As someone who has followed the healthcare industry for a zillion years, clinical trials are incredibly rigorous in the US (at least for initial approval)....but trials and the approval process can't cover all patients and all settings....again particularly in the US. We have an incredibly diverse population and physicians can prescribe drugs as long as the drugs have been approved. It is once he drugs are in the general population that unanticipated problems occur (but I will be quick to add unanticipated benefits as well).

Effexor and the SSRIs have helped a tremendous number of people over the past 25-30 years....they are a huge improvement over older class antidepressants...and the combination of efficacy and low risks (and good marketing) - made them very popular. I believe that most are prescribed by primary care docs - and often to patients who can't or don't want to see a psychotherapist or psychiatrist. If you can think back to the mid-to-late 90s - the SSRIs were heavily promoted and many people would ask for them simply because they felt like they might be depressed.

Then consider that the SSRIs have been so widely prescribed - we find that the drugs have different effects on people based on race, gender, age and co-morbidities (other medical issues and prescriptions - and stuff that isn't prescribed). This is something that no clinical trial could ever account for.

The SSRIs were never really designed for long-term use....and how many on this board can say that they've been taking them 5, 10, 20+ years....I'm in the 22 year boat myself (until 8 days ago). So one thing the clinical trials (even phase 4 which is post approval monitoring) can't account for is the impact of being on these medications for very long periods of time. If issues come to the surface, it is usually found in the clinical setting.

Add to it - anyone who has been on these meds for a long time is a lot older than when they started. I'm 54 and started the SSRIs when I was 32ish. I am physically not the same person - not because of Effexor - but because I am 20 years older.....nothing works as well as it used to...so lots of things I used to enjoy simply don't work for me anymore.

Medicine will always be a balancing act...and it is constantly evolving. Think of all the breakthroughs in treatments found by physicians who looked at a drug and then said, "Let's try this and see what happens." - i.e. off-label use. That willingness to try things in a clinical setting has shown that certain drugs can have benefits in other conditions....that's a good thing.

In the end, we can say that, yes Effexor (and some of the other SSRIs/SNRIs) is really difficult for many people to discontinue. At the same time, many of us also benefitted from the drug for years....and maybe didn't stop sooner because if it ain't causing problems - why change? It is a miserable taper - and that is something that clinicians now know - luckily it is generally not dangerous to the patient (as say tapering from a benzo) and depending on your sense of humor - the pain of the taper means you can spread the "love" you've neglected to give all those people who make ones life miserable. : )