Altruist replied: "Effexor's pros and cons: Pros: There are two last resorts among the modern meds to cure the deepest, blackest depression when your doctor is just switching you from one horsie to another on the med-go-round: Effexor (venlafaxine hydrochloride) and Remeron (mirtazapine). Either in combination with an antipsychotic would really get you out of that hole of despair, but first you should throw away every mirror and scale in your house and buy expandable clothing. But for deep, despairing clinical depression that needs to respond to the standard tweaking of the three most popular neurotransmitters, Effexor (venlafaxine hydrochloride) often pulls people out of the abyss. Cons: For many people Effexor has the absolute worst discontinuation syndrome of an antidepressant. Effexor (venlafaxine hydrochloride) is a medication people utterly loathe to have taken. It is not uncommon for someone to fire doctors during or immediately after they quit taking Effexor (venlafaxine hydrochloride). Effexor's Typical Side Effects: The usual for SSRIs and SNRIs - headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido and a host of other sexual dysfunctions. Most everything but the weight gain and sexual dysfunctions usually goes away within a couple of weeks. Although some women will notice that the sexual side effects will diminish above 200-225mg a day when the norepinephrine kicks in. Maybe Effexor's Not So Common Side Effects: Increased or lowered blood pressure, sweating, farting, anorexia, twitching, shock-like sensations. Also alcohol intolerance and/or alcohol abuse. So Effexor (venlafaxine hydrochloride) is going to be just the thing to talk about at AA meetings. I used to have these last two listed as rare side effects, but I've received way too many e-mails and have read far too many similar reports on various other sites after putting up this page about both of them. As is often the case here, the anecdotal evidence will often trump what is in the US PI Sheet. Best guess to date as to why both of these side effects can happen - Paul of Leeds (in the U.K.) posits that Effexor's broad spectrum use of liver enzymes probably interferes with alcohol clearance and tolerance, thus leading to the type of alcoholism that affects people without the proper enzymes to effectively metabolize alcohol. Between that and the way Effexor works your liver, you're probably better off giving up booze entirely if you're taking this med. Interesting Stuff Your Doctor Probably Won't Tell You: Few, if any doctors, will discuss the possibility that Effexor (venlafaxine hydrochloride) could become a permanent part of your life, whether you like the results of Effexor (venlafaxine hydrochloride) or not. Granted that is a very rare adverse effect, but it does happen. It's hard enough to get them to discuss SSRI discontinuation syndrome., let alone get them to admit that Effexor's symptoms are the absolute worst and the longest lasting of all serotonergic drugs. The discontinuation from Paxil (paroxetine) is bad enough, it's much, much worse with Effexor (venlafaxine hydrochloride). And the way Effexor (venlafaxine hydrochloride) works on neurotransmitters is very complicated. Your doctor may or may not explain this to you. Here's how it works: First it starts to work on your serotonin. Then somewhere around 200 mg a day it starts to work on norepinephrine. Then around 300 mg a day it starts to work on your dopamine. Mileage will vary for each individual, and there's no guarantee on getting all that much dopamine action Effexor's Dosage and How to Take Effexor: Effexor (venlafaxine hydrochloride) comes in immediate and extended release flavors, although hardly anyone takes the immediate release 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 75mg 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 antidepressant, it takes a month to feel any positive effect, so give it a month. Seriously, don't move up above 75mg a day for at least a month. You'll know if it's going to do anything then. If you feel nothing, give up and take a much easier discontinuation. 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 375mg a day for the most severely depressed of patients. The older immediate release version is pretty much the same, except that the dose is divided into two or three doses a day. Days to Reach a Steady State: Three days. How Long Effexor Takes to Work: Up to one month. Effexor's Half-Life & Average Time to Clear Out of Your System: Effexor (venlafaxine hydrochloride) does the double metabolism trick, so its half-lives are 3-7 hours and 9-13 hours. That means the combined half-life is anywhere from 12-20 hours, so it takes anywhere from two to five days to clear out of your system. This is a huge part of why Effexor's discontinuation syndrome is so harsh. No popular SSRI does the double metabolism, and the half-lives of each metabolism is so bloody short. So while you clean out of one metabolite, you still have another one in your system. Your body is completely confused! Wyeth states in the pharmacokinetics section that there's only one active metabolite worth mentioning. Who the hell knows about other metabolites and what part they play in Effexor's discontinuation syndrome, or how long you should take in stepping down your dosage! How to Stop Taking Effexor: 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'll take 10 weeks to get off of Effexor (venlafaxine hydrochloride). Believe me, it's better that way. Also, once you get down to that last 37.5mg a day, ask your doctor for a Prozac (fluoxetine) prescription or samples. Generic fluoxetine will even do. 10mg a day is all you 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 Effexor and you cannot function, get on the Prozac for a week or two, then stop taking the Prozac. You'll find you'll have either no discontinuation syndrome, or it won't be nearly as bad. Comments: This is a multiple reuptake inhibitor, acting sort of as both an SSRI and NRI, so be sure to read up on all three classes of meds, as those pages will cover a lot of stuff common to all meds similar to Effexor (venlafaxine hydrochloride). Everybody hates their meds because of the costs and the side effects, but people just loathe Effexor (venlafaxine hydrochloride) because the discontinuation can be so harsh; it's the med everyone wishes they never took. Yes, people will change doctors because some doctor had the nerve to punish them with Effexor (venlafaxine hydrochloride). Yet for many people it is a godsend, because the combination of serotonin, norepinephrine and dopamine reuptake is literally just what the doctor ordered for the darkest of depressions. Of course Effexor (venlafaxine hydrochloride) has to be complicated about it, it can't just work on everything all at once from the beginning. Oh, no. First it starts to work on your serotonin. Then somewhere around 200 mg a day it starts to work on norepinephrine. Then around 300 mg a day it starts to work on your dopamine. Mileage will vary for each individual, and there's no guarantee on getting all that much dopamine action. Of course as you up your dosage to get to the next neurotransmitter, you keep pushing the previous neurotransmitter, whether you need more action on them or not. And that's what leads to problems, and why people have to stop taking Effexor (venlafaxine hydrochloride). So they stop taking it from a higher dosage, and they stop taking it quickly, and they learn about things like brain shivers. For people in the bipolar spectrum Effexor (venlafaxine hydrochloride) should really be the last of the modern antidepressants that is tried. I feel that the risk/reward benefit runs too high on the risk side of things. More than most SSRIs Effexor (venlafaxine hydrochloride) is likely to trigger not just mania, but rapid cycling. Combine that with the very rare, but still real chance that you could be stuck taking Effexor (venlafaxine hydrochloride) for the rest of your life, even if it doesn't work. That complicates things greatly in Bipolarland. Try everything else first, and if you just react badly to SSRIs, forget about Effexor (venlafaxine hydrochloride) entirely. As for unipolar depression, if you're in the blackest pit of despair and your doctor recommends Effexor (venlafaxine hydrochloride), go for it. What? You don't think I care about you people? I do. For people with unipolar depression a lifelong addiction to Effexor (again, this is a very rare side effect) is just a pain in the ass. Of course Effexor (venlafaxine hydrochloride) works with popular liver enzymes, so there would be dosage adjustments required for some meds, and you'd have extra side effects for having to take 37.5-75mg of Effexor every day, but it wouldn't be making you manic or triggering rapid cycling. As long as the reason why you had to stop taking Effexor (venlafaxine hydrochloride) wasn't too bad, and that reason isn't too harsh at the low dosage, the exceedingly small risk of permanent Effexor (venlafaxine hydrochloride) maintenance is well worth running when weighed against the benefits you'd potentially receive with Effexor (venlafaxine hydrochloride). Effexor (venlafaxine hydrochloride) is also approved for GAD. Yet it frequently makes the anxiety that is part of bipolar much worse. I can't honestly give a good risk/reward analysis for Effexor (venlafaxine hydrochloride) and anxiety. Given the experiences I've read of everyone who has taken it for bipolar and depression, I'm surprised it was even approved for anxiety."