Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s) and published for informational purposes only. We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Venlafaxine is a prescription depression medication, and it's a generic name for the drug. It’s also sold under the brand name Effexor. These two terms refer to the same chemical compound, and will be referred to interchangeably throughout this review. Venlafaxine is also prescribed to treat anxiety and other mood disorders.
This drug is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), which is a similar class of medications to the selective serotonin reuptake inhibitors (SSRI) used in many prescription antidepressants.
In this article we’ll review medical studies on venlafaxine to determine if it’s effective for treating depression. We’ll also highlight some side effects shown in the medical data, and discuss some natural antidepressants which may have a more favorable side effect profile.
Does Venlafaxine Work?
Venlafaxine is a well-studied drug, and has been trialed in hundreds of research studies for treating depression and anxiety.
A clinical trial published in the Journal of Clinical Psychopharmacology evaluated how effective the medication was for treating Major Depressive Disorder (MDD). Patients were instructed to take venlafaxine or a placebo pill for 12 weeks.
Those taking venlafaxine experienced less depression throughout the trial, and the effects were “dose-related”, meaning that those taking higher doses felt more benefit (to a limit).
A medical review published in 2009 compared the efficacy of venlafaxine with other leading antidepressants. The study authors noted that venlafaxine was more effective than SSRIs for MDD. It was also found to be more effective for “treatment-resistant depression,” which is defined as depression which is non-responsive to other medications.
The drug may also be effective for treating anxiety. A meta-study analyzed 14 individual medical trials on venlafaxine for adults with Generalized Anxiety Disorder (GAD) and found it to be effective for most patients in the short-term.
Another study found that the extended release (XR) form of the medication was effective both short-term and long-term for treating anxiety, and for treating patients diagnosed with both anxiety and depression.
Venlafaxine is effective for treating both anxiety and depression based on medical research. This doesn’t mean that it will be effective for every patient; just that it’s shown to be effective on average.
How Does Venlafaxine Work?
Venlafaxine inhibits reuptake of norepinephrine and serotonin, which are two neurotransmitters. In simple terms, this means that the medication slows the body’s ability to process these chemical compounds, which allows them to circulate in the brain at higher concentrations than they would otherwise. Venlafaxine artificially increases levels of both norepinephrine and serotonin in the brain.
Both norepinephrine and serotonin levels are associated with mood disorders, and this is why this class of drugs (SNRIs) is thought to work. Depressed and anxious patients may have naturally low circulating levels of these compounds, which venlafaxine may help normalize.
The most common class of antidepressants are called SSRIs, as referenced previously, and these drugs artificially elevate serotonin but not norepinephrine.
Venlafaxine Side Effects
As is the case with many other prescription medications for depression, there is an increased risk of suicide when taking venlafaxine. A “black box” warning appears on the drug’s FDA label.
This type of warning is the most severe warning issued by the FDA, indicating a potential side effect that could cause serious harm to a patient. This suicide risk appears to be quite low, and is rare when compared to other side effects, but is definitely something that patients should discuss with their doctor, especially if they have a family history of suicide.
There’s also a medical study published in the Prescrire International journal which directly suggests that venlafaxine is more dangerous than other antidepressants. The researchers conducting the study found that venlafaxine caused an increased risk of cardiovascular disorders compared with SSRIs, without any advantages over SSRIs in terms of effectiveness for treating depression.
The study authors also found that overdoses of venlafaxine were more often fatal than overdoses of SSRI drugs.
A broad review of venlafaxine found that the most common side effects of its use are relatively minor, such as dizziness, nausea and sleepiness. The linked study also found that sexual dysfunction was a side effect particularly experienced by men, and likely due to the increased blood pressure response that’s common with the drug.
Venlafaxine Vs. Effexor
As noted in the intro section of this article, venlafaxine is the generic version of the drug and the branded version is called Effexor. Patients are often curious about whether we recommend the generic or the branded version.
Generally, we believe it’s logical to take the generic version of prescription medications, because they tend to be cheaper than the branded version and should be just as effective because they’re formulated with the exact same active ingredient.
An extremely thorough medical review compared the effectiveness and safety of brand-name and generic drugs, and found that there was no benefit, on average, to taking the brand-name medications. This result is to be logically expected, but it’s still useful to verify so with research.
Venlafaxine ER Vs. Venlafaxine IR
Venlafaxine may be prescribed in an Extended Release (ER) version or an Immediate Release (IR) version. The ER version, also called venlafaxine XR, has a higher dosage than the regular version of the drug.
Whether or not a doctor prescribes the ER version depends mostly on patient history and response to the drug. However, it’s worth noting that a medical study found venlafaxine XR to be “significantly more effective” than venlafaxine IR for treating depression.
This is unsurprising given that higher doses of the medication typically have a greater biological effect. Within the approved range, the maximum dose of a drug is typically more effective than the minimum-prescribed dose of a drug, but it also typically comes with a greater risk of side effects.
Venlafaxine and Alcohol
According to the medication’s FDA label, alcohol increases the risk of fatal overdose from venlafaxine. Even if this is a rare risk, it seems clear that alcohol increases the potency of the medication to a potentially unsafe degree, and it seems logical to avoid alcohol use while taking this drug.
This is what the manufacturer recommends on the label.
Given the risk of alcohol use while on venlafaxine, we would urge patients with an alcohol use disorder to speak with their doctor honestly about this issue if they are prescribed venlafaxine. Sometimes patients can be reserved about admitting substance abuse issues to a doctor, but withholding this information could be a serious health risk in this case.
The doctor may prescribe a different medication which doesn’t require abstinence from alcohol if the patient is unable to quit using alcohol.
Venlafaxine appears to cause withdrawal symptoms if stopped abruptly. A 2011 medical review titled “Venlafaxine withdrawal syndrome” found that there was a “high risk” of withdrawal syndrome and that the medication had a greater risk of withdrawal symptoms than SSRIs.
The researchers even noted that symptoms of venlafaxine withdrawal may resemble a stroke.
Due to this risk of uncomfortable withdrawal symptoms, we strongly recommend that patients speak with their doctor if they’re planning to stop using venlafaxine. A medical professional can set up a tapering schedule that can increase the safety of the quitting process, and minimize the risk of withdrawal symptoms.
Venlafaxine is prescribed at a wide range of doses. According to StatPearls, which is one of the largest free medical databases in the U.S., the drug can be prescribed from 25 milligrams (mg) all the way up to 375 mg, which is considered the maximum effective dose.
Typically doses are divided throughout the day, so even patients on a relatively high dose like 300 mg would be taking a few pills throughout the day rather than the entire 300 mg dose in one sitting. This reduces risk of side effects and ensures that the drug is active in the body consistently throughout the day.
Doctors typically prescribe drugs at the lower end of the dosage range to see how a patient reacts. If the patient is unresponsive to a lower dose, they may gradually increase the dose to see if the treatment success improves.
Venlafaxine User Reviews
Venlafaxine has been reviewed hundreds of times on Drugs.com, which is a resource where users of prescription medications can share their personal experience with the drug. We cannot verify the accuracy or legitimacy of any information on this site.
The medication has an average rating of 6/10 for treating depression, which is lower than its rating for treating other mental health conditions.
The top positive review of venlafaxine is published by a user named “Dora” who claims that the drug significantly improved their quality of life:
“I can gladly proclaim this medication saved my life in sooo many ways! I had never felt content until I took [venlafaxine]. The grass was greener, the music was even more beautiful, I am now kind and patient again; I am simply happy! I don't need to constantly seek out pleasurable things to make life more exciting anymore.”
The top negative review is written by a user named “Mistake” who claims the drug caused side effects:
“I was put on venlafaxine in 2001, and soon became functionally narcoleptic and severely depressed.”
Natural Depression Alternatives
Since venlafaxine confers the risk of side effects, including serious side effects like suicide, it may be worthwhile for patients considering the drug to talk to their doctor about trying a milder natural alternative for treating depression first; one without any significant side effects.
St. John’s Wort is an herb which can be purchased as a dietary supplement, which has a significant number of medical studies proving its antidepressant effects.
Research has shown that St. John’s Wort extract (a concentrated version of the raw herbal material) can treat mild and moderate depression as effectively as SSRIs, and has essentially zero side effects.
There is less research suggesting that the herb is effective for major depression, which is what venlafaxine is typically prescribed for.
Unfortunately, herbal supplements are almost never covered by health insurance, so they may not be the best option for patients on a budget. The cost for the supplement will almost certainly have to be paid out-of-pocket, while the cost for venlafaxine may be fully covered by health insurance.
A more experimental antidepressant called ketamine also has some promising medical research suggesting it may be effective for treating depression. As we noted in our ketamine therapy article, this drug has been studied in comparison with pharmaceutical medications, and a recent clinical trial found that one single infusion of ketamine was more effective than a leading pharma antidepressant at least short-term.
We want to note that ketamine is illegal in many jurisdictions and we don’t at all recommend recreational use of the drug. We’re just highlighting it as an experimental therapy that patients may want to ask their doctor about. If it’s legal in your area, it can be administered in a clinical setting.
We’re not suggesting that either of these options are as effective on average as venlafaxine, just that they may be beneficial to patients concerned about the side effects of venlafaxine.