Kathryn (also with a K) - Kaiser has a tremendous reputation (and I say that as a long-time HMO industry analyst). Is your MD your PCP? If so, you could look into switching PCPs...That said, there is a wealth of knowledge at Kaiser so I am certain there is someone on staff who is familiar with Effexor withdrawal....Polite persistency is often the best policy with overwhelmed MDs (especially on a holiday weekend)....Perhaps reframe your question to the MD along the lines of "I have been on the drug for a long time and at a higher than average dosage and there seems to be a lot of clinical evidence that many patients have a difficult time getting off the drug....and my symptoms seem consistent with that evidence. Do you have direct experience with patients withdrawing from Effexor? What do you think may be causing my symptoms? Is it possible to consult with a specialist?"

225mg is a higher than average dose (most people are 75-150mgs assuming you are on the XR version)...my dose for 15 years was 150mg...and I've been tapering down for 3 weeks...my titration has been easy (so far). If you are on immediate release - maybe simply a switch to the XR version will smooth things out (although the smallest dosage is 37.5mg)....but I'm not an MD.

Polite persistency.