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Venlafaxine Tapering (Effexor)

This entry was posted in Antidepressant on by .
Medically Reviewed Fact Checked

Last Updated on July 26, 2022 by Carol Gillette

Alternative to Meds Editorial Team
Originally Published Nov 2, 2019 by Lyle Murphy

Venlafaxine is notorious for severe reactions during venlafaxine tapering or even when a dose is delayed. Despite these difficulties, it remains one of the most frequently prescribed SNRIs today.

Our comprehensive testing, holistic treatment methods, and customized tapering programs—along with your commitment—can gently and safely transform your life.

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About Venlafaxine

venlafaxine withdrawal symptomsVenlafaxine continues to be one of the most prescribed SNRI medications today, sold in a prolonged or extended-release version. Venlafaxine is FDA approved to treat MDD (major depressive disorder), anxiety disorders, and cataplexy.

A number of off-label uses have developed, including the prevention of migraines, premenstrual dysphoria, hot flashes, fibromyalgia, pain reduction, eating disorders, and others.

SNRI medications are designed to target (block reuptake/transmission of) two types of neurotransmitters primarily — serotonin, an inhibitory hormone, and noradrenaline, which has an excitatory function in the CNS. Venlafaxine also blocks the transmission of dopamine, to a lesser extent. This is a powerful drug with a potent triple punch.12

There is a great need for truly helpful antidepressant tapering options for a growing number of people who found venlafaxine ineffective or too laden with adverse effects. Unassisted tapering from venlafaxine can be extremely hard to tolerate, especially if one has been taking the drug for more than a few weeks or months. Even if it has been taken only for some days, gradual tapering is still recommended and supported by research.8 Some people have been taking an antidepressant for many years despite getting less and less in the way of benefits.1

There is an all too typical scenario that can land a person into a trap of sorts. A person can become stuck taking a medication that no longer relieves their depression, pain, or other discomforts, (some are unsure if it ever did help), and yet the drug produces undesirable side effects that were not there before starting the drug. Even worse, trying to stop taking venlafaxine without a gradual and supervised venlafaxine tapering program, incites harsh withdrawal reactions that can occur. These reactions can intensify greatly if a person is trying to quit venlafaxine too fast.8

The puzzle of how to get off venlafaxine without introducing intolerable reactions can completely halt a person’s journey toward better mental health. Our inpatient programs offer a comprehensive set of protocols for persons that are trying to quit venlafaxine safely, supporting the process of getting off venlafaxine in a gradual way, while attaining bettered health as a result. Safely stopping venlafaxine can finally open the door to discovering and addressing the root causes of a person’s original symptoms that may have led to the prescription in the first place. The following guidelines may be useful to discuss with your prescriber if inpatient help is not available to you.

How to Get Off Venlafaxine Safely

We recommend inpatient treatment, or at the very least, working with a healthcare partner who is familiar with the process of safely tapering venlafaxine. Following are some general guidelines to discuss with your prescriber.

Guidelines for venlafaxine tapering include:
  • Venlafaxine has an extremely short half-life, which is the point where withdrawal phenomena are likely to emerge (3-13 hours) if the next dose is delayed. If needed, a strategy of interdosing with smaller dosages over the day may alleviate this phenomenon.3,8,13
  • Venlafaxine is prescribed in the US in extended or delayed-release form. When you cut an XR pill, the prolonged release characteristic is largely lost. Speak to your prescriber about options such as providing a liquid suspension form, or cross-tapering to a longer half-life SNRI which may be a more taper-friendly strategy.
  • Ask your physician to help you design a tapering schedule that is gentle enough for you. If your physician seems unable to do so, find a doctor who is more familiar with the subject.
  • Diet modification: adequate fresh fruits, vegetables, proteins, foods containing omega-3 fatty acids, fermented foods, prebiotics, and probiotics such as yogurt and sauerkraut.15
  • Avoid sugars, refined carbs, and caffeine, to control blood sugar levels.14
  • Avoid recreational marijuana use as it can increase vulnerability to depression.16
  • Exercise:  regular daily walking, especially outdoors in the sunshine, yoga, Qi Gong, Tai Chi, and similar activities are proven to help reduce psychiatric symptoms and improve cognitive function.17
  • Get adequate rest. For insomnia speak to your physician about supplements such as valerian and others that may help without adding more stress to the neurochemistry you are trying to fix.18
  • CBT and other forms of counseling may help when you are physically well enough to participate and may prove highly beneficial even after your venlafaxine taper is complete.19

venlafaxine holistic treatmentThe most comfortable and safe methods of getting off venlafaxine are available at Alternative to Meds Center. At our luxurious and comfortable in-patient center, we address each person as an individual, with an individual treatment plan and program schedule. Each client is consulted daily, meeting with their treatment team, which can help to determine which adjustments may need to be made, etc. Micro-managing each client is key to comfort when it comes to venlafaxine tapering. This is perhaps not the same type of oversight a person receives when seeking help from their prescribing GP.

Typically, while physicians are highly trained in treating physical ailments, doctors have little to no training whatsoever in how to taper venlafaxine or other drugs. So the scant direction given might be some variation of “try cutting your pill in half for 2, or 3, or 8, etc., days, then try cutting that in half for a number of days, or try missing a day, try missing every third day,” etc. Little-to-no oversight between office visits cannot adequately monitor how successfully or unsuccessfully the person’s tapering experience is turning out to be.

Venlafaxine medication is most commonly prescribed as a timed-release medication. The drug manufacturer reported it withdrew the immediate release version in the US due to excessive nausea, which made taking the drug often impossible to tolerate. This is another layer of complexity and a factor that may require some extra attention because of the powerful and sometimes puzzling effects that medication can induce.

Common Side Effects During Venlafaxine Titration

Venlafaxine is associated with many side effects which can start to emerge during the period of time taking the drug.3,11

These can be found and explored more extensively in a series of informative articles on Effexor tapering and Effexor side effects, such as mania, that can be found on our site. But here, we want to focus on the side effects when a person begins to taper from venlafaxine. These reactions can fairly quickly emerge when a person either misses a dose, including being late by a few hours, or when a person is trying to step down from venlafaxine, even when venlafaxine tapering is being done gradually. It is often the sudden change that is associated with potentially intense reactions during venlafaxine tapering. For these reasons, venlafaxine tapering is best done under medical oversight and very gradually.

brain zaps venlafaxineEach person is a unique individual, and naturally, some people will react differently than others. However, there are some symptoms that appear to be statistically common to many, when large numbers of consumers are surveyed. These include a sensation often referred to as “brain zaps,” shivers, or electric shocks through the head area. Commonly, tinnitus (ringing in the ears) and dizziness accompany the brain zaps. These sensations can be quite severe as they can come on randomly, suddenly, and can persist for a time. Brain zaps can be very unsettling, despite the surprising number of doctors who may discount the severity of the phenomenon.9

Another quite common reaction when trying to quit venlafaxine is extreme fatigue. A person may develop a level of fatigue that seems completely overwhelming, leading to a level of apathy or hopelessness that is often associated with suicidality. It is not legal to prescribe venlafaxine to those under the age of 25 because the rate of suicidality is too high in that age range, as discovered in drug trials. Headaches or migraines are also reported frequently as are flu-like symptoms that range from diarrhea to chills, cramps, fever, etc. A person getting off venlafaxine may often experience insomnia, disturbed sleep, crying spells, and brain fog. Nausea is another very common symptom when stopping venlafaxine.10

It may become quite confusing to try and figure out which are the side effects of the drug itself, and which are the side effects of stopping venlafaxine. However, it is not crucial to do so as with a properly administered venlafaxine tapering program, all of these side effects will tend to diminish over time. If symptoms are causing stress and are not getting better, then it may be time to look at the option of venlafaxine cessation in an inpatient, very closely monitored facility such as Alternative to Meds Center.

FDA WARNING: Please remember: Never try stopping venlafaxine “cold turkey” as to do so can increase the severity of the reactions, and can greatly increase the length of time these unwanted reactions will persist.3

Isolating The Root Causes for Symptoms

venlafaxine addiction root causeIsolating the root cause(s) for the symptoms that led to the prescription in the first place may be one of the most important keys to returning to full health. Finding the root causes allows for these factors to be actually treated or corrected. A person may still be in jeopardy of having their original symptoms return unabated, where nothing was ever done to eradicate the cause.

Even the DSM (5th ed.) clearly stipulates that before diagnosis and prescribing medication, certain other factors need to be assessed and ruled out. For instance, if a person was addicted to marijuana, a doctor following the guidelines would not recommend treatment with prescription drugs for depression until substance abuse could be ruled out. That would indicate that the addiction to marijuana was to be treated first. How often is this recommendation actually followed? The DSM-5 also allows for prescribing a bereaved person antidepressant medication after only a two-week period following the death of a loved one. Many have criticized this practice strongly. These inconsistent recommendations can leave a person in a kind of trap where they are still suffering, but they are also now stuck on a drug they are unable to stop taking, within a monolithic system of treatment, that seems wildly off-kilter for many.4

More on Finding the Root Causes for Symptoms

Did you know that researchers have shown that toxins can leak into the gut and bloodstream, and it is believed that these can cause anxiety, stress, and other psychiatric symptoms? 5,6

Did you know that recreational marijuana use can induce depression?7 There are many reactions to what we expose our bodies to that sound like a prescription drug could be “the answer”, when in fact, addressing the root cause could be far more effective, far easier, and more long-lasting.

For More Information on Venlafaxine Tapering

Alternative to Meds Center is very proud to have helped thousands of clients to reduce and eliminate prescription medication comfortably and with a renewed level of health for the client.

We urge you to contact us at Alternative to Meds Center for more information and details on the gentle, safe, and comfortable inpatient venlafaxine tapering programs we offer at our beautiful inpatient facility.

1. Khin NA, Chen YF, Yang Y, Yang P, Laughren TP. Exploratory analyses of efficacy data from major depressive disorder trials submitted to the US Food and Drug Administration in support of new drug applications. J Clin Psychiatry. 2011 Apr;72(4):464-72. doi: 10.4088/JCP.10m06191. Erratum in: J Clin Psychiatry. 2011 Jun;72(6):874. PMID: 21527123.[cited 2022 July 19]

2. Kuehn BM. Antidepressant Use IncreasesJAMA. 2011;306(20):2207. doi:10.1001/jama.2011.1697 [cited 2022 July 19]

3. FDA Venlafaxine label [cited 2022 July 19]

4. Tolentino JC, Schmidt SL. DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry. 2018 Oct 2;9:450. doi: 10.3389/fpsyt.2018.00450. PMID: 30333763; PMCID: PMC6176119. [cited 2022 July 19]

5. Genuis SJ. Toxic causes of mental illness are overlooked. Neurotoxicology. 2008 Nov;29(6):1147-9. doi: 10.1016/j.neuro.2008.06.005. Epub 2008 Jun 24. PMID: 18621076. [cited 2022 July 19]

6. Genuis SJ. Toxicant exposure and mental health–individual, social, and public health considerations. J Forensic Sci. 2009 Mar;54(2):474-7. doi: 10.1111/j.1556-4029.2008.00973.x. Epub 2009 Jan 31. PMID: 19187449. [cited 2022 July 19]

7. Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J. The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies. Psychol Med. 2014 Mar;44(4):797-810. doi: 10.1017/S0033291713001438. PMID: 23795762. [cited 2022 July 19]

8. Campagne DM. Venlafaxine and serious withdrawal symptoms: warning to drivers. MedGenMed. 2005 Jul 6;7(3):22. PMID: 16369248; PMCID: PMC1681629. [cited 2022 July 19]

9. Papp A, Onton JA. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. Prim Care Companion CNS Disord. 2018 Dec 20;20(6):18m02311. doi: 10.4088/PCC.18m02311. PMID: 30605268. [cited 2022 July 20]

10. Rosenbaum JF, Zajecka J. Clinical management of antidepressant discontinuation. J Clin Psychiatry. 1997;58 Suppl 7:37-40. PMID: 9219493. [cited 2022 July 20]

11. Carvallo AF, Sharma MS, Brunoni AR, Vieta E, Fava GA, The Safety, Tolerability and Risks Associated with the use of Newer Antidepressant Drugs: A Critical Review of the Literature Karger Journal of Psychotherapy and Psychosomatics 2016;85:270-288 [cited 2022 July 20]

12. Singh D, Saadabadi A. Venlafaxine. [Updated 2022 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: [cited 2022 July 20]

13. FDA label Effexor XR (venlafaxine extended-release capsules) [cited 2022 July 20]

14. Aucoin M, Bhardwaj S. Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification. Case Rep Psychiatry. 2016;2016:7165425. doi: 10.1155/2016/7165425. Epub 2016 Jul 14. PMID: 27493821; PMCID: PMC4963565. [cited 2022 July 20]

15. Butler MI, Mörkl S, Sandhu KV, Cryan JF, Dinan TG. The Gut Microbiome and Mental Health: What Should We Tell Our Patients?: Le microbiote Intestinal et la Santé Mentale : que Devrions-Nous dire à nos Patients? Can J Psychiatry. 2019 Nov;64(11):747-760. doi: 10.1177/0706743719874168. Epub 2019 Sep 17. PMID: 31530002; PMCID: PMC6882070. [cited 2022 July 20]

16. Feingold D, Weinstein A. Cannabis and Depression. Adv Exp Med Biol. 2021;1264:67-80. doi: 10.1007/978-3-030-57369-0_5. PMID: 33332004.[cited 2022 July 20]

17. Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15-28. doi: 10.2190/PM.41.1.c. PMID: 21495519..[cited 2022 July 20]

18. Management of insomnia: a place for traditional herbal remedies. Prescrire Int. 2005 Jun;14(77):104-7. PMID: 15984105. [cited 2022 July 20]

19. Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive Behavioral Therapy for Depression. Indian J Psychiatry. 2020 Jan;62(Suppl 2):S223-S229. doi: 10.4103/psychiatry.IndianJPsychiatry_772_19. Epub 2020 Jan 17. PMID: 32055065; PMCID: PMC7001356. [cited 2022 July 20]

Medically Reviewed by Dr Samuel Lee MD

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Venlafaxine Tapering (Effexor)
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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.

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