From the Guidelines
Venlafaxine (Effexor) withdrawal can cause severe and disabling symptoms, including anxiety, agitation, low mood, and somatic symptoms, which can have a sudden onset and be protracted.
Effects of Venlafaxine Withdrawal
- Severe anxiety: patients may experience intense anxiety symptoms, which can be debilitating and affect daily life 1.
- Agitation: agitation is a common symptom of venlafaxine withdrawal, which can manifest as restlessness, irritability, and mood swings 1.
- Low mood: patients may experience a low mood, which can be a symptom of venlafaxine withdrawal, and can be challenging to distinguish from a relapse of depression 1.
- Somatic symptoms: somatic symptoms, such as dizziness, headache, and nausea, can occur during venlafaxine withdrawal 1.
Importance of Tapering
- Tapering procedures: determining optimal tapering procedures to minimize withdrawal symptoms is a current topic of debate among clinicians, highlighting the need for careful planning and monitoring when discontinuing venlafaxine 1.
- Support services: patients may require support services, including better information and discussion of treatment options, better monitoring of progress during treatment, and more community support, to manage withdrawal symptoms effectively 1.
Clinical Considerations
- Discontinuation symptoms: venlafaxine has been associated with discontinuation symptoms, which can be severe and disabling, emphasizing the need for careful consideration when discontinuing the medication 1.
- Patient education: educating patients about the potential risks and symptoms of venlafaxine withdrawal is crucial to ensure they are prepared and can seek help if needed 1.
From the FDA Drug Label
Discontinuation symptoms have been systematically evaluated in patients taking venlafaxine, to include prospective analyses of clinical trials in Generalized Anxiety Disorder and retrospective surveys of trials in major depressive disorder Abrupt discontinuation or dose reduction of venlafaxine at various doses has been found to be associated with the appearance of new symptoms, the frequency of which increased with increased dose level and with longer duration of treatment Reported symptoms include agitation, anorexia, anxiety, confusion, impaired coordination and balance , diarrhea, dizziness, dry mouth, dysphoric mood, fasciculation, fatigue, flu-like symptoms, headaches, hypomania, insomnia, nausea, nervousness, nightmares, sensory disturbances (including shock-like electrical sensations), somnolence, sweating, tremor, vertigo, and vomiting During marketing of venlafaxine HCl, other SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), and SSRIs (Selective Serotonin Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e. g. paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures.
The effects of Venlafaxine (Effexor) withdrawal include:
- Agitation
- Anxiety
- Confusion
- Dizziness
- Dysphoric mood
- Fatigue
- Flu-like symptoms
- Headaches
- Insomnia
- Nausea
- Nervousness
- Nightmares
- Sensory disturbances (including shock-like electrical sensations)
- Sweating
- Tremor
- Vertigo
- Vomiting It is recommended to gradually reduce the dose rather than abrupt cessation to minimize these symptoms 2.
From the Research
Effects of Venlafaxine Withdrawal
The effects of Venlafaxine (Effexor) withdrawal can be severe and may include:
- Severe discontinuation symptoms, such as headache, nausea, fatigue, dizziness, and dysphoria 3
- Electric shock-like sensations, which may occur after cessation of treatment and persist for several days 4
- Delirium, which has been reported in at least one case during gradual tapering of the dosage 5
- Serious withdrawal symptoms that can affect motor and coordination skills, making it dangerous for patients to drive 6
- Somatic and psychiatric symptoms, which can resemble a stroke in some cases 7
Characteristics of Venlafaxine Withdrawal Syndrome
Venlafaxine withdrawal syndrome can occur after abrupt discontinuation of the medication, and its mechanism is similar to that of selective serotonin reuptake inhibitors (SSRIs), but of higher intensity 7. The syndrome can include:
- Severe symptoms, such as those resembling a stroke
- Somatic symptoms, such as headache and nausea
- Psychiatric symptoms, such as dysphoria
- Electric shock-like sensations
Treatment and Prevention
Treatment options for Venlafaxine withdrawal syndrome include re-inclusion of Venlafaxine or a SSRI antidepressant 7. To reduce the risk of withdrawal syndrome, patients should be informed about the possibility of its occurrence and should be advised to adhere to a strict medication routine or not to drive a car 6.