Effexor For Life

In a study that parallels an earlier study (and accompanying post – Lexapro for Life), Dr. Martin Keller (presumably a primary investigator on this study) found that long-term venlafaxine (Effexor) use reduces risk for depression. In fact, he said,

these data showed that venlafaxine extended release can help prevent new episodes of depression -- providing an option to the millions of adult patients with depression who have experienced a disappointing setback or who are still seeking symptom relief.

Please note that I have text of a document from PR Newswire indicating that he made the above statement, but I don’t have a link to the text.

His comments are not all that different than those of Dr. Susan Kornstein, who was quoted as saying the following about the long-term effects of Lexapro:

These findings indicate the importance of maintenance therapy for patients with recurrent major depressive disorder beyond four to six months of improvement, even if a patient’s depressive symptoms appear to be resolved

This study: The Effexor results have not been published to my knowledge, but from what I gather from the study description, this study examined people who were on Effexor and received some sort of therapeutic response while taking it. Then, some of them kept taking Effexor and some were assigned to take a placebo (of course, not knowing they were switched to placebo). Those who took Effexor were significantly less likely to experience a recurrence of their depressive symptoms compared to those on placebo. So, apparently, you should be on Effexor forever. As noted above, Keller (and in a similar study, Kornstein) say this means that you should stay on your meds long-term because they prevent depression.

Withdrawal from Effexor: Just like Kornstein, Keller has absolutely misinterpreted the evidence. For example, in one small study, discontinuation of venlafaxine was associated with adverse events in 78% of patients compared to 22% of patients who stopped taking a placebo. Another, larger study found, similarly, that Effexor was related to increased rates of discontinuation symptoms compared to placebo. There are frequent reports to a national medication hotline in the UK regarding discontinuation symptoms when patients stop taking Effexor. In addition, there are also case reports of experiencing shock-like sensations during venlafaxine withdrawal. For a brief read on these shock-like sensations, check out this brief read in the British Medical Journal. In addition, it is now known that for paroxetine (Paxil), another antidepressant, healthy (not depressed) volunteers at times experienced depression upon ceasing taking their medication. Given the similar mechanism of action between Effexor and Paxil, one would expect a similar result for Effexor.

A quote from Dr. David Healy helps to summarize this fundamental manipulation of evidence by drug companies (and their allied “independent” academics):

It is clear now that the companies must have known that a certain proportion of these patients re-randomised to placebo, who subsequently complained of depressive and anxiety symptoms, will have been suffering from withdrawal problems. These withdrawal problems however appear to have been used as a basis for claiming that continued SSRI intake had a prophylactic effect against nervous and depressive problems. Based on such studies companies sought and have received licences to make these claims regarding prophylaxis.

In other words, because SSRIs and similar drugs (e.g., Effexor) have withdrawal symptoms that sometimes lead to depression, it looks like they are effective in preventing depression because people often get worse shortly after stopping their medication. The drug companies (Wyeth, in the case of Effexor) would like you to believe that this means antidepressants protect you from re-experiencing depression once you get better, that they are a good long-term treatment. A more accurate statement is that antidepressants protect you from their own substantial withdrawal symptoms until you stop taking them.

See No Withdrawal, Mention No Withdrawal: I do not say this as a personal affront to Keller, Kornstein, or any other academic who has made public statements regarding the long-term efficacy of antidepressants, but it seems odd that anyone, particularly anyone with research credentials, could ignore the solid evidence that there are substantial withdrawal symptoms associated with antidepressants. Many researchers apparently continue to toe the line of the drug companies that “it’s the depression, not the drug” that causes depression to return.

The Current Verdict on Long-Term Outcomes: Depression is indeed a nasty condition that often returns after it is successfully treated or after it just vanishes due to the passage of time. So yes, we should treat it. However, let’s keep in mind that antidepressants are barely more effective than a placebo in the short-term and, as we see here, can lead to problems in the long-term, where one can either choose to stay, for years, on an antidepressant (perhaps indefinitely) or have a good chance of risking some heinous withdrawal effects. Psychotherapy is much better in the long-run for depression, but it still does not positively impact many people. Like it or not, psychotherapy for depression has the best (though limited) success rate, perhaps due solely to its lack of causing withdrawal effects, or at least causing them at a much lower rate than meds.