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A promising finding

The smallest dose of venlafaxine may be the hardest one to drop

Imaging of related drugs shows effect rising steeply at low doses and flattening: the last cuts remove the most. Of 824 people on strips built on that idea, 72% stopped; none tapered without them.

Venlafaxine

The last step off venlafaxine looks easiest: barely a dose. Imaging of related drugs shows the reverse: effect climbs steeply at low doses and flattens higher up, so halving a small dose removes more than halving a big one. Dutch tapering strips, daily pouches of falling doses, use that idea: of 824 users, most after failed attempts, 72% stopped, and 66% of those asked years on were still off. No one tapered without strips for comparison. Venlafaxine's most hopeful number is its least tested.

The findings behind this

1?
Mood & wellbeingThe last few milligrams of venlafaxine may matter most when tapering

Brain imaging of related drugs shows a dose's effect rises steeply at low doses then flattens, which is why some guidance shrinks each cut as the dose falls. No trial has tested this for venlafaxine.

★☆☆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 argument comes from imaging of SSRIs, not venlafaxine, and from receptor occupancy rather than from a trial that measured how people felt. No randomised trial has compared hyperbolic with straight-line tapering of venlafaxine.Click to keep this openSupport moodVenlafaxine
2?
Mood & wellbeingMost who tapered with strips and replied years later were still off

Of 824 people using the strips, most after earlier failed attempts, 72% stopped; of 408 asked one to five years later, 66% were still off. Nobody tapered without strips for comparison.

★☆☆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.CautionNobody tapered without the strips for comparison, so the figures describe the users, not the strips' effect. Response rates were 48% and 59%, and outcomes were self-reported, some recalled from up to five years earlier. The authors' institute received a grant from the pharmacy that makes the strips.Click to keep this openSupport moodVenlafaxine

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