Venlafaxine hydrochloride, commonly known as Effexor, was the very first SNRI to get approval by the FDA, in 1993.(cit 1) Though immediate-release Effexor has been discontinued by the drug manufacturer, it was replaced in 1997 by Effexor XR (extended release) in 1997. An immediate release version is still sold under the generic name. SNRIs primarily manipulate two neurotransmitters, serotonin and noradrenaline which may help explain some of the drug’s side effects, and challenges of Effexor withdrawals. Both subjects will be described further below.
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Effexor XR is FDA-approved to treat the following:
Generalized anxiety disorder (GAD)
Panic disorders (PD)
Major depressive disorder (MDD)
Social anxiety disorder (SAD)
What Is Effexor Used For?
In addition to the above, off-label uses (2,3) include:
Prevention of migraines
Sleep paralysis, muscle weakness, emotional dysregulation, and other cataplexy symptoms
Premenstrual dysphoric syndrome
ADD (attention deficit disorder)
Complex pain syndrome
Does Effexor Create Healthy Brain Chemicals?
No. No drug creates natural hormones. The proposed function of drugs such as Effexor is to manipulate how various natural neurotransmitters in the central nervous system are processed. Effexor primarily affects serotonin by blocking its reabsorption along the nerve channels, and to a lesser extent Effexor also impacts noradrenaline in similar fashion.2
The body makes serotonin from the amino acid tryptophan which is plentiful in bananas, pineapples, turkey and other foods. It is likely that exposure to sunshine also plays a key role in healthy levels of serotonin production.4
Most of the serotonin in the body is produced in the gut. Although decades of drug advertisers’ claims have saturated our perception of serotonin as a “brain chemical”, the bulk of this natural chemical is produced and found outside the brain and the central nervous system entirely. Receptors for serotonin are found everywhere in the body, as well as inside the CNS and brain. Serotonin is a master hormone whose function is to regulate nearly every behavioral and physiological function in the human body including mood, sleep, digestion, appetite, blood flow, perception, memory, addiction, sexuality, body temperature, motor control, among many, many others.5
It is the job of the adrenal glands to produce norepinephrine or noradrenaline from tyrosine, an amino acid primarily obtained from the diet. Effexor suppresses the reuptake of noradrenaline which (for a time) magnifies its effects, especially at higher Effexor dosage levels. Noradrenaline is naturally created in a healthy body to support alertness, attention, focus, learning, and is designed to provide the “fight or flight” response when we perceive a dangerous situation.
Alternative to Meds Center emphasizes the importance and efficacy of proper diet for attaining natural mental health, over the mechanics of manipulation of natural hormones via drug therapy.
Is Effexor Bad For You?
Effexor is not a hormone, and not a vitamin. It is a drug that interferes with how the natural chemicals of the body are managed and distributed, to compensate for things like a possible poor diet, exposure to neurotoxins, dissatisfaction with lifestyle quality or environmental stressors and circumstances, or medical conditions whose symptoms have not been otherwise resolved. This medication is known for its unpleasant and long-term side effects. Studies show that patients prescribed Effexor can develop numerous symptoms and health risks.(1,2)
Increased risk of suicidality
Elevated blood pressure
Closed angle glaucoma, blurred vision
Loss of appetite, anorexia
Irregular bowel movements
Sexual side effects
The FDA placed a black box warning for suicidal thoughts and behavior on the drug’s packaging. Patients have reported magnified feelings of depression, agitation, and thoughts of self-harm and suicide. These emotions are often reported at the beginning of treatment or during a change in dosage. A major study conducted by Annalisa Rubino, published in the British Medical Journal indicates that Effexor was associated with a higher risk of both completed and attempted suicide and also worsened depression compared to other antidepressants.(1,6)
Effexor isn’t for everyone. Populations who should not take Effexor XR include these, according to warnings given by the FDA.1
The drug can severely impact pregnant mothers, causing fatal birth defects.
Nursing mothers are advised not to take Effexor.
Persons with a previous or current history of seizures since the medication can increase the risk of seizing.
Effexor Addiction and Withdrawal Symptoms
Should you Take Effexor and MAOIs (Monoamine Oxidase Inhibitors)?
MAOIs are a class of medication used to treat depression. In conjunction with Effexor, the potential for adverse effects have led to consequential and sometimes fatal reactions to the body, including high body temperature, rapid fluctuations of heart rate and blood pressure, agitation, delirium, and the risk of coma.
Along with serotonin syndrome, Effexor is a drug associated with bleeding. Other common medications such as aspirin and some anti-inflammatory drugs like (NSAIDs), warfarin (Coumadin), etc., can increase this risk. Be aware of drug-to-drug interactions and to stay safe, ensure you discuss all medications you take with your prescriber to avoid these risks.
Allergic Reactions to Effexor Ingredients
Any patient who is allergic to the ingredients contained in Effexor should not be prescribed this medication. The consequences could be fatal, and would require immediate medical intervention in hospital or ER. Effexor’s ingredients include gelatin, hypromellose, iron oxide, titanium dioxide, ethylcellulose, and cellulose.
Should a Person Take Effexor XR with High Blood Pressure?
Venlafaxine has been known to raise blood pressure and increase hypertension in some patients, and should not be prescribed until the condition has been controlled. Extreme caution is advised where cardiovascular conditions are present, especially at dosages over 200 mg/day. 7
Should a Person Take Effexor with a History of Liver or Kidney Disease?
The liver is the organ that metabolizes venlafaxine and the drug is excreted via the kidneys. Thus, there is an increase in risk for patients with renal or liver disease that could cause serious effects due to the drug’s decreased rate of clearance. 1
Should a Person take Effexor XR who has Glaucoma?
Venlafaxine can trigger pupillary dilation that could cause harm in high risk individuals. Those who have a history of eye pressure or are at risk for certain types of glaucoma should discuss such risks and concerns before taking Effexor.9
Should a Person Combine Effexor XR and Alcohol, Recreational Drugs?
The pairing of alcohol or other recreational drugs can increase drowsiness and fatigue and can lead to overdose. In pre-marketing trials, 20 instances of acute overdose were recorded where Effexor or Effexor XR was either taken alone or combined with other CNS depressants such as alcohol or other drugs.
What Are the Long-Term Side Effects of Effexor?
Very little research has been done on long term effects of SNRIs, although medical consensus is clear that due to dependency issues, withdrawal from antidepressants and anti-anxiety drugs in general should be slow and gradual. According to the work of Justin Gagnon et al published in the Frontiers Journal of Nutrition, the amount of research that has been done on antidepressants in general is disproportionate with the very high frequency of prescribing them.
That said, one clinical report published in Nature documented a patient who developed glaucoma issues after one day of treatment with venlafaxine. The pain and pressure went away when Effexor was discontinued. The FDA label cautions those with diabetes, bleeding issues, bipolar, heart conditions, thyroid issues, and many other conditions about taking Effexor, but it doesn’t stipulate why exactly. Although there are not many cases studying the long-term effects of Effexor and other newer antidepressants/anti-anxiety drugs, the issues that accompany difficult withdrawals from them have been shown comparable to those of the benzo class, known for its crushing and lingering after effects. The pharmaceutical industry has turned away from such trials and focused instead on finding better new drug formulations.(1,8,9,10)
Can I Stop Taking Effexor Cold Turkey?
The FDA warns against discontinuing venlafaxine all at once. Since Effexor XR is an extended release drug, it is best to work with medical oversight who can help you with accurately reducing the dosage, or converting to a different formulation to help ease the shock to the body. Become familiar with the risk factors and symptoms you may experience before gradually removing Effexor from your routine altogether. Some people have milder symptoms than others, some experience debilitating and ruinous withdrawals.12
Paresthesias (prickling, tingling sensation on the skin)
Electric-shock sensations, “brain zaps”
Tremors, jerks, Parkinsonism
SNRI withdrawal syndrome 12 is a common experience for anyone with a moderate to severe drug dependency. It is important to bear in mind that each individual has a unique body chemistry, and thus their withdrawal symptoms will be largely specific to them. The withdrawal period may begin as soon as a day, or some hours after the last dosage, or sooner, especially if you have been taking immediate-release venlafaxine. Each individual’s metabolic and genetic factors will impact the rate of withdrawal.
It is strongly advised not to quit Effexor cold turkey since this can induce a state of shock and an overwhelming and impossible experience to endure without medical intervention. Implementing a tapering strategy with your doctors or choosing a prescriber who is familiar with Effexor withdrawal is strongly recommended. The holistic detox methods used at Alternative to Meds Center are particularly effective for Effexor withdrawal, which are provided in tandem with inpatient medical oversight to provide bridge medications and other medical and holistic interventions to soften the experience.
Medical consensus consistently recommends that tapering off of Effexor slowly can help reduce the negative symptoms one can experience when discontinuing use.
How Long Does It Take for Effexor to Get Out of Your System?
Effexor has two formulations: immediate-release and extended-release. The half-life is calculated based on various factors including the drug’s formulation, condition of the liver and kidneys, genetics, and other factors and can range from 4 – 21 hours. 11
Can Venlafaxine show up on a drug test?
Yes, Effexor can appear on both screening tests and confirmatory tests. Confirmatory tests will differentiate Venlafaxine from other medications. There are several different kinds of tests that are used. For example, Effexor will appear on a urine test if administered in the past 48 hours. Effexor can also be detected from a blood test within three days of intake, and a hair follicle test can be detected up to 16 months later.
Individual factors do play a key role in test results, such as:
Age-related factors, such as slowed metabolism from liver disease can prolong the time it takes for Effexor to clear your system.
Patient’s Body Mass Index and Metabolism:
An individual’s body mass index may impact the rate of medication metabolism and excretion. A study published in the Journal of Psychoneuroendocrinology found patients with a higher BMI cleared medication more slowly than those with a lower BMI. However, another study published in the Journal of Clinical Pharmacokinetics showed that genetics can also contribute to a slowed or elevated clearing rate, (see next section) despite other factors such as obesity. (13,14)
A person with poor metabolism functions might have a lengthier removal time. Research out of The National Center for Biotechnology Information described patients who carry two inactive copies of CYP2D6 (Cytochrome P450 2D6, an enzyme that helps break down drugs) who were reported as “poor metabolizers.” They may experience decreased capacity for (slower) metabolization of the substance. However, individuals with more than two copies of functional CYP2D6 are considered “ultrarapid metabolizers” and may have a much faster rate of metabolism. 15
Renal And Hepatic Functions:
A patient suffering from hepatic fibrosis or cirrhosis or dysfunctional kidneys typically retains the Effexor in their body longer because the affected organs are not able to metabolize and clear the drug as quickly compared to healthy organ functions.
PH Of Urine:
A low PH of urine will accelerate the removal of the drug. High PH of urine (alkaline urine) would aid in venlafaxine reabsorption, allowing the body to retain more of the medication compared to more acidic urine.
A person who regularly takes low doses of Effexor could metabolize and excrete it more quickly than someone taking a higher dosage.
Incorporating other drugs:
Mixing Effexor with any kind of antidepressant can affect serotonin concentration in the body to dangerous levels, which can be lethal. Harmful and sometimes life-threatening drug-to-drug interactions and CNS depression can happen when venlafaxine is combined with lithium, St.John’s Wort, alcohol, opiates, or other psychoactive agents.5
How Do I Wean Off of Effexor?
The process of weaning off Effexor should be monitored by a medical professional familiar with coming off antidepressants. The process might seem meticulous, but slowly tapering off of the medication will help aid in a safe recovery, reducing the associated symptoms, and shortening the length of time that symptoms may linger.
Introducing a taper schedule will vary from person to person, so taper plans will depend on several factors like dosage, frequency of use, and how long the drug was taken. You can find examples of tapering guidelines and helpful therapies by referring to ATMC’s Effexor Tapering page.
If you’re looking to detox from Effexor, remember that there are many factors in the weaning process for any drug, and if not well-managed, the side effects of antidepressants can be severe. Safe detoxification could look like a well-curated out-patient prescription plan or a supervised inpatient detoxification setting.
Though the journey of removing substances from your system can be a difficult one, the professionals at Alternative to Meds Center are here to help make the holistic detox process exponentially more bearable.
Contact us today to discuss your situation and take the first step into your new healthy, Effexor free life.
This content has been reviewed and approved by a licensed physician.
Dr. Michael Loes, M.D.
Dr. Michael Loes is board-certified in Internal Medicine, Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr. Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally, he is a well-published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response, and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.
Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.