Venlafaxine
SNRI for MDD, GAD, panic, social anxiety. | Compound
Aliases (2)
▸ Overview TL;DR
SNRI for MDD, GAD, panic, social anxiety. Effective at high doses for severe/treatment-resistant depression but has the worst discontinuation syndrome of any antidepressant ("brain zaps," dizziness, flu-like symptoms). Not relevant to Dylan.
▸ Mechanism of action
At doses <150mg/d acts mostly as SSRI. Above 150mg adds clinically meaningful NET (norepinephrine reuptake) inhibition. At 300+mg adds weak DAT inhibition. Active metabolite desvenlafaxine (Pristiq) has more balanced 5-HT/NE profile from start.
▸ Pharmacokinetics Approximate
Approximate decay curve drawn from the half-life mention(s) in the source notes. Real PK data not yet ingested per compound.
▸ What to expect Generic
- 1Week 1Tolerability and dose-response.
- 2Week 2-4Early effect window.
- 3Week 4-8Peak benefit assessment.
- 4Week 8+Cycle decision point.
▸ Side effects + safety
- Common (>10%): Nausea, sweating, sexual dysfunction, ↑ BP (dose-dependent, monitor at >150mg), insomnia.
- Less common (1-10%): Tremor, anorexia, ↑ HR, dry mouth.
- Rare-serious (<1%): Serotonin syndrome, hyponatremia, hypertensive crisis, severe withdrawal syndrome (functional), suicidal ideation <25 yo.
- Specific watch periods: BP at every visit; first 4 weeks for activation/SI.
▸References5 sources
PMID 29477251
2018Cipriani 2018 network MA.
PMID 30032535
Antidepressant discontinuation symptoms (Davies + Read).
PMID 21199948
Venlafaxine BP elevation review.
PMID 16390886
STAR*D venlafaxine arm.
PMID 18316756
SNRI sexual dysfunction.