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Venlafaxine - Long Term Adverse Effects

Richard Lathe rlathe@ed.ac.uk


Sir - I write to report adverse effects of venlafaxine from observations on one subject and from a wider survey of the literature. One subject receiving venlafaxine (Efexor XL, 75 mg/day) for 6 months reported headaches and related symptoms of severity sufficient to preclude normal function. Discontinuation was found impossible, medication was recommenced according to a schedule for tapered removal.

Following complete discontinuation the headaches disappeared, but investigation revealed that the subject had experienced debilitating inertia for the period of the medication. Longer-term problems have also became apparent: 1 month later the subject still reports sudden episodes of nausea, temporary disconnection, palpitations, tremor, sweating, unsteadiness.

On investigation I find that this is not unusual. There is a volume of literature on the acute and chronic adverse effects of discontinuing Venlafaxine, including nausea, memory loss, tinnitis, altered sleep patterns, digestive disturbances, and tremor, termed the 'serotonin syndrome' (1). Indeed, the manufacturer (Wyeth) could face charges for failure to issue proper warnings (2). New guidance from the FDA recognises the adverse consequences of Venlafaxine discontinuation (4). It is notable that the information issued with Venlafaxine (Efexor XL) in November 2001 only speaks of transient adverse effects 'for a few days' (5).

In summary, the prominent side-effects (6) including debilitating inertia are clearly undesirable when comparable results can be obtained with other therapies(7). Further, the duration of medication here (8 months) is, as far as I can establish, longer than the maximum period of clinical trials 8): a strong argument can be made that the drug administration should be restricted to less than 6 months, with tapered discontinuation scheduled from inception.

Richard Lathe
Biomedical Sciences, Faculty of Medicine, University of Edinburgh, George Square,
Edinburgh EH8 9LS, UK (rlathe@ed.ac.uk)

I personally called Peter Breggin (The Antidepressant Fact Book) to ask him how long 'withdrawal' symptoms persist. He told me that recovery, whatever form it takes, is usually complete within two years. After that you are probably stuck with whatever symptoms persist.

That was four years ago, one year into withdrawal. I basically stopped recovering at 2 years just like he said. But now, at 5 years, I am finding some of my problems getting slightly worse, especially after a course of Ultram (weak opioid but also boosts serotonin and norepinephrine) and a year of morphine. Each of these drugs seems to have temporarily masked the long-term symptoms but on withdrawal they were slightly worse, or maybe it is just age catching up with me. Personally I think that any drug that strongly tweaks neurotransmitters will have permanent effects, more severe if taken daily in the long-term, or if taken repeatedly in short episodes, or if taken in very high doses. Basically any chemical insult that brings about neurotoxic changes or plasticity adaptation will cause permanent damage. The only question is, will the person have enough residual capacity that the damage is unnoticeable, or will it be obvious?

I know I have tried a some but since my mind has not been well as far as memory goes I could not say for sure which ones. I can tell you none have replied to me.
I have read two of healys books have not been able to get tracys book in the library have read the prozac backlash too. I have been to every one of these stes except the last drdacyh.
While I have learned a great deal enough that I will never take another of these drugs and all drugs are suspect...I have learned how to accept it all. Guess there are some thing not so easy to learn.

Are there certain symptoms that do not go away? Could you list he ones that seem to be an issue.