About Effexor XR
Effexor was FDA-approved in 1993 to treat major depressive disorder. Due to major side effects, the drug was reformulated to an extended-release form in 1997 and is only available in extended-release form (XR) today.
Effexor XR is classed as an SNRI, because it targets 2 main neurotransmitters: serotonin and norepinephrine (adrenaline). Serotonin acts as a buffer, with anxiolytic, inhibitory properties. In contrast, norepinephrine acts as a stimulant. This is the “fight or flight” hormone that causes increased heart rate and other excitatory effects. Another change was that the FDA extended the list of what it approved to treat, including panic disorder, and several types of anxiety disorders.
SNRIs are called second-generation or atypical antidepressants. All antidepressants however are off-shoots of the now very controversial “chemical imbalance” theory which informed most mainstream treatment and drug development for the past 50 years or more.9,11
How Does Effexor XR Work?
While researchers are not fully certain how the nerve signal transfers associated with these two neurotransmitters operate, preventing reabsorption of both effectively boosts the amount of each available to the brain. By blocking reuptake by other cells and providing a larger amount of norepinephrine and serotonin to the brain, SNRIs such as Effexor XR were theorized to prevent depression and anxiety. SNRIs are dual inhibitors. However, the evidence remains unclear, and individuals may respond unpredictably to SNRIs and SSRIs in ways that are not completely understood.12
What is Effexor XR FDA-Approved to Treat?
As an SNRI, Effexor XR is approved to treat multiple depression and anxiety-related disorders in adults by improving mood, energy level, and even your interest in daily living activities. However, the FDA has mandated a black box label for the drug, warning of increased suicidality in patients under 25; thus, approved treatments are for adults over 25 only.
Currently, Effexor XR is FDA-approved to treat the following disorders:
- GAD (general anxiety disorder)
- SAD (social anxiety disorder)
- PD (panic disorder)
- MDD (major depressive disorder)
General Anxiety Disorder
GAD occurs when a person experiences excessive anxiety, worry, and other symptoms for six months or more. Additional symptoms can include:
- Fatigue
- Restlessness or inability to sleep
- Sleep disturbances
- Inability to concentrate
- Irritability
- Muscle tension
Major Depressive Disorder
MDD is perhaps best known as severe and lingering depression. Many people diagnosed with MDD may feel worthless, hopeless, or suicidal. In addition, many people experience:
- Eating or sleeping more or less than usual
- Low energy
- Nervous energy and agitation
- Thoughts of death and dying
Panic Disorder
Panic disorder involves sudden, repeated feelings of intense anxiety, fear, and panic. Over time, an individual can develop feelings of fear in anticipation of experiencing the next panic episode. Symptoms include:
- Chest pain
- Heart palpitations
- Dizziness
- Shortness of breath
- Sweating
- Nausea
Social Anxiety
Individuals experiencing social anxiety primarily present with a fear of being judged by others. The most common symptoms include:
- Sweating
- Shaking
- Nausea
- Flushing
- Difficulty speaking
Effexor Off-Label Uses
The vast majority of physicians will try to do the right thing for their patients. Their license allows them to prescribe drugs off-label, but often they do so without comprehension or awareness of the drug’s limitations or the potential consequences. Doctors are influenced by drug company promoters, and some observers have expressed concern over how psychiatry turned normal sorrow into depressive disorders. No studies have shown antidepressants have any efficacy for low-back pain or in treating the pain of fibromyalgia, yet these off-label uses are common examples of limitations in practice.13-15
Some other examples of off-label uses of Effexor XR include these:
- Obsessive-compulsive disorder (OCD)
- ADD/ADHD
- Post-traumatic stress disorder (PTSD)
- Premenstrual dysphoric disorder (PDD)
- Hot flashes
- Migraine prevention
- Diabetic neuropathy
What Are Some Effexor XR Side Effects?
Effexor XR, like many other prescription medications, can present a host of negative side effects. Effexor XR side effects range from minor to life-threatening, which for some, may cause worsening of symptoms instead of getting better.8
Most commonly reported Effexor XR side effects can include:
- Headache
- Nausea, vomiting
- Sweating
- Diarrhea, constipation
- Nervousness
- Restlessness and insomnia
- Abnormal dreams
- Fatigue, weakness
- Sexual dysfunction
- Dizziness
- Dry mouth
Serious Effexor side effects can include:
New or worsening emotional and behavioral problems, i.e., aggressiveness, irritability, thoughts of self-harm, thoughts of harming others, hostility, anxiety, impulsivity- Suicidality, not just in the under-25 population 17,16
- Bone breakage
- Dizziness leading to falls
- Dangerously increased heart rate
- Changes in urination and kidney function, including increased urination or difficulty urinating
- Low sodium levels, indicated by headache, difficulty focusing, and weakness
- Increased bleeding, including gastrointestinal, vaginal, and other forms of excessive bleeding
- Serotonin syndrome—a dangerously high level of serotonin that can cause shivering, fever, seizures, coma, mental confusion, and death
- If taken during pregnancy, there is an increased risk of preeclampsia and heavy bleeding after childbirth
- Wide-angle glaucoma, eye pain, swelling around the eye, changes in vision
- Mood “switching,” also known as Effexor mania
Quitting Effexor and Effexor Withdrawal Symptoms
As a result of the above side effects, or lack of efficacy, some patients may choose to discontinue Effexor XR altogether. People who quit Effexor XR abruptly are at high risk for severe withdrawal symptoms. Withdrawal phenomena from venlafaxine, an SNRI, are more intense than SSRI withdrawals. Without medical oversight, these can become dangerous, and even life-threatening. Abrupt venlafaxine withdrawal can look much like a stroke, so it is important to work with a medical professional who understands what venlafaxine withdrawal can look like and treat it properly.10
Symptoms of Effexor XR withdrawal can begin as early as a few hours or days after the last dose. For about 50% of people, minor withdrawal symptoms can dissipate over the course of a few days. In the other 50% of cases, more severe withdrawal symptoms will arise. If the withdrawal is not done safely and gradually, Effexor XR withdrawals can continue for weeks, months, and in some cases, years. This is referred to as “protracted withdrawal.”
Effexor withdrawal symptoms include:
- Physical symptoms such as nausea, migraine, fever, chills, fatigue, dizziness, and vertigo
- Stroke-like symptoms, loss of muscle control
- Gastrointestinal and other flu-like symptoms
- Insomnia
- Psychiatric symptoms such as suicidality, heightened emotions, crying spells, fear, anxiety, sudden mood swings spiraling into depression, suicidal thoughts, “the spiral into doom”
- Brain zaps—sudden electrical shock sensations within the head and neck
- Brain fog, mental exhaustion
Effexor XR Alternatives
If you have been diagnosed with depression and/or an anxiety disorder, you are far from alone. Together, depression and anxiety disorders make up the most commonly treated set of symptoms in the United States and elsewhere. Estimates range from 2-8% or higher for depression. For anxiety, the estimated range is between 4 – 27% with the US at the higher end of those numbers.6,7
If you are experiencing some of the above-listed symptoms of major depression, GAD, social anxiety, panic disorder, or one of the other off-label conditions commonly treated by Effexor, alternatives may provide a viable solution. Similarly, if you are taking Effexor and experiencing negative side effects — including Effexor mania — it may be time to consider an alternative. However, it is important to safely taper off Effexor and consult a physician regarding all alternative options.
Here is more information about antidepressant alternatives, such as those available at ATMC.
If coming to an inpatient facility, such as the residential program at Alternative to Meds Center, is not possible for you, more help is available from these trusted treatment resources: immh.org and acam.org
Euphoria
