Hi all, There has been a lot of discussion in this thread about tapering off and stopping Effexor and other antidepressants. We sought the input of a Mayo Clinic pharmacist and here what she had to say:

"Most antidepressants should be tapered before discontinuing. Patients should check with their healthcare provider for discontinuation recommendations. Taper directions can depend on the reason for discontinuation, the particular antidepressant being discontinued, the current dose and other patient-specific factors. Abrupt discontinuation of venlafaxine is more likely to cause withdrawal symptoms and relapse than many other antidepressants because of its short half-life. Likewise, strategies for switching between antidepressants require similar consideration from a care provider. Here at Mayo Clinic, we pharmacists work together with physicians to help determine the best strategies for each patient.

Patients may decide to discontinue their antidepressants for a variety of reasons. Some people feel better after taking an antidepressant and may feel they don’t need it anymore. The course of antidepressant therapy varies. Some people have lifelong mood symptoms that can be alleviated with antidepressants. Others may have difficult times in their lives where treatment is required while they work through the situation and/or find other mechanisms to alleviate symptoms. A clinician can help patients determine the appropriate treatment course based on patient history, symptom severity and other patient-specific factors.

Some patients may experience side effects. Management of side effects depends on their severity, expected duration, other options and patient-specific factors. For example, many patients experience stomach upset when starting antidepressants, but this is usually short-lived, and the benefits of continuing treatment usually outweigh the risk of stopping the antidepressant or having the same effects with another anti-depressant.

“Cold turkey” discontinuation of venlafaxine can cause agitation, sweating, fatigue, nausea, restlessness, tremor and relapse of depression. A slow taper is recommended, and tapering may need to be adjusted based on patient-specific factors listed above and for patient response to the taper.

Genetics play a major role in our response to venlafaxine. People with poor 2D6 metabolizer status may not respond to venlafaxine and thus may not be subject to the same withdrawal symptoms as those who were metabolizing the drug properly. Routine genotype testing is not routinely recommended but could explain lack of response to venlafaxine and certain other medications. Mayo Clinic offers this type of pharmacogenetics testing that can be ordered by our providers. For more information see: http://mayoresearch.mayo.edu/center-for-individualized-medicine/

The most important thing to remember is that each patient is different and may respond differently to the same treatment. We have to communicate openly with our healthcare providers to get the most from our medications. Sometimes this entails some trial and error, but it is worth getting the right therapy in the end.

You can read more about Pharmacogenomics in this article https://www.seattletimes.com/life/wellness/depressed-genetics-affect-how-drugs-work/."

Has anyone had genetic testing that altered their treatment plan or improved their condition?

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