done very slowly!
A very short radio show story:
Many years ago we were doing a live radio show. We got a call from a listener who compared venlafaxine (Effexor) to American Express. That was at a time when the company was promoting American Express Travelers Cheques and then the American Express Credit Card using the advertising slogan: “DON’T LEAVE HOME WITHOUT IT.” Here is an example to jog your memory.
The caller to our radio show suggested that we should call Effexor “SIDE EFFEXOR”…because you should never leave home without out it. The implication was that if you forgot your venlafaxine when going on a trip that you would experience withdrawal symptoms.
Why Don’t Doctors Warn People About Discontinuing Antidepressants Too Quickly?
A reader relates a tale of woe and intrigue:
Q. Getting off venlafaxine (Effexor) was the most difficult period in my life, including stints in the ER for suicidal ideation. When the doctor had me go from 150mg to 100mg, it caused me such great distress that I thought I was going to die.
A bump back up to 150mg made me to go ballistic. Then he had me use Prozac to bridge off the Effexor in three weeks, which was way too fast.
Doctors should warn patients right at the start that these drugs could be very difficult to stop. They should also offer more useful advice.
A. A review of 79 studies found that venlafaxine is one of the antidepressants that is most likely to result in severe symptoms when discontinued (Lancet Psychiatry, July 2024).
We agree that people should be warned about the potential for withdrawal problems before they start such a prescription. Some people find the online Ashton manual gives them guidelines for discontinuation. Read about it here.
Some healthcare professionals used to tell patients that any symptoms experienced when stopping an antidepressant were caused by the original mental health problems returning. They could not be caused by the medication.
This Reader Was Not Taking Venlafaxine for Depression, but still experienced a withdrawal reaction:
Q. I suffered from hot flashes for years before my doctor prescribed venlafaxine. It worked great!
After a few years, I wanted to eliminate some pills, so I stopped venlafaxine. That was a bad idea!
My head felt horrible, and I thought I was having a stroke. At the doctor’s office, my BP was sky high, so they sent me to the ER.
Eventually my readings normalized, but that was scary! I would never have taken this drug had I known how miserable I would be going off it. No one warned me.
A. It sounds as if you might have experienced “discontinuation syndrome.” That is the medical term for withdrawal symptoms. Although doctors prescribe venlafaxine off-label to ease hot flashes and night sweats, the FDA has approved it only to treat depression, anxiety and panic disorder. Such antidepressants can trigger very unpleasant symptoms if discontinued abruptly (Lancet Psychiatry, July 2024).
Problems such as dizziness, headache, nausea, irritability and insomnia are especially common upon stopping venlafaxine abruptly. As a result, people taking this and similar medications should ask for guidance on gradual tapering.
A Reader Wants to Know
Q. I had tried to get off Effexor XR a few years ago (venlafaxine), and the results were typical: agony, muscle aches, brain zaps and a depression worse than I had before starting on the drug.
Six months ago, thinking I had learned from experience, I crafted a foolproof plan. I reduced super-gradually (counting little beads inside the capsule).
At first, this went well. I was so proud of myself. Finally, I was down to five of those little beads. Then I got a horrible dizzy spell, and soon I slid down the rabbit hole again, just as if I had stopped suddenly. After suffering for two weeks, I called the prescriber. The first time, he had told me that I was being a hypochondriac. This time, he told me that “Some people can never quit Effexor.” I wanted to smack him! Instead, I started taking half the regular dose.
I was literally “hooked.” Will I be forced to take it for the rest of my life?
A. Your doctor, like many others, should take antidepressant withdrawal very seriously.
An article in The Lancet Psychiatry (online, March 5, 2019) points out that the symptoms can be severe.
“All classes of drug that are prescribed to treat depression are associated with withdrawal syndromes. SSRI withdrawal syndrome occurs often and can be severe, and might compel patients to recommence their medication. Although the withdrawal syndrome can be differentiated from recurrence of the underlying disorder, it might also be mistaken for recurrence, leading to long-term unnecessary medication. Guidelines recommend short tapers, of between 2 weeks and 4 weeks, down to therapeutic minimum doses, or half-minimum doses, before complete cessation. Studies have shown that these tapers show minimal benefits over abrupt discontinuation, and are often not tolerated by patients. Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms.”
The authors suggest that drugs such as sertraline (Zoloft) or paroxetine (Paxil) should be tapered very gradually. The smaller the dose, the smaller and slower the reduction. It may take many months or even years to get off the drug completely.
We suspect that this would also help with your withdrawal from venlafaxine, a similar antidepressant. Some people remove just one bead every few weeks as they get closer to weaning off completely. Yes, this is a slow process, but that’s how hard it can be to avoid the “discontinuation syndrome.”
You may wish to look for a doctor who can help you with this instead of telling you it is impossible. You might also be interested in our Guide to Dealing with Depression, which discusses difficulties due to withdrawal and suggests a few nondrug approaches that may also help. You may also find our FREE Guide to Psychological Side Effects of interest.
Why Doesn’t the FDA Tell Doctors How to Stop Venlafaxine?
Drug companies and the Food and Drug Administration are very good at telling doctors how to start prescribing medicine. They seem far less interested in telling physicians or patients how to stop such medications. Here is an in-depth article we wrote titled:
Getting Off Venlafaxine Can Be Incredibly Challenging
Desvenlafaxine (Pristiq) Withdrawal:
It’s not just venlafaxine. A chemical cousin of venlafaxine is desvenlafaxine (Pristiq). You can read about the problems of discontinuation syndrome with this drug at this link. There are 384 comments, should you wish to learn how other people have managed to overcome the discontinuation syndrome.
Share your own experience about how to stop venlafaxine or any other antidepressant in the comment section below.
Citations
- Henssler, J., et al, "Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis," Lancet Psychiatry, July, 2024, doi: 10.1016/S2215-0366(24)00133-0
