The use of venlafaxine at doses higher than 225 mg/day. The balance of risks and benefits
Łukasz Święcicki

The paper discusses the results of a study on the use of venlafaxine at doses higher than 225 mg/day. It seems that the use of such doses may be intentional, especially in patients with treatment-resistant depression. When used at doses of up to 225 mg/day, venlafaxine is a serotoninergic agent (an agent that inhibits the uptake of serotonin). When used at a dose higher than 225 mg/day, the drug has significant effects on the inhibition of noradrenalin reuptake. The fact that doses ranging between 225 and 300 mg/day increase serotonin reuptake is also significant. Although this effect is relatively small (estimated at about 5%), it may be clinically significant according to some authors. Thus, venlafaxine administered at high doses is more efficacious compared to both fluoxetine and the group of selective serotonin reuptake inhibitors (SSRI), when assessed as a whole group. In terms of efficacy, venlafaxine is also the least comparable to the agents from the group of tricyclic antidepressants. Venlafaxine is usually well tolerated even at high doses. Although unpleasant symptoms associated with the withdrawal of venlafaxine (dizziness, nausea, vomiting, general malaise) may be a problem, there is no sufficient evidence indicating that the prevalence and severity of these symptoms may be dose-dependent – this is rather an individual response.