Effexor (Venlafaxine)

"Venlafaxine extended-release capsules
WYETH SNRI approved for panic disorder

This dual-acting antidepressant is believed to exert its effect through the inhibition of neuronal serotonin and norepinephrine reuptake. Venlafaxine was approved on November 18, 2005, for the treatment of panic disorder, with or without agoraphobia, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)...

Safety. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Any clinician considering the use of venlafaxine or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Pooled analyses of short-term, placebo-controlled trials of different antidepressants in children have revealed a greater risk of adverse events representing suicidality during the first few months of treatment in those receiving antidepressants. Patients with MDD, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidality or unusual changes in behavior, whether or not they are receiving antidepressant medications, and this risk may persist until significant remission is achieved. Adult and pediatric patients with MDD or comorbid depression with other psychiatric illness being treated with antidepressants should be observed for clinical worsening and suicidality, especially during the initial few months of a course of pharmacotherapy, or at times of dose changes, either increases or decreases. Adverse reactions, some of which were serious, have been reported in patients who have been recently discontinued from a monoamine oxidase inhibitor (MAOI) and started on venlafaxine, or who have recently had venlafaxine therapy discontinued prior to initiation of an MAOI. These reactions have included tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, and death. It is recommended that venlafaxine not be administered in combination with an MAOI, or within at least 14 days of discontinuing treatment with an MAOI. Similarly, at least 7 days should be allowed after discontinuing venlafaxine therapy before initiating therapy with an MAOI. Venlafaxine therapy has been associated with sustained increases in blood pressure in some patients. As such, it is recommended that patients receiving venlafaxine have their blood pressure monitored regularly. Abrupt discontinuation or dose reduction of venlafaxine at various doses has been associated with the appearance of new symptoms, the frequency of which increased with increased dose level and with longer duration of therapy. Patients should be monitored for symptoms when discontinuing treatment with venlafaxine, and a gradual reduction in dose rather than abrupt cessation is recommended whenever possible. Clinically relevant increases in serum cholesterol have been recorded in venlafaxine-treated patients. As such, measurement of serum cholesterol levels should be considered during the course of long-term venlafaxine therapy. The most common adverse events associated with the administration of venlafaxine include anorexia, constipation, dry mouth, somnolence, tremor, abnormal ejaculation, and sweating.

Dosing. For the treatment of panic disorder, it is recommended that initial single doses of 37.5 mg/d of venlafaxine be administered for 7 days. Patients not responding to 37.5 mg/d of venlafaxine may have their dose subsequently increased to 75 mg/d for 7 days, followed by increases of 75 mg/d at 7-day intervals to a maximum dose of 225 mg/d. Venlafaxine should be administered in a single dose with food either in the morning or in the evening at approximately the same time each day. Each capsule should be swallowed whole with fluid and not divided, crushed, chewed, or placed in water, or it may administered by carefully opening the capsule and sprinkling the entire contents on a spoonful of applesauce. This drug/food mixture should be swallowed immediately without chewing and followed with a glass of water to ensure complete swallowing of the pellets."

- Effexor HR in Formulary Journal (December 1, 2005)

"By contrast there is a striking scarcity of studies on current heavily prescribed drugs like Prozac, Zoloft, Paxil, Luvox, Wellburtin, Effexor, serzone and others. Given the enormous amount of research on neurotoxicity, one has to wonder at the large number of studies of illegal drugs and so few on drugs being prescribed to millions of people, most of whom are unaware of the potential risks.
Researchers say that one reason for the lack of adequate studies on popularly prescribed medications like the Prozac group is the control pharmaceutical companies exercise over research on drugs as long as they are covered by their patent. For animal research, the pure form of a drug is needed from the manufacturer, as the pill contains too many additives. But in order to obtain the pure drug, researchers can be required to sign onerous contracts, which, among other things, grant the company the right to veto the publication of the results. The careers of scientists depend on publishing their work. Few can invest the time, energy and money in studies a pharmaceutical company may not allow to be published. All of the serotonin boosters are still covered by the patents. Even when the patent on a drug runs out, obtaining funding for costly animal research is typically granted by review boards. Most of the people who sit on review boards are researchers with ties to the pharmaceutical companies that fund at least some of their research. Just one reviewer opposed to a study can easily raise objections that block it."
-pp. 102- 103, Held Hostage in Prozac Backlash by Joseph Glenmullen, MD (2000)

"One of the least svory marketing efforts is Wyeth's campaign to "educate" college students about depression. What is really being marketed in the condition. If students can be convinced that they have a treatable depression, selling the company drug Effexor is easy. To that end, Wyeth sponsors a ninety-minute forum on college campuses called "Depression in College: Real World, Real Life, Real Issues". It features doctors, psychologists, and Cara Kahn of the MTV reality show Real World Chicago, who takes Effexor. In 2002, when the campaign was launched, Wyeth told Alex Bean of The Boston Globe that four colleges had agreed to host the forum. Harvard declined. It's provost, a psychiatrist who was formally head of the National Institute of Mental Health, told Bean, √Źn the case of celebrities speaking, who are actually being paid by the company, there is a risk that inappropriate marketing will go on". That's putting it mildly. Bean himself was more outspoken: "Millions of college students feel lousy, for any number of reasons: they are far from home; college is an unfamiliar and sometimes threatening environment; the object of their affection is inattentive. God knows we all have been there. Do they need a $120- a-month Effexor fix to see them through these tough years? Probably bot. But who could be more suggestible, or vulnerable, than a boy or girl making the transition to adulthood?"
- pp. 152- 153, Marketing Masquerading as Education in The Truth About Drug Companies: How They Deceive Us and What to Do About It by Dr. Marcia Angell (2004)

"For their advertising campaign in the general media and professional journals, the manufacturers of the new antidepressants have developed themes, catchy slogans like those used in cigarette or beer adds. Effexor advertisements have the theme of reclaiming one's life. One ad shows a playful, laughing mother and a young daughter running up the stairs. Beneath the rheumy photograph is a note written in crayon, "I got my mommy back". Another ad shows a rugged father and son with the note "I got my dad back". Still another shows a happy husband and wife leaning into each other in an affectionate hug. Below, two wedding bands are pictured intertwined beneath a note that reads, "I got my marriage back".
-p.231, Held Hostage in Prozac Backlash by Joseph Glenmullen (2000)

"Effexor is another of the popular new antidepressants of the last decade with sever withdrawal effects. Effexor is even shorter-acting than anty pf the Prozac group. One of my patients on Effexor was rushed to the hospital in an ambulance after she became dizzy, lightheaded and faint while at work. The emergency room doctors could find nothing wrong with her. Eventually, they concluded she must be anxious. Only when the same symptoms recurred a month later did the patient realize the common feature was that on both days she had forgotten to take her morning dose of Effexor. The severe withdrawal symptoms had emerged within hours. Since then, she has been extra-vigilant never to forget to to take the Effexor on time."
-p. 75, Held Hostage in Prozac Backlash by Joseph Glenmullen, MD (2000)

There was Justin Cheslek, twenty, who went to his college health service complaining of insomnia. After a workup, in which the physician noted "no suicidal ideation," Cheslek received a prescription for Paxil. When he complained that he didn't like the way it made him feel, he was put on Effexor. Within twenty-four hours, he had a seizure. Five days later, he hung himself in his apartment. As his father recounted the details to an FDA advisory committee: "He didn't leave a note. Beneath him were his laptop computer and a glass of Coke. It was as if some sudden impulse had made him do this. We grilled his girlfriend about his mood and behavior in the months prior to his death. She said his demeanor changed dramatically around her birthday, February 22. Justin started taking Paxil February 21."
-p. 204, Generation RX: How Prescription Drugs are Altering American Lives, Minds, and Bodies by Greg Critser (2005)

"On January 25, 2008, Pfizer agreed to acquire Wyeth for $68 billion, or $50.19 per share, a 29 percent premium over the market price before rumors of the deal leaked. Pfizer is already the largest pharmaceutical company in the world, and combined with Wyeth, the company expects to earn over $20 billion in cash each year. Pfizer has stated that it plans to save $4 billion a year with the merger."
-Pfizer Broadens Beyond Pills with $68 Billion Wyeth Buy in the Wall Street Journal (January 26, 2009)

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