What is the use of Venlafaxine (Effexor)?

From the Guidelines

Venlafaxine should be used with caution due to its potential for increased suicide risk, discontinuation symptoms, and other adverse effects, and its use should be carefully monitored and supervised by a healthcare provider. When considering the use of venlafaxine, it is essential to weigh the potential benefits against the risks, particularly in children and adolescents, as studies have shown an increase in harmful outcomes, including hostility, suicidal ideation, and self-harm 1. The American College of Physicians recommends that clinicians choose pharmacologic therapy, including second-generation antidepressants like venlafaxine, based on adverse effect profiles, cost, and patient preferences, and that they regularly assess patient status, therapeutic response, and adverse effects of antidepressant therapy 1. Some common side effects of venlafaxine include nausea, headache, dizziness, dry mouth, sweating, and sleep disturbances, and it can also be associated with sustained clinical hypertension, increased blood pressure, and increased pulse 1. Key points to consider when prescribing venlafaxine include:

• Starting with a low dose, such as 37.5 mg or 75 mg daily, and gradually increasing as needed and tolerated
• Monitoring for potential adverse effects, including increased suicide risk, discontinuation symptoms, and other serious adverse effects
• Regularly assessing patient status, therapeutic response, and adverse effects of antidepressant therapy
• Continuing treatment for an adequate duration, typically 4-9 months after a satisfactory response, to minimize the risk of relapse or recurrence 1. It is crucial to prioritize the patient's safety and well-being when prescribing venlafaxine, and to carefully consider the potential risks and benefits in each individual case.

From the FDA Drug Label

Venlafaxine tablets, USP are indicated for the treatment of major depressive disorder The efficacy of Venlafaxine Hydrochloride Tablets in the treatment of major depressive disorder was established in 6-week controlled trials of adult outpatients whose diagnoses corresponded most closely to the DSM-III or DSM-III-R category of major depression The efficacy of venlafaxine HCl extended-release capsules in maintaining an antidepressant response for up to 26 weeks following 8 weeks of acute treatment was demonstrated in a placebo-controlled trial The efficacy of Venlafaxine tablets, USP immediate-release in maintaining an antidepressant response in patients with recurrent depression who had responded and continued to be improved during an initial 26 weeks of treatment and were then followed for a period of up to 52 weeks was demonstrated in a second placebo-controlled trial

Venlafaxine is used to treat major depressive disorder.

• Key points:
  • It is used for the treatment of major depressive disorder.
  • The efficacy was established in 6-week controlled trials.
  • It is also used to maintain an antidepressant response for up to 26 weeks following 8 weeks of acute treatment.
  • It is used in patients with recurrent depression who had responded and continued to be improved during an initial 26 weeks of treatment 2
  • Important: Venlafaxine HCl is a prescription medicine used to treat depression 2

From the Research

Overview of Venlafaxine

• Venlafaxine is a medication available by prescription in the U.S. both in an immediate release and an extended release formulation 3.
• It has the effect of potently blocking the serotonin and norepinephrine transporters, and is approved by the FDA for the treatment of major depressive disorder and generalized anxiety disorder 3.

Efficacy in Anxiety Disorders

• Controlled trials have demonstrated the efficacy and safety of venlafaxine in the treatment of anxiety disorders, including social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, panic disorder, and obsessive-compulsive disorder 4.
• Venlafaxine is generally well-tolerated, with side effects that usually abate with continued treatment, making it an important alternative to selective serotonin reuptake inhibitors for patients with anxiety disorders 4.

Efficacy in Depressive Disorders

• Venlafaxine has been shown to be effective in reducing symptoms of depression in patients with major depressive disorder, with statistically significant separation between venlafaxine and placebo groups seen at week 2 and all subsequent assessments 5.
• The probability of remission at week 8 decreased with increasing baseline Hamilton Rating Scale for Depression (HAM-D) total score, but baseline HAM-D total score did not predict response 5.

Efficacy in Comorbid Conditions

• Venlafaxine has been shown to be effective in patients with comorbid major depressive disorder and generalized anxiety disorder, with significant pairwise differences noted between venlafaxine and placebo at week 12 for several efficacy variables 6.
• Response, defined as > or = 50% decrease in symptoms score, was achieved in 66% and 59% of comorbid patients for HAM-D and Hamilton Rating Scale for Anxiety (HAM-A), respectively, in the venlafaxine group at week 12 6.

Mechanism of Action

• Venlafaxine inhibits the reuptake of both serotonin and norepinephrine, making it a dual-acting serotonin-norepinephrine reuptake inhibitor antidepressant 4, 7.
• This mechanism of action is thought to contribute to its efficacy in treating a range of psychiatric disorders, including major depressive disorder, generalized anxiety disorder, and social anxiety disorder 3, 4, 7.