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Myth check

Is venlafaxine really the hardest antidepressant to come off?

Venlafaxine ranks third for withdrawal reports worldwide, and its fast clearance is the likely reason. But how often withdrawal actually happens to someone stopping it has never been pinned down.

Venlafaxine

Venlafaxine's reputation as the antidepressant hardest to come off is backed by reports: in the World Health Organization's withdrawal reports, it ranked third. The likely reason is speed: its blood level halves in about five hours, and fast-clearing antidepressants drew 5.4 times the withdrawal reports of slow ones. A report count says how much of a drug's reporting is withdrawal, not how many who stop get it. The reputation is earned; the odds for any one person were never measured.

The findings behind this

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Mood & wellbeingOf all antidepressants, venlafaxine is among the hardest to come off

It ranked third in a worldwide database of withdrawal reports. Its short half-life is the likely reason: fast-clearing antidepressants draw about five times the withdrawal reports of slow ones.

★★☆Single study — solid evidence, such as one good trial or a large observational dataset, but not replicated at the top tier.A report count is not a rate: it says withdrawal made up a large share of a drug's reports, not how many users had it. The drugs with the strongest signals were also the most reported and most talked about, which the authors say may inflate their ratios. Among 19 people who had once stopped fluoxetine, a drug that lingers for weeks, remembered withdrawal was as severe as after venlafaxine.Click to keep this openSupport moodVenlafaxine
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Mood & wellbeingHow often venlafaxine withdrawal happens has never been pinned down

The big reviews give one rate for all antidepressants. The one head-to-head number, 43.5% moderate-or-worse withdrawal at eight weeks against 34.3% on sertraline, was an unplanned analysis of a trial.

★☆☆Contested — the evidence disagrees with itself, or the finding carries a caution. A caution or conflict always shows one star, however strong the sources are.CautionThe percentages were extracted by a later review from the trial's tables; the trial's own summary gives only the direction. Withdrawal was a side outcome of a trial built to compare how well the drugs worked, after eight weeks of use, so it says nothing about longer use. A review of 61 reports found withdrawal most often with venlafaxine but could give no pooled figure.Click to keep this openSupport moodVenlafaxine

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