Significant increase in risk of suicide and completed suicide on Effexor in many clinical trials when compared to SSRI's (which I'm no particular champion of either) aside, is the inability of patients to successfully get off Effexor. An NE reuptake inhibitor with a minuscule half-life being prescribed as an antidepressant is simply never something I would recommend over an SSRI. Noradrenaline is not a 'smooth' feeling for lack of a better word. I wouldn't recommend a small dose of an XR CNS stimulant as an antidepressant for the same reason I wouldn't recommend an SNRI - it's counterintuitive when you take into consideration the problems that the average patient looking to try anti-depressants has (high levels of anxiety, stress, OCD, and other variations of anxious, avoidant, and phobic traits). They are not good candidates for NERI's. I am concerned primarily with withdrawal. More specifically, the inability to withdrawal in a healthy, sane, productive manner for long term users of Effexor. The benefits of any of these medications must outweigh its withdrawal symptoms for me to not be very concerned for the future wellbeing of the patient. Of course I'll be downvoted by the people who will doggedly defend the orthodoxy re: modern psychiatric medication prescription because many seem to be relatively unconcerned with the mental well-being of the patients 5,10, 20+ years from now. After all, most won't be in the trenches with the patients who are attempting to taper after long term SSRI/SNRI/Benzo use. Keeping these patients on these prescriptions until the day they die with little to no regard for the fact that anti-depressants and benzos simply stop working seems to be the general goal of modern pharma.

I'm not going to enable a patient who in all likelihood doesn't actually understand the mechanism of the drug they're taking to become dependent on a benzodiazepine that they will not even feel nor have any relief from (that is if they're lucky and their symptoms don't actually worsen over time with use) x number of months/years down the road when I'm well aware that benzo withdrawal is not only deadly, but debilitating at best for the patient in every aspect of their life. Effexor withdrawal is not the same as benzos, true, but its pretty damn bad. But there are plenty, including many psychiatrists, who would disagree with me. My question to them would be: how are all of the patients doing after long-term (5,10+ years) extended use? If they can even answer, I'd be surprised.