PsychRounds: The Psychiatry Podcast [SNRI] - Venlafaxine (Effexor) & Desvenlafaxine (Pristiq)
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Jan 12, 2024 Dive into the world of SNRIs, focusing on Venlafaxine and Desvenlafaxine. Discover their history, mechanism of action, and unique dosing strategies. The discussion highlights potential side effects, especially the risks to blood pressure at higher doses. Learn about innovative approaches for treatment-resistant depression, such as combining Effexor with mirtazapine. Gain insights into the importance of tailoring prescriptions to individual patient needs, including considerations for adherence and monitoring health factors.
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Venlafaxine's Mechanism & Uses
- Venlafaxine is the first FDA-approved SNRI, effective for multiple anxiety disorders and depression.
- SNRIs increase serotonin, norepinephrine, and dopamine by inhibiting their reuptake transporters, acting like modern TCAs with fewer side effects.
Effexor Discontinuation Experience
- Some patients love Effexor, but others experience unpleasant discontinuation symptoms like dizziness and brain zaps.
- This discontinuation syndrome can quickly turn patients off from continuing the medication.
Choosing Venlafaxine Formulations
- Prefer using extended-release Venlafaxine for better tolerability and once-daily dosing.
- Immediate-release is useful for absorption issues but requires twice-daily dosing and has higher withdrawal risks.