You mentioning Effexor is interesting. That's often a first-line antidepressant given to guys on androgen deprivation therapy because it mitigates hot flashes. I've been really fortunate not to have that specific side effect (I get chills, the exact opposite, to the point where I'm wearing sweatshirts outside in 90 degree weather). I have heard bad things about that one from other people, too. Maybe an anti-anxiety med would be better then I could sleep more than the 3-4 hours I'm getting now and wouldn't have so much free time to ruminate.