Last updated 4/4/2024
Why this is challenging
Suffice to say this is a different challenge than tapering other antidepressants. One of the reasons is because the smallest capsule is 37.5 mg, which means all steps have to be fairly large.
Did I say “capsule”? Right. Its full of little beads. Can’t be cut in half.
But wait, isn’t there a pill version? Yes, but it’s “immediate release”. It makes big mountains and valleys of venlafaxine in your bloodstream. Your brain doesn’t like that. Once the capsules came out, which are “extended release” (XR), we all stopped using the pill version. The capsules work much better (fewer side effects or withdrawal symptoms in between doses).
Here’s a simple taper. Many people will be able to gradually stop this way. If withdrawal symptoms are too severe with 37.5 mg steps, there’s another way described farther below.
A simple venlafaxine taper
No matter where you start, lower the dose by 37.5 mg steps. This will require a combination of prescriptions so make sure your prescriber knows what you’re doing and is ready to help.
If you’re taking 300 mg per day in the form of two 150 mg capsules, you might think “nah, I can just begin by going down to 150 mg per day”. But you’re going to need 37.5 mg capsules later anyway. so get them now.
Many insurance companies won’t pay for more than one 37.5 mg capsule per day. They want you to use 75 mg capsules. Okay, get some of those too. See what you’ll need below.
Jump in from whatever dose you’re currently taking. These are 37.5 mg steps:
Dose | Create with (all in mg) |
450 | 3 x 150 |
412.5 | 2 x 150 1 x 75 1 x 37.5 |
375 | 2 x 150 1 x 75 |
337.5 | 2 x 150 1 x 37.5 |
300 | 2 x 150 |
262.5 | 1 x 150 1 x 75 1 x 37.5 |
225 | 1 x 150 1 x 75 |
187.5 | 1 x 150 1 x 37.5 |
150 | 1 x 150 |
112.5 | 1 x 75 1 x 37.5 |
75* | 1 x 75 |
37.5* | 1 x 37.5 |
The last steps
*If you have been coming down okay, maybe only a little trouble at each step, using the Tapering Antidepressants information about how fast to go… you might start having a lot more trouble at these last steps. Each 37.5 mg decrease is a much bigger part of your dose than when you started. From 75 to 37.5, it’s a 50% reduction. From 37.5 to zero, its a 100% reduction!
If you can tough it out through these last couple of steps, more power to ya’. If you don’t want to go through that, you have two choices.
The “Prozac bridge”
The antidepressant fluoxetine/Prozac has a very long lifetime in the bloodstream. It sort of tapers itself off when stopped, gradually fading away (faster at first and slower near zero, which is exactly what we want here).
Many people have used fluoxetine to “bridge” the gap between the lowest doses of venlafaxine and zero venlafaxine. They simply stop venlafaxine, all at once (from 75 mg or better yet from 37.5 mg) and substitute fluoxetine.
For some people, a single dose of fluoxetine 20 mg is enough. Just one fluoxetine capsule, and that’s it. The fluoxetine tapers itself from there. Other people who have had more severe withdrawal symptoms coming down on venlafaxine will require more doses of fluoxetine. A few will end up completely switched over to 20 mg of fluoxetine daily, which they then can taper more easily to zero (fluoxetine comes in a liquid, so even the most severe withdrawal can be managed with tiny fluoxetine steps).
Some experts-by-experience object to the idea of starting a new antidepressant just to get off an old one. That does make sense: the new one is not guaranteed to be problem-free. So this “bridge” method is best used when the last 37.5 steps were terrible and the method below seems impractical. Impractical versus “new medication”: it’s not an easy decision.
SurvivingAntidepressants.org’s methods
The good news is that you’ve got a lot of people ahead of you figuring out ways to get off of antidepressants. Some of them have shared their experience: what they’ve been through and how they handled it. A few of them have become guides and advisors. And one of them founded a website where you can access all their experience: SurvivingAntidepressants.org. What a gift she has given the world.
You can go there right away and explore. Or if you like, I’ll summarize just briefly and point you toward their venlafaxine page.
Summary: this is a community of people whose withdrawal symptoms have been extreme. There are thousands of users on the website. That gives us all a least a glimmer of an idea about how common severe withdrawal is (not rare, we can say that much for sure).
On the site, people who were taking venlafaxine, and some who still are, share their experience and how they’ve managed it. Most of them resorted to “bead counting”. Open the capsule, spill out the beads, and count or weigh them. To lower the dose, gradually remove a few more beads from each dose.
There are about 100 beads in a 37.5 mg capsule. So this is not easy, but it’s clearly do-able, just read their descriptions. Off you go: SurvivingAntidepressants’ venlafaxine Tips page).