Venlafaxine
Effexor
Serotonin-Norepinephrine Reuptake InhibitorGeneric availableTDM data
The mechanism of action of venlafaxine in the treatment of MDD, GAD, SAD, and PD is unclear, but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through inhibition of their reuptake.
Compare Venlafaxine →FDA-Approved Indications
- Major depressive disorder (adults)
- Generalized anxiety disorder (adults)
- Social anxiety disorder (adults)
- Panic disorder, with or without agoraphobia (adults)
Common Off-Label Uses
- Social anxiety disorder
- Panic disorder
- PTSD
- Migraine prophylaxis
- Neuropathic pain
- Vasomotor symptoms (menopause)
- ADHD (adjunct)
What Sets This Drug Apart
- Dose-dependent SERT-to-NET recruitment: below 150 mg/day acts primarily as an SSRI; above 150 mg adds meaningful noradrenergic reuptake inhibition
- Broadest FDA indication set among SNRIs: MDD, GAD, SAD, and Panic Disorder all approved
- Among the highest discontinuation syndrome rates of all antidepressants; taper gradually over weeks and warn patients about withdrawal symptoms
- Active metabolite desvenlafaxine (O-desmethylvenlafaxine) accumulates and contributes to effect — CYP2D6 poor metabolizers have higher parent:metabolite ratios
- Dose-dependent hypertension (3-10%); blood pressure monitoring essential during titration
- XR formulation allows once-daily dosing with improved GI tolerability vs IR; most prescribing uses XR
Boxed Warning
SUICIDAL THOUGHTS AND BEHAVIORS