Disclaimer: None of the information in this article constitutes medical advice. All statements are merely the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Venlafaxine, alternatively referred to by its full chemical name venlafaxine hydrochloride or venlafaxine HCL for short, is a prescription medication approved by the FDA to treat depression and anxiety. It's the generic version of the drug, and the branded version is named Effexor.
Is venlafaxine proven to be effective for both anxiety and depression? Does the drug have concerning side effects? Is the branded version more effective? And how do real users rate this medication?
In this article we'll answer all of these questions and more as we review medical research on venlafaxine to determine if it's effective for anxiety and depression, document its side effects, compare its efficacy to Effexor and share real, unsponsored user reviews of the drug.
How Effective is Venlafaxine for Anxiety and Depression?
Venlafaxine has been studied in hundreds of clinical trials testing its effectiveness for reducing symptoms of depression and anxiety.
A clinical trial published in the Journal of Clinical Psychopharmacology evaluated whether venlafaxine was effective 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 patients on venlafaxine for depression were 14% more likely to respond to treatment than patients on than selective serotonin reuptake inhibitors (SSRIs) for treating depression. 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 is also 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 reducing symptoms of anxiety, and for treating patients diagnosed with both anxiety and depression.
We will conclude from the available research that venlafaxine is effective for treating both depression and anxiety.
Venlafaxine Side Effects
As is the case with many other prescription antidepressants, there is an increased risk of suicide when taking venlafaxine. A “black box” warning appears on the drug’s FDA label indicating such.
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 or personal history of suicidal thoughts or attempts.
A medical review published in the Prescrire International journal concluded 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.
The study authors also found that overdoses of venlafaxine were more often fatal than overdoses of SSRI drugs.
A meta-study on venlafaxine found that the most common side effects of the drug 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 increased blood pressure which is a side effect of the drug experienced by some patients.
Overall, venlafaxine has a relatively concerning side effect profile in our opinion, and it may be worthwhile for patients with moderate or minor depression to speak with their doctor about medications with lower risks.
Real, Unsponsored Venlafaxine User Review
One of the most popular YouTube videos on venlafaxine is published by a creator called Brei DelGiudice who shares her experience after using the medication for three months.
She explains her response to the drug, whether she was afraid to start the medication, whether she's experienced any side effects and more. The video is unsponsored:
Is the Branded Form of the Drug More Effective?
As noted in the intro section of this article, venlafaxine is the generic form of the drug and the branded form is called Effexor. Patients are often curious about which version is more likely to be safe and effective.
Generally, we believe it’s logical to take the generic version of prescription medications, because it tends to be cheaper than the branded version and should be just as effective because both contain the same active drug 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 means that generic venlafaxine should be just as effective as branded Effexor.
According to SingleCare, the average retail price of Effexor extended release (ER) is currently $676.33 while the average price of venlafaxine ER is only $150.86.
Does Venlafaxine Cause Withdrawals?
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.
A YouTube creator named Alexandra Stott shared her experience withdrawing from venlafaxine including what symptoms she experienced:
Venlafaxine ER Vs. Venlafaxine IR
Venlafaxine may be prescribed in an 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 major depression.
This is unsurprising given that higher doses of a medication cause a stronger biological effect. Taking a larger dose is also associated with an increased risk of side effects, so it may be logical for patients to speak with their doctor about venlafaxine IR first and only progress to venlafaxine ER if they are still experiencing negative symptoms.
Venlafaxine Dosage
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.
Does Venlafaxine Interact With 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.
The drug manufacturer recommends on the label that patients entirely avoid alcohol while on either Effexor or Effexor XR.
It's extremely important given the negative interaction between venlafaxine and alcohol that patients are honest with their doctor about their alcohol intake. Even moderate alcohol intake can increase the risk of negative health outcomes while taking venlafaxine.
For patients who regularly consume alcohol and are unable to stop, their doctor should be able to prescribe a different medication that does not have a negative interaction with alcohol.
How Does Venlafaxine Work?
Venlafaxine is a member of a drug class called serotonin and norepinephrine reuptake inhibitors (SNRIs). This means that the medication slows the body’s ability to process and break down serotonin and norepinephrine, which allows these neurotransmitters to circulate in the brain at higher concentrations than they would otherwise.
Both norepinephrine and serotonin are associated with mood disorders. 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 this class of drugs artificially elevates serotonin but not norepinephrine.
Our Mental Wellness Recommendation
We recommend a platform called Brightside to patients dealing with mental health issues. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.
A medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.
Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.
Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.
The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.
Interested patients can check out Brightside at this link to the brand's website.
Venlafaxine User Reviews
Venlafaxine has been reviewed over 2,600 times on Drugs.com, which is a website that allows users of prescription medication to publish reviews sharing their experience.
The drug has an average rating of 6 out of 10 for treating depression, and an average rating of 6.5 out of 10 for treating anxiety.
The top positive review of venlafaxine for depression 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.”
