I arrived back from a holiday a couple of weeks ago, but it was only today that I got around to changing the leftover Euros back into UK money. Since I bought the Euros at the Post Office, I could change them back commission-free as long as I had the original receipt. So, I was looking through a drawer for it (I did find it, incidentally), when I came across my Efexor patient information leaflets.
Efexor (called “Effexor” in the US), or venlafaxine hydrochloride, is an antidepressant drug which I was treated with for almost 3 years, and which I finally came off more than 4 years ago. I always kept the leaflet from each pack, and ended up with a stack of them, held together with a rubber band. I keep them as a symbol of having overcome depression, and as a cautionary reminder of the hell of the drug’s side-effects.
First off, you can learn a bit more about others’ experiences with Efexor withdrawal at this site. Since March 2000, the US FDA (Food & Drug Administration) has forced labelling changes for the drug, confirming a severe dose- and time-related withdrawal syndrome, and potentially fatal side-effects. This post contains a few of my own experiences with Efexor.
I was treated with doses ranging from 75mg right up to 375mg per day, which is a high dose. At 375mg/day, you have weekly blood-pressure checks, which is some indication of the seriousness. The side-effects increased in intensity and frequency in proportion to the dosage. Let’s start with the side-effects I experienced which are actually listed in the patient information leaflet.
- Sleeplessness. I'd lay awake for hours upon hours every night, simply unable to sleep. The doctor in charge of my case attempted to help by prescribing sleeping pills. He tried several prescriptions, working his way up through progressively more intense doses. At last, he said he couldn't continue, since he'd have to give me "veterinary doses". None of the sleeping medications had any effect whatsoever.
- Sweating. All of a sudden, at odd times and for absolutely no external reason, I'd break out in severe sweats - so severe that sweat would be running down my face within half a minute of the onset. The sweats would stop just as rapidly. There was no pattern to this.
- Nausea. Without fail, every single day after taking the morning tablet, I'd feel very nauseous. The only solution was to lie down for half an hour. I got up, had breakfast (woe betide anyone taking Efexor on an empty stomatch!), took the tablet, then lay down, fully awake, for half an hour until the nausea passed. The nausea would hit within a few minutes of swallowing the tablet. I did this for nearly three years of my life.
- Tingling. A bit like "pins and needles", I'd get tingling sensations at odd times in my extremities, usually within an hour of taking a tablet. There was a unique quality to the tingling, though; it had an undercurrent of vibration, somehow. Not just like ordinary restricted-blood-flow tingling.
There are certainly other listed side-effects which I experienced, but those are the ones which stand out in my memory due to frequency. Far more serious, however, are those not listed, but consistently reported by those who have been “treated” with the drug.
- Needing to activate my appetite. I woke up every morning with no appetite whatsoever, and the only way to "enable" my normal hunger was to have something sugary. I had to have a sugary drink (like Coke or Irn Bru or whatever) at the start of the day, or I would develop no appetite for anything. Drinking something sugary would activate my appetite within 5 minutes or so.
- Brain tingling. Very disturbingly, and indeed hideously in retrospect, I could feel the drug doing something to my brain. It wasn't exactly a "feeling" in the tactile sense, but it was a sensation. It's very difficult to describe; it was almost like some kind of pressure-related sensation, right in the centre of the brain. The sensation was very precisely localised; it had a cascade-like quality to it. This would occur about 10 minutes after swallowing a tablet.
- Collapse. Occasionally, the drug would cause horrible debilitation. Most memorably, I was in London, on a train from Watford in to Baker St. I began to feel suddenly very strange whilst approaching Baker Street, and just managed to make it off the train and up the first set of stairs before everything just went wrong. I sat down heavily onto the floor, and felt extreme nausea, dizziness, tingling and light-headedness all at once. A very intense sweat came on immediately, and I couldn't get up for about 10 minutes - actually could not lift myself from the floor. I sat there on the floor until it passed, just as suddenly as it had come on. It felt as though whatever central control systems the body has had all gone haywire simultaneously. It was a very, very frightening experience - I genuinely believed I was dying. It was the most utterly hideous feeling, and it felt as if it must certainly be how you feel before death. It was awful, really terrible. There were similar incidents very occasionally, but thankfully none quite so extreme.
- Zoom-outs. Very regularly, perhaps 4-5 times per day at its peak, I'd experience a bizarre phenomenon which I named a zoom-out (the combination of this and the following effect was my experience of what others call "electric shocks", "brain zaps" or "brain shivers"). It was as if my sense of the "nearness" of the world around me just zoomed away from me suddenly, leaving me somehow suspended in space, far away from everything. The sounds around me similarly zoomed away, leaving them seeming to come from a great distance. When I saw the movie The Matrix years later, specifically the bit where Neo and Trinity are in the "loading program", and huge racks of guns just zoom in from far away in the background, I thought that was very like zoom-outs, but in reverse, obviously. With zoom-outs, the universe would zoom back in within half a second or so, leaving me momentarily staggered. I've just re-read this, and it really doesn't describe it very well, but I'm not sure how to word it any better. It's not a nice feeling at all, and very dangerous if you're driving or such at the time.
- Foghorns. These were auditory hallucinations, which sounded very like an extremely loud foghorn, played through cheap speakers right inside my skull. The intensity and rawness of the sound just smashes into you, seeming to actually buzz your whole head for a moment. I've heard a Britney Spears song, "Stronger", which starts with three loud, electronic blaring sounds which have a passing similarity to the foghorns. Perhaps if you strapped some cheap little speakers to your ears, cranked the volume all the way up, and played the first second or two of that song, you'd have an idea what it's like. The foghorns would occur at odd times through the day, and periodically if I was lying down.
- Withdrawal symptoms. Missing one dose, by even 45 minutes, would immediately bring on severe withdrawal symptoms; usually a whirlwind selection of the side-effects I've already mentioned. Think about that: just one dose, 45 minutes late, and you're on the floor. Awful, terrible stuff.
At some point in the second year of this “treatment”, I came to the realisation (or rather, finally allowed myself to realise) that the drug was damaging me; damaging my neurochemistry in some way, and hurting my body. I became thoroughly disenfranchised with the whole concept of antidepressant medication, and resolved to read as much as I could on the subject. I also realised, blissfully, that I was the only one who could end this; who could climb out of the hole. My recovery progressed rapidly after that, and as I said my treatment for depression was formally discontinued over 4 years ago. By that time, I’d been “coming off” the drug for 6 months.
Efexor must be tapered down over a period of time in order for you to be able to stop taking it, which shouldn’t surprise you given the instant killer withdrawal symptoms. I suffered hell through the so-called “discontinuation period”, with the aforementioned effects battering me each day, and my mind begging me to just take one of the tablets, to quieten it all. Thankfully, by this stage I had a healthy fear of the drug to strengthen my resolve to wean myself off it.
Most of the secondary side-effects had more or less vanished by the time I completely stopped it (and yes, like most who have experienced Efexor, I accelerated my discontinuation schedule against my doctor’s recommendation, simply because the thought of still taking it had become unbearable). Many of the more serious effects persisted. Appetite-activation was still necessary for maybe three months. Zoom-outs persisted for about two years after completely stopping taking Efexor. Foghorns still occur very occasionally, even today, when I’m lying in bed at the end of the day, before falling asleep. Truth be told, once in a blue moon I’ll even still get the occasional zoom-out. Efexor has made a possibly permanent change to my neurochemistry.
Thankfully, the rulings of the US FDA, and increasing pressure from ex-patients, has lead to a general trend towards Efexor no longer being the primary choice for treating recurrent depression - but it is still very commonly prescribed. If you’re entering treatment for depression, talk to your doctor about whether or not drugs are truly necessary. Cognitive therapy, for example, can be extremely effective, and indeed can fortify your emotional defenses for life in general well into the future.
The key point to remember is that there is no wonder-drug which will pull you out of the black hole; at best, you’ll get an artificial floor to rest on awhile, but you may pay dearly for it, even years after your recovery. If your doctor prescribes venlafaxine, voice your concerns before it’s too late.