Talk:Venlafaxine/Archive 1

Generic extended-release venlafaxine

Hi. this article says that generic extended-release venlafaxine will not be available in the US until 2010, but I'm looking at my wife's prescription right now and it's generic extended-release venlafaxine (at least that's what it says) and it's July 2009. Did something change in regulations? A lawsuit perhaps? Could someone change this to reflect the new reality? Thanks!70.105.73.44 (talk) 03:51, 7 July 2009 (UTC)

EDIT to Generic extended-release venlafaxine

After doing some more research I now realize that what my wife has been prescribed as equivalent to Effexor-XR (venlafaxine-ER) is not AB-rated to Effexor-XR [1]. If someone could consider a way to make this clear to the layman that would be directed here by a search engine as he looks for answers, I think that would be great. I was studying the subject because my wife, although on the same dose of venlafaxine-ER as she was Effexor-XR, is having similar side effects to those she would experience if she missed a dose.

Something worth looking in to. We'll have to call the doctor. Anyway. Thanks for pointing me in the right direction! —Preceding unsigned comment added by 70.105.73.44 (talk) 04:22, 7 July 2009 (UTC)

Reality of this drug

i haven't been to this article for some time, but glad to see that the reality of the risks of this drug have been put here with the preponderance of studies. The first part of the article doesn't reflect this adequately.63.250.127.245 (talk) 01:54, 28 January 2009 (UTC) I have added a comment about the black box warnings as the opening statement is badly misleading and prejudiced to make it seem as if this drug is wonderful and without risk. That is not only disingenous but it is misleading. I suggest that my edit be left in place and if anyhone objects to this, please submit for editorial review. This is a FACT and though i have not put a citation, i am sure all editors know that this is beyond question or argument. it is a FACT.... I found a new website that lists items about SSRI and SSRN's in relation to reported side effects and events in which the group of drugs were named or the specific drug was named .. this has more than a thousand entries.. each which is linked to the actual item for review by readers. this is not a statistical study, but is a factual list of actual articles in media about the drugs...ssristories.com i am not posting this in the references by i do suggest that active editors review this.. as i think it deserves to be in this article about this drug and this group of drugs. I am sure at some point, researchers are going to look at these events as more than coincidental.. There was another mass murder in New York State.. i remember when i was a university student that outrage at the Texas Tower massacre, but we seem to have these events happening with a much greater frequency, and it is not a wild stretch to reflect on whether these drugs are the cause.. 67.208.18.54 (talk) 19:16, 5 April 2009 (UTC)

Statement on contraindication in children and adolescents

The statement that venalfaxine is countraindicated in children and adolescents is not supported by either the references or the data. This is a major error. —Preceding unsigned comment added by 129.255.132.90 (talk) 17:04, 3 February 2008 (UTC)

I am pretty sure that the black box warnings for this drug do have these contraindications. I believe that was one of the main thrusts of the changes to the usage of this drug and a main point of the black box warnings. I suggest you read the actual script on the Wyeth site. Szimonsays (talk) 05:32, 7 June 2008 (UTC)

Adverse Effects

This section needs to be revised.People editing this article seem to have no understanding on how adverse events are reported and later published. Some of the "rare" adverse events reported for venlafaxine are; menopause, rheumatoid arthritis, cellulitis, tendon rupture and breast enlargement, if one is to mention any of the rare adverse events I feel they need to put it in context.I think it's reasonable to assume that most of these "rare" events are not caused by the medication.Secondly, this article in particular emphasizes the adverse events of this drug and puts undue weight on them.Perhaps mentioning the common adverse events(>5% of treated patients and occurs at twice the rate compared to placebo) would suffice ? --Tdonner 12:27, 7 December 2006 (UTC)

why deleting the side effects? To scale them is a good idea. I am accidental working with those drugs and happened to be confronted with such rare side effects. Was happy to read them up and do the patient referral to special site.Robi123 18:45, 5 May 2007 (UTC)

i added a reference for the mao/serotonine syndrome problem and did minor editing.---89.60.228.151 (talk) 22:36, 24 February 2008 (UTC)

Withdrawal effects

I see another deletion/dilution of the information on the Effexor Petition which is the most exhaustive documentation of the side effects including withdrawal of this drug. If you don't like the composition, edit and revise, but stop deleting this. It is highly relevant to this entry on Wikipedia. People have a right to have knowledge of this that is not minimized or washed down.

I have one question: how do you differentiate withdrawl effects due to addiction from withdrawl due to "the results of the brain attempting to reach neurochemical stability." I would argue all withdrawl effects are the result of the the brain and body attempting to re-attain homeostasis. For example, caffeine blocks adenosine. When you stop taking caffeine, you become hyper sensitive to adenosine, and the results are withdrawl. As your body re-attains homeostasis, the withdrawl symptoms go away. So what's the difference?

- Yeah, there is no difference between "brain attempting to reach neurochemical stability" and "addiction." People simply don't want to take something that is physically addictive so the companies get creative in their wording. see physical dependency. I vote this be changed to reflect that it is in fact, physically addictive.

I agree with these comments. Some of the editors are constantly deleting any reference to this drug being "addictive" and only leaving in Wyeth research both in vitro and animal studies with rather limited application to the actual experience of patients using Effexor. This is supported by some rather narrow perception of what "addiction" means. As this is not a drug compendium and the definition of the term "addiction" is clearly subject to some argument and interpretation, the term "addiction" clearly belongs in the encyclopedic entry for Effexor and is supported by THOUSANDS of users, as well as a number of recognized authorities - the distinction between "physical dependency" and "addiction" is rather a blurred area. One could make distinctions between the impact of addiction on illicit drugs and that of effexor, but clearly patitents who are put on this drug without being advised of serious adverse effects, nor of withdrawal symptoms and are then faced with trying to get off the drug, describe this as being "hooked", "addicted", and "dependent". Leaving this out of the section on physical and psychological dependency is simply ridiculous beyond reason or ethics. Those are are doing this.. STOP..... if you want to argue the issue or provide useful edits that retain clarity, then do so, but stop this nonsense of removing material that is absolutely relevant to this entry.

Addiction is very different from physical dependence. A person can have a physical dependence for a medication, suffering symptoms if he doesn't take it, while not being addicted. I sometimes forget a medication I take that is that way--there's no craving to take it. But does any smoker forget to have a cigarette? To equate them is ridiculous, wrong, and dangerous. 68.83.72.162 (talk) 10:02, 16 January 2009 (UTC)

This notion of difference between physicaldependency and addiction is peculiar in reflection. If someone needs nitroglycerin to prevent pain from angina, that is certainly not addiction, but is it physical dependency? Pain is pain. However, the full range of withdrawal symptoms caused by heroin or crack=cocaine are not so different from withdraw symptoms of effexor in expression, even if quite different at the neuronal level. For someone who has been impacted by effexor the results cumulate in a desperation to have the drug to relieve the symptoms and while there is no "rush" or "elation" as in cocaine or heroin, the distinction in practical terms is rather academic. The action is at the level of neurons, and call it waht you wish, it hsa major impact. It is more dangerous to waste time arguing about the nuances of "addiction" and "physical dependency" than to understand the impacts are serious. Perhaps there is a need to more carefully define "addiction" but the important thing in this article is to be clear about impacts for the reader. Fortunately, that has happened here. 63.250.127.245 (talk) 00:21, 22 February 2009 (UTC)

any experience with these drugs?

If you have a specific question about this drug, you might consult the Wikipedia:Reference desk. --David Iberri | Talk 22:44, Apr 19, 2005 (UTC)

You can also email me about it or google for it. But single anecdotes are not generally useful for any other purpose than entertainment value. Zuiram 09:24, 14 November 2006 (UTC)

At medium dosages, venlafaxine blocks the reuptake of norepinephrine as well as serotonin. At about 225 mg/day, venlafaxine blocks the reuptake of serotonin and norepinephrine

Are these two sentences saying the same thing? Ubermonkey 22:33, 22 September 2005 (UTC)

Actually, the relative affinities remain the same, also at higher doses. You'd have to take pretty amazing doses to achieve any other effect, which would cause serotonin syndrome. What they appear to be saying is that the effect on norepinephrine starts to get noticeable at higher doses, which is true, and kind of the point Zuiram 09:24, 14 November 2006 (UTC)

• Yes. I rephrased the paragraph so as to be more understandable. ZZYZX 09:25, 8 October 2005 (UTC)

I've been under the impression that one of the common reasons for discontinuation of Venlafaxine in women is anorgasma, caused by delay in the sexual response system. Perhaps this should be listed under common side effects. -Cameron Van Sant 9:11, 12 November 2005 (UTC)

Are we documenting your "impression", which would be original research, or are we going to cite hard figures, for which supportive data would be necessary? JFW | T@lk 00:30, 13 November 2005 (UTC)

Such sexual side-effects are common in all centrally acting serotonergic drugs. Effects on orgasm in men and women is listed as a common side effect in the Norwegian PI sheet, and the SPC provided to the Norwegian authorities. A quick google should turn up the same information in English. As to whether it is a significant cause of discontinuation, I doubt you'll find good sources for that. In light depression, anorgasmia might be seen as a bigger problem than the depression itself, but that's unlikely in moderate-to-severe depression. Zuiram 09:24, 14 November 2006 (UTC)

Severe discontinuation symptoms

I have commented out this sentence which has to go unless someone comes up with a Wyeth reference for severe discontinuation syndrome:

Wyeth-Ayerst refers to these severe withdrawal symptoms in its product literature as a "severe discontinuation syndrome".

Please note that this not about the existence of these symptoms but about Wyeth's calling them a "severe discontinuation syndrome". The worst thing I could find in Wyeth's online documentation was: "While these events are generally self-limiting, there have been reports of serious discontinuation symptoms" (see Effexor info for healthcare professionals (USA only)). AvB ÷ talk 13:30, 21 January 2006 (UTC)

I've removed this sentence. AvB ÷ talk 19:37, 29 May 2006 (UTC)

Discontinuation of this medication sucks. I get the brain shivers even after missing one dose.--K8TEK 23:12, 20 April 2006 (UTC)

(First time writing so if this is useless then please delete as appropriate. If I miss just one dose I get a dizzy head-spinning type sensation and feel nauseous. Also I find Myself edgy and unable to stand any slightly uncomfortable situation. This is with or without a knowledge of my missed dose. Gem-Ra! (talk) 00:04, 5 November 2008 (UTC)

Yes, some people are very susceptible to the side effects of this drug. Then again, I seem to recall reading somewhere that the same people also benefit the most from its therapeutic effects. I hope it works for you. Anyway, it's important that patients know the possible advantages and disadvantages when choosing a medication. AvB ÷ talk 19:37, 29 May 2006 (UTC)

One of the major problems about this drug is the way in which many physicians have been prescribing it without warning patients of the seriousness of side effects or the fact that withdrawal effects are MAJOR -- NOT A JOKE. If you want to get an idea of the impact of this drug on patients, look at the Effexor Petition website and just scan the more than 10,000 comments. I wish that some of these doctors would try the drug themselves for a few months. Unfortunately, the drug firms do not promote side effects. The trend now is for drug companies to shift responsibility onto doctors as the warnings are now unmistakable and if a physician failed to advise a patient properly, they could potentially be sued for malpractice. It is moving in that direction very fast. There are recent histories of how vicious and influential drug companies can be (The Olivieri Case and the David Healy case - both in Toronto involving drug firms, the university and clinical institutions).

The withdrawal syndrome is fairly well documented, and large numbers of anecdotal reports indicate that it is more common with Venlafaxine than with the SSRIs. It is also treatable by introducing an SSRI medication upon cessation. The paresthesias (electric shocks) are also alleviated by SSRIs, and apparently also by benzodiazepines. Google provides a few references, for example this one and this one, both of which qualify as sources for Wikipedia. However, I very much doubt that Wyeth would emphasise this point in their literature as suggested by the removed line; if anyone has actually seen it on their page, use the Wayback Machine to check that date, and we can source it. Otherwise, it stays out. Zuiram 09:32, 14 November 2006 (UTC)

External Links

Dirk is a representative from Effexor. He can't allow people to know this drug is not going to help anyone because he wants money. He is one of those people who values money more than the lives of people. Don't buy in, don't give him what he wants, spit out your Effexor. —Preceding unsigned comment added by 65.79.138.222 (talk) 05:07, 23 August 2008 (UTC)

If you have direct evidence that Dirk is a representative that should be posted here as it may have impact on his position or not, but if there is no direct evidence, then this is pure speculation, and it verges on defamation to imply his views would be due to this relationship. So, either post it or the comment is worthless. 63.250.127.245 (talk) 00:28, 22 February 2009 (UTC)

someone removed the link i had placed to the Effexor Petition. There is no reason why this should be removed. This is an honest website with 11,000 signatories, most describing their experiences with this drug. This is an important element of patients saying what happened to them and it should remain here so those who look up this entry can see this perspective. This should not be removed again please without any explanation. I will replace it if it is removed again.. and no one needs to have an editing war. If you have a reason why, state it. We are not in a dictatorship where information is screened by the "truth police".. There is tons of information on side effects, but the petition site is one of the few in which patients tell of their experiences,, THOUSANDS OF PEOPLE.

There is an organized gang of vandals systematically removing all negative drug-related information from Wikipedia. I suggest you put that link back. Someone has hired a PR firm to systematically purge all negative drug information from Wikipedia.

I ;put the link back and someone has removed it again.. STOP THIS NONSENSE... THAT IS NEARLY 12,000 EFFEXOR USERS WHO DESERVE TO BE RECOGNIZED AND WHOSE EXPERIENCE DESERVES TO BE HERE... STOP REMOVING THE LINK WHOEVER IS DOING THIS...... 12,000 PEOPLE AGAINST ONE... WHOEVER IS REMOVING THE LINK.....

This page is about the compound venlafaxine, not about petitions against it. That part of the discussion has its own page. Maybe you should check the history of the page, and see how things evolve. I am sorry. --Dirk Beetstra ^{T C} 20:13, 3 September 2006 (UTC)

TThe focus of this article is the drug, not specific problems with that drug which are covered in detail elsewhere. The problem with the drug has been noted here. If you think the link is notable, then surely the appropriate place for it is SSRI discontinuation syndrome, not here? Instead of trying to suppress negative information, someone was kind enough to add your link onto the appropriate page. Walkerma 03:35, 4 September 2006 (UTC)

Dirk, as i have commented before, you are doing a disservice to readers by censoring useful and relevant information about this drug. The page on anti-depressants has a section on controversy, and effexor has plenty of controversy on its own .. Readers have a right to know this and not to have one person contantly deleting material added by others that is relevant to the current knowledge about this drug. This is relevant information about this particular drug and readers should have the right to know this specific information aobut this drug. The material i add is not my view, or judgemental, it is information provided by researchers and also by thousands of users... a separate link is fine for the larger material, but this does not preclude paragraphs making this knowledge readily available to the Wikipedia audience who deserve to have this information THERE on the main page for Effexor. Censorship is not part of the wikipedia philosophy except for inappropriate material such as racism. The full story on the SSRI's and SSRN's is not yet done.. Effexor is the riskiest of this group, and this needs to be imparted without blocking reference to the petition, nor of the reality of practices in the prescription of the drug that put people at risk. I am not going to stop ensuring that this information is there.. I suggest the editing war stop so that the appropriate material is there in an appropriate form. Sam

I note that some of the points made require references.. i will find these.. the comment about the user info stating "unpleasant" was in the previous user info.. I replaced that one with a more appropriate user info that is more up-to-date and reflects the side effects in more realistic terms. the note about doctors over-prescribing is from a guideline.. but it may take a bit of time for me to find the actual document.. The issue of whether Effexor is addictive or users are drug dependent is really a distinction of semantics more than anything else.. There are some varying views on the definition of addiction. Many users who have suffered the effects of withdrawal use the term addicted when describing how they view the impact... The term is used in a variety of ways and is perfectly OK in this context as well. I am not changing this for now, but I will be do so when i have reviewed the usage of this term more fully. At that point, i will leave the current descriptions in, but will add the broader perspective of addiction that is used in language and that is necessary in this entry as well. Let the reader make up their own mind about the usage of the term here. I appreciate that we don't get into an editing war again. The final verdict on this drug is still not out yet but the thousands of users speak very loudly to the issue. Sam

Lawsuit

Filed in 2004 due to the discontinuation of the drug side effects. www.effexorwar.com which leads to http://www.pcalawfirm.com/

As of 12/10/10, both of these links are dead. —Preceding unsigned comment added by 76.115.191.41 (talk) 06:14, 11 December 2010 (UTC)

Effexor and Effexor XR

Does anyone know the difference between Effexor and Effexor XR? I have looked extensively on the web and there are two ideas regarding the difference. the first being that it is slightly different formulation. The second is that it is a controlled released drug. Meaning that the drug is absorbed over a longer period of time supposidly giving less side effects. I can not find anything from Wyeth. Any help on this would be much appreciated. --benjaminevans82 July 2006

I take Effexor XR. My pharmacist said that the main difference between the two was that XR lasts about two hours longer. -- ajk1962f-wikipedia(at)yahoo.com

• Yes, XR is extended release. The non-XR version of Effexor must be taken several times daily, whereas the XR version, which is in a capsule, can be taken only once a day.

I have updated the article accordingly --Benjaminevans82 19:14, 8 October 2006 (UTC)

Mechanism of Action

From the article:

"At low and medium dosages, venlafaxine inhibits serotonin reuptake alone, similarly to a selective serotonin reuptake inhibitor (SSRI). At higher dosages (from about 225 mg/day), venlafaxine inhibits the reuptake of norepinephrine as well as serotonin. At high dosages (starting around 300 mg/day), it inhibits dopamine reuptake in addition to serotonin and norepinephrine."

Would it be possible to get this subtantiated? I see the claim repeated multiple times on various web sites, but never with proper citations. --Supergloom 17:45, 20 July 2006 (UTC)

"Preclinical studies have shown that venlafaxine and its active metabolite, O-desmethylvenlafaxine (ODV), are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake."

I have also noted how several web sites claim that venlafaxine affects diffrent neurotransmitters depending on the dosage.I'm almost certain this is not the case however.

I agree with you. Clearly venlafaxine is an SNRI and has effects on both norepi and serotonin at all dosages. There may be some dopamine effects at all dosages, but psychologically useful changes in dopamine reuptake require higher dosages. If you give enough of a weak reuptake inhibitor to a patient, the effect will be stronger, so it's dose-dependent in that sense. Based upon the prescribing information, it's implied that there are at least *some* dopamine effects, otherwise they wouldn't mention it. It also seems to be the prevailing wisdom among psychiatrists that high doses (such as 225-300mg/day) cause significant effects on dopamine, whereas lower doses do not. Aside from that, I don't think the amount of dopamine reuptake in low vs. high levels of venlafaxine has been quantified, but I would expect higher doses of the drug to cause more dopamine reuptake inhibition, as would be expected with any drug and its effects. See the section I wrote under "Neurotransmitter Effects" for more info. ZZYZX 10:52, 31 August 2006 (UTC)

Neurotransmitter Effects

Someone asked me via my talk page about venlafaxine dose and how it relates to neurotransmitter levels. He wasn't a registered user, and I'm not even sure this is the article he's referring to, however, here is his question and my response:

Hello! Could you cite the source of your inbformation concearning venlafaxine's dose-dependant effects on serotonin and noradrenaline.I can't find any reliable information to support the claim that noradrenaline reuptake only occurs at medium to high dosages. Also, Wyeth's information on the pharmacodynamics of venlafaxine state that it's a potent inhibitor of both serotonin and noradrenaline and a weak inhibitor of dopamine reuptake.Thank you in advance and please excuse my poor English.

-Thomas

I'm not sure which article you're referring to, so I can't put the source in myself, but the information is part of the official prescribing information for Effexor (venlafaxine HCL) that was released by the manufacturer (Wyeth). The statements can be found in the section "Clinical Pharmacology." The manufacturer's site only had PDFs, but this page (www.rxlist.com - Clinical Pharmacology of Effexor) has the info:

http://www.rxlist.com/cgi/generic4/effexor_cp.htm

It (and official prescribing information) include this statement:

Preclinical studies have shown that venlafaxine and its active metabolite, O-desmethylvenlafaxine (ODV), are potent inhibitors of neuronal serotonin and norepinephrine reuptake and weak inhibitors of dopamine reuptake.

Noradrenaline and norepinephrine are the same thing, but the word "norepinephrine" is used more commonly when it comes to brain chemistry. Incidentally, the same thing is true with adrenaline and epinephrine (i.e. they are the same chemical). I think I wrote (if not then I should have) that serotonin and norepinephrine reuptake are altered at all doses, but dopamine reuptake is only significantly altered with higher doses. Venlafaxine is therefore considered an SNRI (serotonin/norepinephrine reuptake inhibitor), though all three neurotransmitters are effected in a dose-dependent manner. Let me know if you need more info.

Feel free to contact me via my talk page if you need more info. ZZYZX 10:38, 31 August 2006 (UTC)

Footnotes

These are not actually footnotes, but are references. Footnotes will appear at the bottom of a particular page of text in a book or in a scientific paper, but when references are listed at one location at the end of an article, these are not actually footnotes.Can someone advise how to add to this section as the actual references are not visible.I cannot add sources at present time.The requirement to add citations for some items and not for others is rather confusing and arbitrary. There is a lot of material here that is not at all referenced. One could nit-pick and ask that every sentence be referenced and that would be ridiculous.Some information is so well known and often mentioned in literature on anti-depressant drugs,that asking for a citation is redundant, for example, if a person is taking alcohol or other drugs, this comorbidity increases risk when taking an anti-depressant and is on all information sheets for the drug -- this is very well known and hardly requires a citation. I am deleting the request for citations in such cases.

Bold statements about addiction and studies saying the drug does not actually work for depression require a footnote to verify that this information is correct, I agree that every sentence doesn't need to be referenced but controversial issues do. For example the kinetics section does not reference after every sentence but does have a general footnote at the end, drug information sheets are useful for this purpose as they summarise all the information. If information is so well known and often mentioned in literature then footnotes should be easy to find, the burden of evidence lies with the editors who have made an edit.Mr Bungle 22:04, 3 October 2006 (UTC)

Could you advise on how to add a reference.. The listed footnotes are not actually footnotes. These should be titled References. Footnotes are typically placed at the bottom of the specific page where they are noted by a number, not at the end of an article. I will find the reference to some studies showing that the actual effect on reducing depression by Effexor when compared to placebo is negligible. There has been some amazing work done on placebo effect, in which effects of a drug for Lupus were mimicked by placebo when the patient did not know de facto whether the medicine taken was the drug or the placebo. I am sure this doesn't always work, but rather amazing stuff to read. As I noted above,the comorbidity risk for suicide is very widely known and appears in guidelines for Suicide Prevention, and for treatment of both Bipolar disorder and Borderline Personality Disorder. One of the papers I listed includes this but I don't know how to add to the references as the edit sheet does not list the references (called footnotes, but not actually footnotes, unless my knowledge of the convention is incorrect. I appreciate it if we don't get into editing wars. The material I add is not without support. e.g. section on the word "addiction". An encyclopaedia is not a drug compendium, and therefore information about effects on patients and patient feedback should be as important as strictly clinical material. There is a tendency for drug companies to overemphasize the positive effects and minimize negative effects (e..g. "unpleasant" side effects), therefore the overall entry for a drug should be open to adverse views based on evidence and on opinions of recognized authorities e.g. David Healey, Glenmullen, Breggin as well as a forum such as a petition by users now more than 12,000 strong. Sam

Physical and Psychological Dependency

I checked the references for the last cut/slash/replace edit and found these to be not supportive of the script. One of the references actually was based on "perception" of general public and not that of actual users of Effexor. I will keep putting back the correct material in this. I don't know who is doing the cutting, but you are ignoring the experience of more than 12,000 people and who are you to make this distinction that severe withdrawal does not swignify dependency. That is exactly what is meant by physical dependency --- a need for the drug to not feel sick, bad, anxious and the entire host of severe withdrawal symptoms that are well known. Why are you a supporter of effexor???? There are users who benefit from this drug and are ok with being on it forever, probably millions of people, but there is a reality of 12,000 users who have had bad effects and this reality should not bve watered down. Sam

Why are you not a supporter of effexor? you obviously have a significant disdain for effexor and are doing everything to make it sound as horrible as possible. I have added references supporting the severe withdrawal effects that can happen, that doesn't mean the drug is addictive, I placed a well referenced section (the references were completely supportive of the script, did you even read them?) on addiction and the results of an opinion poll which showed many people think antidepressants are addictive, its a common belief and you are doing you best to compound that belief. You continually edit without providing any supportive evidence whereas I am trying to actually formulate scientific information on the drug, why should effexor have a section on addiction and them completly ignore other drugs that cause withdrawal symptoms. Why haven't you taken your crusade to beta blockers or lithium? I will keep putting the correct well referenced neutral information back in. The petition is just about irrelevant for this page, sure there is 12000 or so people signed on it, check #11886, should we add this persons side effect in the adverse effects section? Anybody can write anything they like on this petition, it shouldn't be anywhere near an encylopedia.Mr Bungle 21:57, 6 October 2006 (UTC)

It seems we are making slow progress. I did read the references Mr. Bungle, and did not find that they supported the script.Please go the the effexor petition page and read thousands of comments and then come back and in all honesty, write that the drug does not cause dependency. I did ask how to add references. I have plenty of those. There was recent article in The New York Times about how data from drug trials is distorted to give impression of efficacy when in fact the efficacy is rather limited. This was written about the actual statistical results of anti-cholesterol medication in preventing heart attacks. The actual results showed that the protection was very slight in terms of outcome. This was in last Sunday's New York Times. I know someone whose wife is on effexor at low dose and it has helped her a lot, but I also know that the risks of this drug, and the side effects and dependency are poorly explained if at all to patients, and that doctors have been poorly trained in use of this drug, and further, that some actually did not know anything about the risks and side effects, until the numerous alerts. Effexor is the worse of this group of drugs for side effects. The fact that one or a few individuals add inappropriate comments does not invalidate a survey no more than a few spoiled ballots invalidate an honest election. You want to deny the feedback of thousands of people? Get real please.

The opinion poll about people thinking that anti-depressants are addictive in no way changes the experience of thousands of people with this drug. YOu think that an opinion poll about a general belief is applicable to a specific case? It is not.. that is a fallacy.. The petition is valid information and it deserve and it should be here... if it were not here, that would be an unbelievable dishonesty.. Like a fascist state trying to tell the truth they want to tell.This is not about being a supporter of Effexor or not..it is about conveying truth and facts. You want to push aside reality and make it all sound like it is no problem. IT IS A PROBLEM when people are ill informed about a drug, and people suffer for this. I have personal experience of this. I try hard to be neutral but factual, and to convey reality. You want to argue about what "addiction" means. If someone cannot survive without taking a drug due to neurological pain, you don't think that is addiction? This is not an effexor website (you actually put their website at top of the list of links -unbelievable!!!!!!).This is an encyclopedic entry that should be factual and present all aspects of a subject in honest and informative fashion so that a reader is well informed on the subject. Read Glenmullen's book "The antidepressant book" full of references and information. Read David Healey's honest and incisive works on this subject -- "The Anti-depressant Era" for example, that gives a detailed history of the evolution of the use of drugs in psychiatric practice.This is not the first instance of risk of drugs in which the risk-benefit was not properly relayed to patients or the public. I am willing to work with you to get it right, but i will oppose you trying to paint a rosy picture and not let the facts speak. There are plenty of opposing papers on the benefits and risks of anti-depressants. The verdict is not out yet. It may be that for a large group of people the anti-depressants are absolute lifesavers, but that for others, a smaller group, they are life threatening. Both of these groups, and their families need to be well informed. One of the earlier links described the severe effects as "unpleasant" -- those were the actual words. I have a background in science, and i am sure we can make this better, but i will not stand back and let anyone delete relevant information for the sake of "supporting" a drug. That should not be your purpose to support, nor mine to oppose.. the responsible thing here is to INFORM...and to do so honestly and truthfully and factually. If you let me know how to do the reference (footnotes) entries, I will add some referential material..

Notwithstanding our respective positions, Best wishes, Sam

Mr. Bungle.. what is this supposed to mean? This is not what severe discontinuation syndrome is about. People have tried to wean themselves off this drug and you want to blame them for "non-compliance"?. You are discounting the real experience of people on this drug with this kind of language? This is not reality. "Often patients recognize the link between noncompliance with their medication and discontinuation symptoms and may describe their experience as dependence or "addiction".[13] Your comments are not grounded in this reference. The word addiction and dependence do not appear in the abstract. Is this a quote from the article or your own filter to the abstract that does not mention either of these words or even comment on dependency. I will wait for your reply. If it is your filter, then it is not an accurate representation of the article. If I don't hear a response, I will delete that section and replace it with another referenced comment that will accurately reflect the literature. Sam

Changing the heading from Physical and Psychological Dependency to Drug Abuse and Dependency is clearly incorrect as the section says nothing about drug abuse. I think both of us should research the term drug dependency to come to an accurate description of what this actually means. I am willing to let go of the term "addiction" except as a comment that users state, and stick with the meaning of drug dependency. Read the section on withdrawal in Wikipedia. It confirms that anti-depressants cause drug dependency. It is a well written piece and deserves a link. Taht is good enough for me. Sam

Reply

Re the article I cited: The abstract is a 257 word summary of the article, the actual article is 5000 words and 14 pages long, it can be accessed via ingentaconnect at full text this is subscription only and will cost you to download the pdf (alternatively if there is a university library near you can go down there and download it or make a photocopy). The comments from this paper summaries what is known about discontinuation/withdrawal syndromes and I highly recommend reading it.

I didn't change the heading but changing it back is fine, drug abuse and addiction are traditionally discussed together as most drugs which cause dependency are characterized by compulsive drug-seeking and abuse behaviors. A definition of dependence from the diagnostic and Statistical Manual of Mental Disorders put out by the American Psychiatric Association.

Here is a simplified version: A maladaptive pattern of substance use, leading to clinically significant impairment or distress as manifested by three or more of the following, occurring at any time in the same 12-month period:

• 1. Tolerance
• 2. Occurrence of withdrawal syndrome
• 3. Substance taken in larger amounts or over longer periods than intended
• 4. Persistent desire or unsuccessful attempts to cut down or control use
• 5. Excessive time spent obtaining, using or recovering from effects of substance
• 6. Substance use takes priority over social, occupational or recreational activities
• 7. Substance use continues despite persistent or recurrent harm

In terms of these definitions most antidepressants have no clinically significant potential to cause dependence. Lets do venlafaxine: 1. No, 2. Yes, 3. No, 4. Maybe, 5. No, 6. No, 7. No. As mentioned in the article lots of drugs cause withdrawal effects are not thought of as addictive.

I suggest reading Wikipedia:Footnotes for more information on footnotes and how to use them (you can probably also get an idea just by editing the page and looking at how they are set up, just dive in, if you make a mistake someone will fix it). If David Healey, Glenmullen, or Breggin have published work on the subject then it can be added (with a cite) and there would be absolutely no problem with that. Your personal experience (good or bad) should not cloud your judgment and lead to biased information in an article, we need to remain neutral. I don't work for Wyeth or particularly support effexor, but if it wasn't for me (and others) this article would be one long diatribe against the evils of venlafaxine. There is a large amount of evidence in the medical literature about the benefits of this drug (albeit studies probably supported financially by Wyeth) but even so, no scientist is going to fudge results just to paint a 'rosy' picture of the drug. All drugs have risk and benefits we need to weigh them equally and not over emphasize the negative (or positive). I added the opinion poll as antidepressants and mental illness in general have a stigma about them. Most people on the street already think antidepressants are addictive when generally they are not. The petition reinforces this perspective, I am not comfortable with the petition being mentioned for reasons stated above, but I let it slide as people do have the right to know it exists. I have left in some of your information intact, but I plan on editing it in the future (mainly because you use such emotive language). I could care less what order the external links are in, so go hard on rearranging them. We also seem to have taken over this discussion page, if you want you can move it to mine or your discussion page.Mr Bungle 06:04, 7 October 2006 (UTC)

Appreciate your feedback. I agree that the piece should not be a diatribe against effexor but at the same time it should also not be a whitewash. I prefer the dialogue open as it enables other editors to read views of editors. I have not see that many changes to the article during some time other than my own and some who kept deleting my entries. I am learing some aspects of using Wikipedia, and learned how to be more objective. I cannot claim to be disinterested at neutrality - but my overall concerns are not so different from Healey or Glenmullen, and the points I have added do reflect some of their concerns. In terms of the DSM IV rating, I would include 4, 5 and 7. Many users dislike the side effects of using the drug and stay on it because of the severe effects of discontinuing it,, even when gradually. I still think that your way of softening the "addictive" notion as if all those users' view of being "addictive" were merely a prejudice against the drug - rather than their experience strikes me as not accepting such evidence as having real weight. I still believe that the petition deserves to be here..

I think you are naive (with all respect) if you think that some researchers are not swayed or driven to prejudice to "fudge" results for a variety of reasons, including continuing financial support. "Fudging" results can be very very sophisticated in terms of how data is presented and I had mentioned a recent article in the NY Times on how this has been done in the case of the anti-cholesterol statins. You might also wish to read up on the Olivieri and the Healey cases in Toronto,, the first, the Olivieri controversy was a case in which a drug firm threatened a scientist with legal action if they published results against a drug that was under development for treatment of thalassemia (an iron metablism genetic defect). This is well worth reading and is very well documented. The second case was also in Toronto, and Dr. David Healey who had been offered a chair at University of Toronto heading a department in the Centre for Addiction and Mental Health had this withdrawn after he gave a keynote address on the risks of anti-depressants, specifically prozac. Eli Lilly who is the drug company that developed and sells prozac is a major contributer to UofT. He sued UofT and the case was settled out of court, it is believed with a rather substantial cost to the university.

There is plenty of evidence that the risks of the anti-depressants were largely minimized and there is still major concern that some of these drugs may be causing violent behaviour in some individuals in addition to the increased risk of suicide ideation. This is why any article on an anti-depressant drug must have this information in balance. Everyone has different writing styles. Your edits on the dependency section always try to put attitude about dependency or "addiction" as a prejudice or ignorance of patients. This is not balanced - not at all. We know that effexor does not have the effect of heroin, or cocaine, or amphetamines, but we are talking about physical dependency, and just like nicotine, if a user feels uncomfortable without a certain titer of a drug in their system, or if the effect of not having gthat titer is severe, then the distinction between "dependency" and word "addiction" is really more semantics than actuality. Nictotine dependency or "addiction" is certainly not the same as opiate derivative dependencies, but any smoker will tell you that they are addicted. I think you need to revise your entry in the physical and psychological dependency section as it is just not balanced and it basically minimizes the severity of dependence. I am sure that any user trying to get off effexor will disagree with you from personal experience, and to argue against that is like telling someone that a toothache is in their imagination because the dentist can't find the source. As i have noted elsewhere, the full story on anti-depressants is not out yet. I am glad that you have left some of the advice elements i wrote in the article. These can save lives and need to be there, and if you look at the current sheets on effexor by wyeth and others, these are there in detail. You must also consider that the black box warnings do shift a lot of responsibility to physicians and away from wyeth, but with Wikipedia as a known source of information, there is an ethical responsibility by editors to present the facts and NOT to dilute reality by making it seem as if users' experiences are merely subjective and not real. A recent paper links reduction in suicide rates with start of use of the SSRI anti-depressants, and i have seen concerns published through the APA by particular clinicians of the view that the black box warnings and negative publicity might cause deaths by suicide as patients do not take anti-depressants. This was a rather disingenous positon as it presumes that patients should follow advice of the doctor and not be "frightened" by possible side effects. Healey speaks to how psychiatry has moved more to drugs than to non-drug therapies. There was a tendency among general practictioners prescribing anti-depressants with no advice to patients or families. Once a kid was 16, some doctors did not even consider it necessary to inform families. The black box warnings have changed this dramatically as they place accountabiity on doctors even more than on the drug manufacturer. There is a similar controversy about use of Ritalin - concerns about over-prescription of this drug on the basis of inadequate and shoddy diagnosis, or as a crutch for teachers who do not know how to manage children or youth who may be inherently hyperactive. Diagosis is mostly based on testing that is highly subjective. Taht is not to say that there are not kids with ADHD that benefit from the drug, but many doctors are not even aware of the fact that Ritalin is also a street drug, and kids are getting hurt -- one of the side effects of Ritalin addiction is behaviour that mimics OCD, so kids may be diagnosed with OCD because of doctors not knowing how to detect ritalin addiction (it is snorted like cocaine, and the effect is similar). Mr. Bungle, this is an area in which an editor must be very well informed. One article does not support a fact necessarily. The effexor entry must provide good information to users - and not be merely a "compendium" type of entry. I have said it before, but an encyclopedic entry must give a lay reader balanced information that enables them to understand a subject in a broad context. I left in your opening entry about receptors for opiates, etc., being different than those for effexor, but this hardly answers the question and most lay readers won't even know what you are talking about. Effexor does impact more receptors than the other SSRI's as it is actually a SSRN. What does that mean in terms of effect on the patient.? Perhaps a better lay explanation would be of benefit. I am not expert on neurophysiology though I have perused presentations on the action of various drugs on the CNS. At any rate, the bottom line is that the entry must give balance. We are on the left and right of this right now, but I do believe we can improve the entry and in this do a service to readers. I cannot but recall a famous case about 20 or more years ago in which a particular drug was used for severe cases of acne, but doctors who prescribed it were not aware of one very serious but rare side-effect. That side effect was anaplastic anemia that was untreatable and FATAL. Did not happen very often , but when it did, the cost was unbelievable to a family, to the patient. There were about 300 cases per year in the U.S. When this was revealed more widely, the question then to patients and their famiies was - "is the cure worth the risk?" The drug was then taken off the market. The drug company simply did not put much emphasis on the risk. Mr. Bungle, this is the moral issue in writing about a drug on Wikipedia. The article must be balanced and fair. And there is clear ethical responsibility of editors to do that. WE are lay people mostly, and the entry is not a scientific dissertation, but the material must inform. I will try to learn the citation methodology so i can add these where i can. Please respecxt my entries as I will respect yours. If I disagree, i will post here. and vice versa. I am sure we can make this article better. Sam

Message to Skinwalker..

I am afraid that I am a novice in messaging in Wikipedia. I do my best to contribute honestly to entries and that is what I have tried to do in the Effexor entry.

I learn here as well. The talk here has others who have expressed views similar to mine about some entries. I am careful about factuality of entries and have learned to modify language so that it is logically correct. I am new so don't know how to add references yet, but every comment i have made is based on reading material and extensive review of materials on the anti-depressants. I am not a physician, nor a pharmacologist, and I would never venture into areas that I do not have knowledge. The argument about dependency is a valid one. The use of the term addiction has various interpretations. For an editor to neutralize reality as if he were a ghost writer for a drug company is absolutely unconscionable and unethical.

I am willing to learn, to be corrected, to be wrong (that is one of the best ways of learning), but i think that a Wikipedia policy is to be respectful of others. Editing wars are not respectful of others. Deleting entries is also not respectful of others without valid arguments otherwise anyone can delete anyone else at a whim. Pretending that a reference supports a view when the script is a fallacious argument is also dishonest. Demeaning a petition by finding a few invalid signatories is disrespectful of those who wrote honest and truthful accounts of their experience.

I don't think that Wikipedia intends to censor honest efforts of editors to ensure that article entries are informative. That is my purpose. To ensure that an article is informative.

I cannot fathom any other motive. Skinwalker, if you wish to continue dialogue, please teach me how to do that here. I don't know how and the hour here grows late. perhaps next time

Sam (aka Szimonsays) —Preceding unsigned comment added by Szimonsays (talk • contribs) (7 okt 2006)

Beware this article.

It is sad and scary that this article is on the first page of google search results for Effexor. If you are looking for any accurate information about this medication, stay away from this page, and the wikipedia pages of any other psychopharmaceuticals. Many of the people editing Wikipedia are seriosly mentally ill, whether psychotic, delusional, or paranoid. By editing Wikipedia their paranoid delusions, previously shouted on the street to strangers, become respectable.

While there are plenty of reputable people editing Wikipedia, at any given time you have no way of knowing whether the version of the page you are reading is written from the POV of a doctor or an untreated mental patient. It may be reasonably accurate for an hour, then full of misinformation and bias the next. While an article on, say, calculus can usually be considered to be accurate, articles on psych medications tend to attract the genuinly insane- people who have been prescribed these medications and need to warn the world of the evil doctor-conspiracy to control their minds.

This is one case where you really want to stick to the real encyclopedias if you want to be sure to get factual information. --72.19.81.122 18:11, 9 October 2006 (UTC)

We depend on references to prove the validity of statements. Any statement without a reference should not be trusted any more than you would trust anything else on a discussion board or personal web page. Anything with a reference should only be trusted as much as the reference itself is trusted.

I think it should be made much more obvious to first-time visitors that the encyclopedia is not written by experts, but by regular people. Then no one will have as much of a problem with its inaccuracies. We mislead people into thinking that we're a reliable, authoritative source, but we ourselves don't read it as if it is.

That said, "real" encyclopedias have errors and biases, too. — Omegatron 14:22, 10 October 2006 (UTC)

Beware the above Comment

I had written a long reply to this comment, but lost it, so must make this brief. Wikipedia has been compared to hard copy encyclopaedias and online versions and has been given a good rating with respect to accuracy of entries. I am confident that the vast majority of people who do edits here do their best to contribute useful information. I would never edit an article if i did not have some knowledge to be able to contribute usefully, and i imagine that most people operate like that. The accusations in the above rant are pure nonsense - truly. The article has improved in providing better information to readers. Any reader who has more than a passing interest in the anti-depressant drugs in particular and Effexor specifically can do a search on the net and check some of the information. I am confident that they would find that the added material is relevant and factual.

It is very sad when a person must add such a dishonest accusation which is really a form of fallacious argument called "ad hominem" that means attack and discredit the opponent instead of sticking to the facts. And that is all that the above rant is.. it is nothing more or less than that. The user signature is also invalid. That is equivalent to a poison pen letter, so readers can judge for themselves Szimonsays

Wikipedia is generally a fairly useful starting point, which is what an encyclopaedia should be. The psychopharmacology sections, however, are often fairly inaccurate. I do not, however, have a paper encyclopaedia around to compare it with, so I'll refrain from commenting on that. This said, anyone choosing to trust wikipedia (without reading the sources) over their psychiatrist's advice is out of their mind, and hence the majority of the errors and omissions are of little consequence. Zuiram 09:38, 14 November 2006 (UTC)

I agree. Non-experts often hold excessive skepticism for wikipedia articles. When questioned about the accuracy of information on wikipedia, usually they say it is high quality. The0ther 00:28, 5 December 2006 (UTC)

Addiction

I realize that it is bad form to reply at the top of the thread, and I apologize for that. But the fact is that it's simple semantics. Addiction as a medical term has a clear definition, which venlafaxine (and other drugs that have antidepressant use as an approved indication) does not fit. It also has a colloquial use, which is more nebulous, and may well apply. The objective fact is that there are problems with discontinuation that some patients are not able to deal with, and that some dotors do not know how to treat. These problems are treatable, however, by introducing an SSRI with a long half-life, which will lead to a milder discontinuation. If even that is intolerable to the patient, a benzodiazepine can be used for a few days to a few weeks to resolve it.

As a simple explanation in laymen's terms of a few of the differences here:

• It does not inherently pose a long-term danger to your physical or mental health to discontinue venlafaxine, although it may most certainly be unpleasant, and the depression may return (which may, however, be dangerous). Abrupt discontinuation of commonly accepted addictive substances will be a much bigger problem than discontinuing venlafaxine for the majority of people.
• After venlafaxine is out of your system, you will not feel compelled to start using it again. You may still be depressed, and seek treatment for that, but another suitable drug will substitute quite nicely. After addictive substances are out of your system, however, most people report a long term persistent craving, and there is a significant relapse rate.

More to the point, even if it were addictive, that would have no relevance. Several drugs that are used in the legitimate treatment of various medical problems have addictive properties, such as opiate pain killers and CNS stimulants (dexedrine, desoxyn, methylphenidate). The reason they are used, is that the benefits outweigh the problem.

The benefits of venlafaxine in light depression may not outweigh the costs, which is a subjective judgement which belongs in a discussion with your therapist, not on wikipedia. But if it works against a moderate or severe depression, as assessed clinically (subjective evaluation of the severity of depression is unreliable, as demonstrated by studies), then the benefit does outweigh the costs.

It remains a sad fact that some of the most effective treatments for moderate to severe depression have been pulled from the market exactly because of the addictive potential, and the fact that a drug like amineptine gets pulled from the market while venlafaxine is allowed to stay should tell you that addiction is a lot more demonized by the people who call the shots than by these patient groups. If addictive drugs were more generally permitted in the treatment of depression, we would see a lot of advances being made in managing addiction, and a lot of people actually getting well and staying well, saving them grief and suffering, and saving society tons of money.

I apologize for the length and somewhat ranting tone, but I hope we can put this subject to rest soon. Zuiram 09:54, 14 November 2006 (UTC)

One of the editors is again diluting comments about addiction regarding this drug. I have read commentary about this issue, that the drug companies prefer to use softer language e.g. severe"discontinuance" effects, rather than severe "withdrawal" effects. The terminology is ridiculous as there is no difference between the two. I have replaced the comment about "addiction" and removed the silly attempt to blame patients.. my goodness, how far can someone go to try to whitewash a real effect!!!!!! Blame the patient!!!! Most of those suffering the effects are people trying to get off the drug, not patients who are refusing to take the drug properly or withdrawing quickly. I have deleted that bit of ridiculous blaming of patients. Szimonsays 01:29, 30 October 2006 (UTC)

We have been over this already, you don't cite your work, if you have read commentary about this issue then cite it. As it stands your opinion is not appropriate for an encyclopedia. The editor will continue to revert it unless you provide reliable cites.Mr Bungle 02:18, 30 October 2006 (UTC)

Nothing I changed can be remotely construed as "blaming the patient". I have been removing your specious and uncited argument about the differences between effexor and hard drug withdrawl being the result of "semantics". If you can find a reputable source that makes this argument, we can discuss how to integrate it into the article in a logical and relevant manner. However, you have not shown any inclination to do so despite multiple requests. You have been repeatedly told to review WP:NPOV and WP:NOR, which you clearly do not yet understand, and I think your long, emotional, and at times unintelligible rants on this talk page serve to demonstrate that. Skinwalker 02:21, 30 October 2006 (UTC)

I am not experienced at putting down citations. Your one reference to the term "addiction" and your language implying that this is caused due to patients not following instructions without really addressing the factual issue is ridiculous. That is how I construe this, and it is clear to me that you do not understand this and want to soften the impact. It is not the patients who are the problem. Not every comment has a citation, though I don't disagree with certain information requiring clear references, however, the semantics of the word "addiction" is mentioned elsewhere and can be easily be reviewed by readers. Why do you persist in not addressing this and trying to give the impression that the users of effexor do not find this product addictive. They, more than you or me, speak to the experience of using this drug and the devastation of withdrawal (not discontinuance as a softened expression of the effect). I will continue to add my comments .. as they are valid. If you want to research this go ahead, appropriately, please be my guest. But you are writing in a tone that puts the blame on patient behaviour. You talk about patients "recognizing non-compliance" - if you do not see the implication you are living in your own delusions. Here is a patient comment.. READ CAREFULLY PLEASE.. "I have been weaning from this drug for almost a year now, and I still must take 75mg every few days, I wait until I can not stand the sensations: electrical zaps in my head that get worse and worse, until I feel like I can not even walk straight, and the hurkey jerky movememnts are horrible. My physician does not believe me and wants me to let go of the last bit, as if it is all in my head, but it's not, and thankfully I have had some left over from when I switched to cymbalta. I don't know what I will do when I run out. I was suicidal before." You are also not complying by calling my comments "rants" and "unintelligible".. hardly reality. Look at yourself in the mirror first. I will find a link to an article on this concern that was written in 2005. Meanwhile I will be deleting your distortion until you stop deleting my comments. yes, we should find references, and if you are honest about integrity in information you will do the citation on my behalf. The term addiction is not as you would wish to want it to be here. It deserves to be handled here in a way that the average reader has a clear understanding of what this really means.. not a distorted censored meaning that hides reality.. Szimonsays 14:15, 30 October 2006 (UTC) READ WIKIPEDIA ARTICLE ON ADDICTION.. This is my reference, and i have added a link to this article on the subject in the article on Effexor. Let the reader decide because obviously you and I live in different universes of what truth is about. Szimonsays 14:30, 30 October 2006 (UTC)

Szimonsays, please. I also cannot concur with your edits now (and that is purely about readability, not contentwise!!!). The resulting paragraph is no hardly coherent, jumps from one part to another, and certain points are used twice, and you have removed a scientific reference. I will try to convert it into one, hopefully neutral, section, without removing too much content and save that somewhere this afternoon. If one of you still disagrees, copy the text to a new section on this talk page, and put a disputed tag on the section in the document. The edit-warring can then continue on the talkpage until you all can agree. --Dirk Beetstra ^{T C} 15:06, 30 October 2006 (UTC)

OK Dirk, sorry if my last edit was choppy. It was morning and I was revising again against a time constriction. I look forward to seeing your balanced edit. I reiterate my point that information must be balanced and not written from a subjective point-of-view. The area of controversy in anti-depressants is such that an editor could find references to support this or that perspective while actually distorting the reality. I believe that this article has improved dramatically in the past few months and now represents a very balanced presentation. This is very important as many people use Wikipedia for information, and I know that edits that try to water down facts are just not honest. Others have expressed this view here in the editing talk, but I have made a personal commitment that the information here is truthful and not a distortion of reality. I met tonight with a young woman who was a former user of this drug, and she told me how it frightened her in its impact on her mental health. That is not to say that the drug does not help many millions of patients, but the risks need to be clearly presented here. Otherwise, the article might as well be a series of links to key articles about the drug, and let the readers decide which is more honest and truthful. Balance in editing is a key factor of what gives Wikipedia its strength. Not one person deleting facts that are supported by links within Wikipedia itself (e.g. the term "addiction".) Thanks again Dirk. I trust you will write something that reflects the truth clearly. Szimonsays 02:01, 31 October 2006 (UTC)

Dirk, if what I just read on addiction in this article is your attempt to find balance, I am sorely and sadly disappointed because it just supports the same narrow view of the definition of addiction that is totally inadquate for this article. I hope not. I will check tomorrow hoping that this is not the case. I am adding a separate comment about the defnitiion of the term "addiction" linking this to the article on addiction in Wikipedia. If you think this is not appropriate, then they better delete that article too. I do hope this wasw not your attempt at balance, because it really still tries to soften the impact of this drug at withdrawal, and uses that sleight of semantics to try to make readers think that this drug is NOT ADDICTIVE. It is clearly addictive by general terminology. this is the actual description in the article on addiction in wikipedia "To wit, pharmacologists continue to speak of addiction from a physiologic standpoint (some call this a physical dependence);" and this is my point - as well as the fact that users of the drug consider it to be addictive as there is a dependency on it. The edit just does not make that clear statement but continues to try to distort truth. Enough is enough. Dirk, this has to stop. I will leave the references to the other point of view, but my argument is as well supported and deserves to remain. Otherwise the war will not stop because i will not leave this distortion of truth to stand.Szimonsays 02:14, 31 October 2006 (UTC)

The article categorically does not deny that venlafaxine can produce dependence. The burden of proof is on you to produce citations for your claims, not others. If you can find a legitimate, non-wikipedia reference for your claim (written by a mental health professional), please post it here and we will integrate it into the article. You are misrepresenting my legitimate actions to maintain NPOV, and you are risking sanctions for your behavior. Let's try to take it down a notch. Cheers, Skinwalker 02:35, 31 October 2006 (UTC)

I would also like to point out that I am personally familiar with the effects of venlafaxine withdrawal, having discontinued it in the fairly recent past. It was horrible, to put it mildly. In a less rigorous forum I would mostly agree with your characterization of the addictive nature of the drug and your criticism of Wyeth's doublespeak on "discontinuation syndrome", but here we must cite outside sources and refrain from editorializing. Cheers, Skinwalker 02:46, 31 October 2006 (UTC)

I am surprised that you will not accept a source within Wikipedia (addiction), for the clarification. It now comes down to finding a source from within the very group who have defined addiction in a narrow context. I have presented plenty of reasons why the word addiction fits in this context, both semantically and also from the perspective of scientific fact. The whole notion that there is even a deficiency in serotonin causing depression is not proven, and I recently read a review from a women's health group expressing concern that the increase in prescriptions of anti-depressants is far higher in women than in men. The marketing of these drugs has increased usage by more than 500% in the relativcely short time since Prozac came on the market and effexor has actually been the drug most prescribed of all. If you yourself have experienced this personally, my goodness, why don't you work with me and help to get the proper resource material to satisfy your need for reference to this. I don't see that defining addiction necessitates the opinion of a medical health professional, because health professionals do not define language at large, and there is disagreement about the definition. There seems to be a stronger basis among the mental health fraternity and pharmaceuticdal companies to exclude the "bad" word "addiction" much in the same vein as using "discontinuance" instead of "withdrawal". If a person suffers withdrawal from heroin or effexor and the effects are horrid, and their dependency on gthe drug is "addiction" in the broadest context of the word, then why be so hung up on using that word. This is the word used by the actual users. If the pharmaceutical companies want to make a distinction between one and other withdrawal - so be it. Would you also refuse to use the word "addiction" to describe smokers dependency on tobacco? I am not fearful of sanctions. I would rather this be resolved in a positive way, but I don't agree with your arguments. I will make an effort to find other resources describing addiction , but I believe we are more in the realm of semantics and etymology than in scientific basis for using a term. Check Websters. Check the wikipedia article on addiction. Let's get this resolved. You are a more experienced wikipedia user than I am, but I stand by the facts here and I still think that the editing war only serves to soften the depiction of "addiction" when referring to withdrawal from effexor. If I were you, I would help find the sources to support the sound basis of using the term without softening it or giving the impression that the drug is not addictive. It obviously is in the basic definition of the word "addiction". I am hopeful you will help in this instead of the warring going on. Szimonsays 13:47, 31 October 2006 (UTC)

I have done a bit of research looking at the terminologies. Webster's does use the basic medical definition. There is a considerable discussion about defining the term -- even to the point of looking at opiate users who manage the use thereby falling out of the strictest medical definition that includes increased out of control use - as if there were social users of opiates much like social drinkers. I think that the Wikipedia article on this is pretty good. I don't think that my previous edit violated anything, but for now I am leaving it out. I still think that the current entry is not balanced and needs better script than is there. It hardly addresses the reality that users experience when they are dependent on this drug. I have found a few articles that I have bookmarked, and am mulling how to do this section the justice it needs and deserves in presenting reality. I really don't think I am far off, and as I said, a fair article covers the issues - even those that may be controversial - in a balanced way so that readers have a good understanding of the subject, not something through subjective filters that may distort. With all due respect... Szimonsays 21:50, 31 October 2006 (UTC)

Severe Discontinuation

someone has again deleted the comment about the Effexor Petition. This is really sad and annoying. I am pasting a reference here to support my edit http://www.cmaj.ca/cgi/content/full/170/4/487?etoc The fact that someone would now remove the very important item about the effexor petition says a lot about the sad corruption of this article to hide reality. That section has 12,000 users who deserve to be known here. Their testimony is reality and it should not be deleted. Whoever is doing this is really a lowlife. Szimonsays 22:05, 31 October 2006 (UTC)

Someone has once again removed the material about the effexor petition. I request that editors determine who is doing this and ask them to desist as this is relevant information that needs to be here. If they persist they should be subjected to sanctions. 66.241.132.98

I have been removing the discussion of the internet petition. You can see this by checking the article's history[2]. If you feel I should be sanctioned, I invite you to file a Request for Comment, but I warn you that other editors are likely to agree with my removal of this material.

The internet petition is an unacceptable source of information per WP:Reliable Sources, because it is an unmoderated and unedited message board with no fact checking or other verification mechanisms. I will continue to revert it on sight. Note that I am not deleting the link to the petition, only the POV discussion of it. Cheers, Skinwalker 02:17, 17 November 2006 (UTC) I don't agree with you in the least. By this standard, if 100,000 people objected to a particular issue or practice, you would discount their experience out of hand. The entry is written in a balanced way to give the petition its due as the experiences of patients, and quite frankly, when one reads the experiences, this is compelling and has weight by preponderance of numbers without being presented as stats. If s scientist were to submit a questionnaire to the petition signatories with a process of validation, this would be a very powerful statement.. and it is a powerful statement as it stands in any case. I will continue to post my entry for this. I will be checking the Wikipedia standards. I cannot understand your position. You want to dismiss all these people out of hand. Their experience deserves to be noted here. If hyou cannot see the moral implications, wow, I wonder what your motivation is. I will check the standards but I will be reposting this every day.. You can count on it. Szimonsays Szimonsays

 I have read the guideline Skinwalker... I am pasting here for your information..

"Wikipedia has a neutral point of view, which means we strive for articles that advocate no single point of view. Sometimes this requires representing multiple points of view; presenting each point of view accurately; providing context for any given point of view, so that readers understand whose view the point represents; and presenting no one point of view as "the truth" or "the best view". It means citing verifiable, authoritative sources whenever possible, especially on controversial topics. When a conflict arises as to which version is the most neutral, declare a cool-down period and tag the article as disputed; hammer out details on the talk page and follow dispute resolution." You are violating the guidelines by not allowing a neutral point of view by excluding relevant information. Not all information must be verifiable in the strict context - and the Effexor Petition clearly is in a category that the sheer volume of specific reports of experiences that can be seen to be common across THOUSANDS OF USERS give this information validity by preponderance of numbers to the repeated details. The history of the information about the anti-depressant drugs has been heavily weighted against users, and this is very very well documented. Readers are entitled to know about the Effexor Petition within the article. Stop being a censor when censorship is not needed. My script on this was very balanced and fair. I will ensure that readers are given this relevant material in the body of the article. How many times have you seen a petition now nearing 14,000 (of which some are blank and a very few are junk) in which patients tell of their experiencesa with a drug. This is the power of the openness of the internet, and it is also part of the power of Wikipedia. You demean this by your actions. I think that the information provided by 13,000 people deserves two neutral sentences and you as one individual should not act as a censor for whatever distorted reason you have. Szimonsays

Efficacy

Some recent news seems to show SSRIs to have a much stronger effect in preventing completed suicide. Here is a quotation from the article on eurekalert.org:

individuals taking an SSRI known as fluoxetine had a 48 percent lower risk of suicide (6.7 deaths per 1,000 total years that individuals took the drug) compared with those not taking medication (11 deaths per 1,000 years), while those taking venlafaxine hydrochloride, another SSRI, had a 61 percent increased risk (22.5 suicide deaths per 1,000 total years of medication use)

source: Antidepressants associated with increased risk for suicide attempts, decreased risk for death

The0ther 00:13, 5 December 2006 (UTC)

—The preceding unsigned comment was added by The0ther (talk • contribs) 00:13, 5 December 2006 (UTC).

patent status

The only information in the article currently on patent status is in the intro:

As of August 2006, generic venlafaxine is available in the United States. It was previously available only under the brand names Effexor and Effexor XR.

I think the situation is actually fairly complex, but I don't have good references at the moment to write anything better. But here is what I understand the situation to be. The compound itself, venlafaxine, is still patented by Wyeth; the patent expires in mid-2008. Wyeth filed in 1997 for a separate patent on the extended-release form, marketed as Effexor XR, which expires in 2017. However Teva challenged this latter patent; Wyeth's case didn't look too good, so they settled it out of court to avoid having their patent actually overturned. As part of the settlement, Teva was given a license to sell "authorized generic" versions of Effexor beginning in mid-2006, two years before the patent is due to expire. So while it's technically true that "generic venlafaxine is available", it's only available from one specific company as part of an out-of-court settlement—it isn't out of patent yet, and is not available from the full range of generics manufacturers. --Delirium 12:06, 12 December 2006 (UTC)

Public Relations Pap

I am amazed at how this document has gradually softened and reports in the literature advising that Venlafaxine has the highest risk for suicide ideation are just not represented here at all. The tone of the article suggests rather that the risk is all in distortion of studies, rather than in actuality of findings.

I just have not had time to address this or to compile the references showing this presented by studies. The last study I read gave a factor of at least 2 times risk of suicide ideation - and the group was not selected for those individuals specifically at risk. Healy reported that normal patients without any depression or known risk factors had increase of suicide ideation and there was a case of a young woman in a study of Prozac who actually committed suicide during the study. I just do not believe this article is currently balanced and it does not properly represent the two positions now taken by scientists about this group of drugs nor Venlafaxine that is considered by some to be the most risky of this group for some patients. As noted in the review of the Healy case - a risk factor of 1 in a thousand may seem low for some procedures (for example, for angiograms that factor is considered acceptable when compared to a risk of death by heart attack), however, the number of angiograms performed annually compared to the number of users of SSRI's or SSRN's is miniscule and the risk factor of 1 in a thousand when expanded to millions of users, is huge. It is also clear that most prescribers simply do not follow the recommendations for precautions and care in patient management. This has in fact been reported in studies.

This article needs a careful review and update to balance the information presented, as it is currently weighted in favour of the drug's use with the risks being minimized and studies showing these risks not even being presented here fairly. I am glad that at least some stuff remained in the article, and it was a battle to even keep that stuff in, but I am disappointed how this piece has become so badly distorted. wow talk about misinformation. The Effexor petition is certainly more than just withdrawal effects, but hopefully some readers will use the link and get some real information on user experience.

I will be getting my references together as I find time, and putting more information here with references to put this article back into the realm of reality rather than distortion by exclusion.A fair appraisal presents all arguments fairly until such time that the preponderance of evidence supports information to a point of clarity and balanced reporting. That is certainly not the case here as yet. 66.241.132.98 21:28, 15 January 2007 (UTC)

FDA

I was disconcerted to see the FDA equated to Federal Drug Administration. It is not ! The acronym FDA stands for Food and Drug Administration. It controls the pruity of both foods and drugs.

Nwbeeson 17:43, 12 February 2007 (UTC)

Brandnames

Is it time to have a section listing all the various brand names for venlafaxine in use around the world?

International Brand Names

   * Depurol® (CL)
   * Dobupal® (ES)
   * Efectin® (AT, CZ, HR, HU, PL, RO, SI, YU)
   * Efexor Depot® (FI, SE)
   * Efexor XR® (AU, ZA)
   * Efexor® (AR, AU, BE, BR, CH, CL, CO, CR, CY, DK, DO, EC, EG, FI, GB, GT, HN, ID, IE, IL, IT, JO, KW, LB, LU, MT, MX, NL, NO, NZ, PA, PT, SE, SG, SV, TH, TR)
   * Effexor Paranova® (DK)
   * Effexor® (FR, IE)
   * Effexor® XR (CA)
   * Elafax® (AR)
   * Faxine® (IT)
   * Flavix® (IN)
   * Norpilen® (CL)
   * Trevilor® (DE)
   * Vandral® (DK, ES)
   * Velafax® (HR)
   * Venlafaxina Combino Pharm® (ES)
   * Venlafaxina Dosa® (AR)
   * Venlafaxina Masterfarm® (ES)
   * Venlafaxina Ratiopharm® (ES)
   * Venlafaxine-Apex® (NL)
   * Venlax® (CL)
   * Venlor® (IN)

cut and paste from here: Merck.com DanBeale 11:05, 6 March 2007 (UTC)

I'm worried about copying a block of text from another source. There's not many ways that a list of brand names and the countries they're used in can be formatted though. I welcome any help to avoid copyvio and to improve this list. DanBeale 11:38, 7 March 2007 (UTC)

massive amounts of POV

There's a lot of POV pushing going on in this article. Some people seem to be adding stuff without talking about it first, and others are reverting without checking what they're reverting to.

Is there anyway that the "I don't like it" stuff could be put in a neater section? DanBeale 23:51, 15 March 2007 (UTC)

Appetite

The common side effects list includes "weight gain". Someone changed this to "loss of appetite" included, but this was reverted as vandalism. I've put it back in, and included "weight gain" too. See these links for the "loss of appetite" claims. Priory 'focus on venlafaxine' netdoctor uk information (taken from the patient information leaflet for venlafaxine in the UK) DanBeale 17:10, 22 March 2007 (UTC)

Hi DanBeale. I reverted because it was an unexplained modification by an anonymous user. Pardon me if there are references, I'm not an expert in the field. Adamantios 20:38, 22 March 2007 (UTC)

Heart issues

Venlafaxine is no longer prescribed in primary care in the UK because of the risk of heart problems. This isn't something we've highlighted and is probably lost amongst a vast list of potential side effects. The revised guidance from the mrha (medicine and healthcare products regulatory agency) is here. From December 2004 it's only been prescribed by specialists, and is to be prescribed after SSRIs have failed. The risk is cardiac ventricular arrhythmia. The guidance seems to have been relaxed slightly in 2006. The National Institute for Health and Clinical Excellence has in its depression guidelines the following:

1.5.2.16 Venlafaxine treatment should only be initiated by specialist mental health medical practitioners including General Practitioners with a Special Interest in Mental Health

1.5.2.17 Venlafaxine treatment should only be managed under the supervision of specialist mental health medical practitioners including General Practitioners with a Special Interest in Mental Health.

1.5.2.44 For patients with pre-existing heart disease venlafaxine should not be prescribed.

1.6.2.5 Venlafaxine should be considered for patients whose depression has failed to respond to two adequate trials of other antidepressants. Consideration should be given to increasing the dose up to BNF limits if required, provided patients can tolerate the side effects.

1.6.2.6 Before prescribing venlafaxine, practitioners should take into account the increased likelihood of patients stopping treatment because of side effects, compared with equally effective SSRIs.

1.6.2.7 Before prescribing venlafaxine, practitioners should take into account its higher propensity for discontinuation/withdrawal symptoms if stopped abruptly, its toxicity in overdose and its higher cost.

1.6.2.8 Before prescribing venlafaxine, an ECG and blood pressure measurement should be undertaken.

1.6.2.9 For patients prescribed venlafaxine, consideration should be given to monitoring of cardiac function. Regular monitoring of blood pressure should be undertaken, particularly for those on higher doses.

The NICE guidance is how venlafaxine is to be used in the National Health Service and hasn't been revised to take into account the info from the MHRA. We need to put some of this in the article. Secretlondon 20:12, 23 March 2007 (UTC)

Userbox available

Code	Result
|{{User:UBX/Venlafaxine}}	This user stays sane with Venlafaxine.†	Usage

--One Salient Oversight 01:47, 4 May 2007 (UTC)

Petition

More emphasis needs to be given to the side affects assocaited with effexor, and more notice need be given to the petition. To those who constantly remove mention of it, I must seriously ask, which do you hold in higher esteem, Wiki's policies on "reliable sources," or people's lives? Like it or not, people use Wiki; that's what it's here for. When it comes to something like drugs, the water need be treated very lightly and carefully. We are dealing with a drug here that currently in excess of 10,000 people claim has ruined their lives. I am sad to say that I can count as 10,001. The things described in that petition are very real, and it deserves much more attention in a supposedly accurate and thorough academic article than a miniature citation near the bottom of the page. When the safety and well being of human beings are at stake, I say that at the very least it mildly supercedes the stringent rituals of Wiki editing. Then again, perhaps I am wrong; but I had no idea that Wiki had joined the hallowed halls of freedom, safety, and democracy as an ideal placed above the value of human life.209.169.89.240 20:14, 10 May 2007 (UTC)

If the things in the petition are very real you'll have no trouble finding real, attributable, quality, sources for them, at which point they can go into the article. Until then it's just a bunch of people saying "This med made me feel . . ." and what they're feeling might not have anything to do with the med. You say that 10,000 people claim venlafaxine ruined their lives; how many people claim that venlafaxine saved their lives? How many people's lives would have been ruined were it not for venlafaxine? I'm not going to find some random internet survey and stuff poor quality number just because I like it. Dan Beale 21:20, 31 May 2007 (UTC)

If 12,000 people using the drug report similar experiences at withdrawal, deleting this from the article is irresponsible. You devalue the personal experiences of users, and the number of users exceeds the number of subjects in most studies. If a scientist took the time to sort the survey input into effects, this would be a powerful "study". This does not mean that the drug is not of value for some people, but when a drug has effect on the brain, the risk of side effects (look at the list in the article) may be very high for some individuals. It is not your job to censor valuable information in this article even if you do not agree with it. Please let the Wikipedia reader have the benefit of the personal experiences of users. Such information provides potential patients insights that they can share with their physicians to determine if they should use this drug. One of the major problems is that most prescribers do not take risks very seriously, and in cases of actual suicide hide behind the defence "the patient had chronic depression and depressed people do kill themselves. Sometimes! not always, and if there is a risk with a drug, this should be communicated to patient and to family.

the petition serves this purpose and is a very valuable resource in this article.. Please do not delete section again. I will reinsert and lodge complaint to mediation if necessary.

anyone with a knowledge of risk of both ssri's and the greater risk with effexor and a bit of common sense would not delete the comment on the effexor petition. Sam B

Wikipedia has strict guides about what information can, and can't, be used in an article, and what external links can be used. If a reputable, verifiable, source says that -for example- venlafaxine increases the risk of suicide then that information can go into the article. I urge you to maintain a neutral point of view, but I also suggest that there's lots of stuff in this article that can be cleared up. Using Patient Information Leaflets is a good way to present risks to patients using information that is accurate and verifiable. Dan Beale 17:06, 20 June 2007 (UTC)

Dan.. your arguments for censoring (it is not editing really) reference to the effexor petition deserve nothing more than disdain except that your censorship is harmful to those who seek information on wiki. Your notion of "reputable" and "verifiable" as applied to the petition are ridiculous. By your standard every election would be invalid as the voters are not "verifiable" or "reputable".. While there may be some petitioners whose feedback may not be reliable, the sheer preponderance of numbers as well as the fact that the information is of known effects of effexor give the petition weight. It is now nearly 15,000 strong. It is noteworthy that some of the "reputable" sources you give so much weight to have been impuned for distortion of reporting of findings, and false reporting is not unknown in the scientific community. Wiki has recently implemented new software to screen editing by vested interests such as employees 0f firms that may have strong negative reports - an example given is watering down of the oil spill disaster by Exxon. The petition stands by sheer numbers as both "reputable" and also "verifiable". You cannot get 15,000 individuals reporting similar life experiences as a "plot". Get serious!!!!! The petition represents real people giving real experience.. Stop deleting the reference to this in the body of the article. It is inevitable that in time researchers will give a fair appraisal to SSRI's and SSRN's such as effexor both for their positive uses and for caution to prevent tragic deaths. That is why the petition is so important. I have not had the time to add back the reference, but i will do so, and I will lodge a complaint if you persist in deleting relevant information because you don't agree. It does not matter that you do not agree. Your arguments are not valid in any case. If you want balance in that - which has been there many times.. describing what the petition is, and the fact that it is anecdotal, but it is powerful just that same and the 15,000 who wrote their input certainly have the right to be heard here Dan... More rights than your deleting this cause you don't agree.. Sam —The preceding unsigned comment was added by 207.61.84.162 (talk)

(Responding yonks later, sorry.) 1) It's not my notion of reputable and verifiable. These are wiki policies, right there in the five pillars "Wikipedia is not the place to insert personal opinions, experiences, or arguments" etc. I'm sorry that you say I'm censoring Wikipedia. I'm not, I'm helping to improve an article by removing a link to poor quality information. I asked for some opinions before I deleted the link; here's the answers I got. There should be a few sites (that meet Wiki's standards) that document people's experiences of using venlafaxine; why don't you try to find and link to one of those sites? Don't forget that you're supposed to keep a neutral point of view. I will always try to remove links to petition-online. You're more than welcome to "lodge a complaint". Dan Beale-Cocks 15:23, 29 August 2007 (UTC)

(I have been away due to illness and after recovery, general "busyness".) Removal of the petition links is just irresponsible Dan. I will be adding the reference to the petition back in very soon, and I will ensure it remains here on a daily basis. I think you may wish to have some arbitration on this. I am not the only one who has commented on the invalidity of your censoring the information that is extremely important. I don't know if you have noted that a recent article in a reputable journal.. I think it was Journal of American Pyschiatric Association (I have to check the name)... purported that the suicide rates had gone up due to the reduction of use of anti-depressants upon the box warnings of the FDA. One the authors was funded by more than one drug firm and the peer review of the article was SCATHING as it was full of distortions of the facts. Perhaps you need to disclose if you have any links with the pharmaceutical industry Dan. Of course, I don'tknow that you do, but the fervour with which you attack the petition gives me pause. I see that the article has improved a lot with more information about side effects and results of studies, but the removal of the reference to the petition is an example of disinformation and is irresponsible. Those 15,000 plus people deserve a voice Dan, and you should not be stifling the fact of the petition. I hope that others will join me in stopping you, and that some of the people at Wikipedia will review this from the perspective of medical ethics as well as freedom of information. I am not adding anything tonight as I want to ensure that the added script is clear and within the standards of Wikipedia, but you can be assured it will be here, and it will be reposted if you delete it again. 216.254.163.88 05:32, 26 October 2007 (UTC)

I've asked for opinions about the link. Very many people say that internet petitions are not suitable for linking to in Wiki articles. You've declared that you will add the link every time it is removed - are you saying that you'll edit war to keep the link in the article? As I've said before, you're welcome to ask other editors or administrators about this. It might be worth taking this matter to dispute resolution. You ask if I have any connections with the pharma industry: Thanks for AGF. I'm happy to answer your question: I do not have (nor ever have had) any connection with any pharma companies. I don't make, distribute, prescribe, or sell any medication or medical products. Dan Beale-Cocks 15:37, 26 October 2007 (UTC)

Dan. I clicked on your link to feedback from others on the petition, and I didn't find anything there on the subject. Perhaps it has been updated and is no longer in the link site that you put here. I would again note to you that petitions and surveys are often used as source material. Petitions are signed by individuals supporting a particular perspective while surveys ask specific questions. In the case of the Effexor petition, the point is there before anyone signs and it is clearly directed at Wyeth, the producer of Effexor imploring them to upgrade their warnings to patients about the real implications of using this drug. More than 15,000 people have signed on to this and even taking into account extraneous entries, the experiences recorded by these people have a validity by sheer weight of numbers of similar reported experiences that are in fact documentation of side effects by a population of patients. Most studies of a drug simply do not have these numbers of people - the cost could be prohibitive and drug firms simply do not test to that extent. If a scientist had the time they could tally the reported experiences in the petition and likely produce a scientific paper keeping in mind the limitations as the petition is not a survey. Having said this, it is rare for there to be this extent of respondents to a petition for a drug - people simply would not bother to write if there were not a strong motivation. Perhaps you want to ignore the march of the monks in Burma, and discredit that because no one validated the motivation of the monks, so their march was invalid. That is really the form of your action conveniently masked by your interpretation of what is valid in a Wikipedia entry. A reference to the petition just adds depth to the article on Effexor and addresses the controversy rather than ignoring this rather dramatic input that is a measure of the power of the internet - but that power must be used for positive goals, and you should not be censoring this. I welcome comment by Wikipedia. While I am strong in my convictions, I am not closed to learning nuances. I simply cannot see how something as powerful as the Effexor Petition should be excluded from this entry. It speaks to the subject with thousands of voices, and readers should be able to find that link with ease, not have it deleted on what is your passion and whim. Sam 216.254.163.88 05:53, 26 October 2007 (UTC)

As has been explained to you many times, internet petitions fail Wikipedia policies on reliable sources, external links, and verifiability. Please stop posting long rants about this. Skinwalker 12:18, 26 October 2007 (UTC)

The discussion is probably in the archive by now. Feel free to ask there for yourself; you'll find people tell you the same thing. Petitions are not useful as sources. The controversy is addressed throughout the article, with references to reputable research. Side effects and increased risk of suicide are mentioned in the the first paragraph. Dan Beale-Cocks 16:03, 26 October 2007 (UTC)

Thanks for the feedback comments. I have looked at the section on reliable sources and verifiability and cannot find any mention of petitions there. I would like to find the discussion in the archives. Not sure how to do that, but will check. Rather than getting into another editing war, I am going to research this and come back when I have something more substantial to support my view or not. I do think that anyone who is involved in the pharmaceutical industry should make this known in the same way that researchers are now obliged to disclose funding sources as authors of papers in which a particular product or article is being discussed, or supported. A recent article in one of the psychiatric journals was found to be a major distortion of facts as I had mentioned. I think that the article has improved with some of the comments about suicide ideation and risks, but it appears quite a bit of stuff about how this product must be managed has disappeared. If you can direct me to the archive, I will look at that. I still hold the view that excluding the petition as a source of patient feedback is not ethical in this context. I may be wrong in the context of the rules of Wikipedia, but in this case, seems a terrible omission of very important infomration. 207.61.84.162 22:47, 28 October 2007 (UTC)

• Here you go: "Reliable sources are authors or publications regarded as trustworthy or authoritative in relation to the subject at hand. Reliable publications are those with an established structure for fact-checking and editorial oversight....Academic and peer-reviewed publications are highly valued and usually the most reliable sources in areas where they are available, such as history, medicine and science. Material from reliable non-academic sources may also be used in these areas, particularly if they are respected mainstream publications." WP:RS

"Questionable sourcesQuestionable sources are those with a poor reputation for fact-checking or with no editorial oversight. Questionable sources should only be used in articles about themselves....Anyone can create a website or pay to have a book published, then claim to be an expert in a certain field. For that reason, self-published books, personal websites, and blogs are largely not acceptable as sources."WP:RS "Material from bulletin boards and forum sites, Usenet, wikis, blogs and comments associated with blog entries should not normally be used as sources. These media do not have adequate levels of editorial oversight or author credibility and lack assured persistence."Wikipedia:Reliable sources/Examples

In other words, the petition website is not acceptable because it lacks editorial oversight and thus, there is no guarantee of its objectivity. What you could do, though, is to find an article in a mainstream press, which satisfies the above requirements, about the petition and refer to it. Also, registering and getting a wikipedia username will give you a better standing. Paul gene 10:26, 29 October 2007 (UTC)

Dan - thanks for your disclosure that you are not involved in the pharmaceutical industry. This is a concern because it was reported earlier this year that this was happening sometimes in Wikipedia entries.

Skinwalker... I do not appreciate your deprecatory statement about my comments as "rants". You are using a classical "ad hominem" argument (i.e. attack the person). Personally, I could care less what you think about my comments. We have disagreed before, and this is what makes democracy - that right of people to express differences. I have read the comments about Wiki policy, and while I still don't agree with this in the context of this subject matter, I will not make any further changes at this time, at least not until I am able to support this in relation to Wiki policies. I am, however, glad that the article has improved significantly. I just read the Effexor Petition again today as this is a dynamic document - and the entries are truly heart-wrenching. I never put any content of the petition in the article as this was not appropriate, but I wanted readers to at least know it existed. I am pasting just one recent entry here in the discussion. " found this petition while trying to research Effexor. I was recently prescribed this drug. My reason for researching was because I started to feel worse depression after starting it - I wanted to know if this was normal. I have taken other antidepressants and have not had these strange feelings before - like I am in a dream, hard to focus, empty. I am scared of going off the meds because of what I've read here. But I will stop taking Effexor - It is not worth the risk. My doctor did not tell me anything about withdrawal or side effects. She seemed all too eager to switch me from Prozac to Effexor. I wondered if the Wyeth-Ayerst sales rep was giving her really cool coffee mugs or something. It's not just the pharmaceutical companies that need to grow an conscience - it's also the doctor's who prescribe them without adequately researching them." I am still of the view that anyone who was researching this drug would appreciate a link to the petition in the article. For those who have actually lost family members to suicide with this drug as a possible trigger, I can assure you they wish that someone had warned them. A similar case some twenty years ago was a drug used as a treatment for severe acne, but one relatively rare side effect was a fatal disease of the blood "anaplastic anemia".. My pharmacist thought this was Accutane but when I checked that is not a side effect. Accutane however, does have very serious side effects and is used as it works so well for acne, but only under very very close supervision and some major restrictions - and is rarely ever prescribed by general practictioners. Well, I have the challenge of seeing in what context a reference to the petition will be permissible in Wikipedia and I am looking forward to a positive resolution of this. 207.61.84.162 23:16, 3 November 2007 (UTC)Sam

Glaucoma section not specific enough?

From the Wyeth web site:

"Mydriasis (prolonged dilation of the pupil of the eye) has been reported with EFFEXOR XR."

It goes on to mention elevated IOP as a side effect. It seems to me that this is primarily an angle-closure Glaucoma problem, not a general glaucoma problem (but I'm not a doctor). I can't find any other info to confirm this, but perhaps if someone knows for certain, the section should be updated. A lot of prescription and OTC medications come with generic "don't use if you have glaucoma" warnings that do not apply to open-angle glaucoma - this gets to be a problem for those with open-angle glaucoma who have to investigate everything to determine whether it applies to them. Michael Daly 17:03, 11 August 2007 (UTC)

suicidal ideation

The article mentions research done using UK data. It should be noted that in the UK venlafaxine isn't prescribed by primary care without reference to secondary care, whereas fluoxitine is. Thus, people on venlafaxine have - as the article says - very many more risks associated with suicide attempts or completion. (To get into secondary care you have to be quite ill first, thus you've probably got a history of DSH, maybe attempted suicide, are severely depressed, are isolated, etc.) I don't want to reduce the suicide warnings at all, but I'd like to make the context(primary care use of prozac VS secondary care use of effexor) a bit clearer. Dan Beale-Cocks 14:42, 29 August 2007 (UTC)

Agreed - and we do need to explain what the risks actually are rather than giving undue weight to side effects that are very, very rare. Secretlondon 20:43, 29 August 2007 (UTC)

I've been thinking about ways to present the risks. The problem with the article at the moment is that it gives a list of common side effects, but doesn't tell the reader how many people in the control group had those same effects. It also mixes up lists from different studies; thus adverse events found in placeabo-controlled pre-market studies are listed alongside voluntary uncontrolled post-market reports and both are given the same weight. this site seems to have a comprehensive list of useful information. Dan Beale-Cocks 20:58, 29 August 2007 (UTC)

Substantial weight loss etc

Substantial weight loss in patients with major depression, generalized anxiety disorder, and social phobia has been noted

Does this mean:

Substantial weight loss in patients with:

• major depression
• generalized anxiety disorder
• social phobia

Or does it mean:

• Substantial weight loss in patients with major depression
• generalized anxiety disorder
• social phobia

? Evercat 01:21, 15 September 2007 (UTC)

I imagine that it means the first - ie Patients with {major depression, gad, sp} who are treated with venlafaxine may experience substantial weight loss. I haven't got any refs for this though. Dan Beale-Cocks 15:28, 27 October 2007 (UTC)

Hypersensitivity

"Venlafaxine is not recommended in patients hypersensitive to venlafaxine."

Come on!

unsigned comment —Preceding unsigned comment added by 190.40.0.49 (talk) 20:26, 18 October 2007 (UTC)

serotonin syndrome

serotonin syndrome is a severe, potentially fatal, condition. The article needs a section about serotonin syndrome, but at the moment there are two sections, and another mention, scattered throughout the article. Should the information be left scattered across two sections, or should it be merged into one section? Dan Beale-Cocks 16:07, 27 October 2007 (UTC)

The side effects/contraindications sections are all muddled up and in need for some bold editing. I would support anything you can do. Paul gene 10:40, 29 October 2007 (UTC)

ADHD Treatment

Venlafaxine has been shown to be effective in treating ADHD in Adults. It is one of the major off label uses of the drug. Does it make sense to include this in the Off-Label-Use section of the article? —Preceding unsigned comment added by 84.185.245.183 (talk) 22:37, 27 November 2007 (UTC)

Is there any source to show that venlafaxine is used in this way? (This doesn't affect inclusion or not but I'm curious to know how other countries handle "off label" uses of medications. It's something I need to look into. Is it just a US thing, or do many other countries do it too?) Dan Beale-Cocks 16:43, 3 February 2008 (UTC)

I have never heard of venlafaxine being used to treat ADHD of any type in adults or in children. There is no empirical evidence backing such a use, and the side-effect profile and incidence of adverse reactions with this specific drug doesn't lend weight to the idea of using this drug as a first-line treatment for anything. Many patients have increased difficulty concentrating - among other adverse reactions - after the initial phase of anxiety, panic, etc. that accompanies starting venlafaxine therapy, but, it is one of the two most effective labelled (thymoleptic) antidepressants out there, along with mirtazepine. (Don't get me started on this new "trend" of drug companies attempting to gain extensions on their patents for neuroleptics by getting them labelled as anti-depressants: I can't think of a class of drugs less suited to the task, except, possibly, reserpine.) Even atomoxetine, a drug that is only an NRI, has been found to be next to useless in treating ADHD in adults - and also has some mean side-effects - and within five years of its introduction, has fallen out of common use in favor of the older and more efficacious drugs with more evidence to back them up, and their newer derivatives, such as mixed amphetamine salts, (D)-amphetamine, and lysine-(D)-amphetamine complex, of which the trade name escapes me at the moment (an unbreakable extended-release form of (D)-amphetamine that can not be abused by insufflation or injection). LM Ph.D. Ph.D. D.Pharm.Sci. 75.179.176.190 (talk) 05:16, 31 May 2010 (UTC)

I have been prescribed this medication as an off-label treatment for Adult ADHD. I asked for Strattera (as my psychiatrist is rabidly anti-stimulant) and it turns out it still isn't available in generic form here, my insurance won't cover the cost of the name brand, & I don't have the $$ to pay for it out of pocket. So, Effexor was her next choice, and I came here again looking to see if there was any other mention of this use of Effexor as ADHD treatment. While it makes some sense, Strattera being an NRI, and Effexor being an SNRI, I'm still not sure that I believe this would be a good treatment...especially since my shrink literally SMIRKS when I bring up my ADHD issues (and tells me to try a gluten-free diet, or not consume sugar or white flour & that should clear it up. Whereas I *HAVE* lived on such a diet, and did so for 2 years...while I felt better overall, it did NOT clear up my ADHD issues!), and I have a feeling my shrink "doesn't believe in ADHD" just as she "doesn't believe in stimulants". I think I need a new shrink. ;) But I did want to mention that, yes, Effexor *IS* sometimes prescribed off-label for ADHD. Kailey elise (talk) 15:33, 16 December 2010 (UTC)

Patient Experiences

This is an excellent article in the New York Times by a writer telling of his experiences with Prozac and Effexor. Good stuff.. but it affirms the importance of putting the Effexor Petition link back into this article. This is a professional writer and his material is absolutely on target and of great important in this encyclopedic entry. This is not a drug compendium nor the DSM (which by the way has nothing to do with Statistics). It is an encyclopedic entry about a drug of a group that has much controversy with respect to disclosure of effects by drug companies. I suggest that a review be undertaken to have the effexor petition placed in this section as an issue of freedom of expression and ethical considerations to give voice to 15,000 users who have put their thoughts on line. Others should have tghe right to know about this.. otherwise this entire article is a sham notwithstanding the improvements. 63.250.127.244 (talk) 00:24, 3 February 2008 (UTC)

reputable links about patient experiences can go in the article. Online petitions are not reputable sources, and can give undue weight to a POV. Dan Beale-Cocks 16:41, 3 February 2008 (UTC)

your statement disputing a petition as a "reputable source" is questionable. Newspapers publish results of surveys that are based on asking individuals questions about opinions. A petition can be the support of a pov, but in the case of the effexor petition it has a huge volume of personal experience and is quite beyond dispute on sheer volume and independence of stated experience. it has never been presented as a scientific study, but it should not be discarded as lacking "reputability" as if to imply that the bulk of the statements are false. The reader has the opportunity to look at the patient experiences and form their opinion and in doing so it empowers patients to be able to ask doctors appropriate questions of concern. This is not a medical journal, nor a drug compendium but an encyclopedic entry about a drug, and patient experience of this unique character as is possible on the internet belongs here as much as the dialogue of editors about what is or what is not suitable. We need more contributors to step up so that a few editors cannot effectively block important information or block contributors like myself who may disagree and who are then blocked instead of allowing the views to be expressed. This is not disruption. This is the way that ideas are argued in a democracy.. not by censorship but by allowing arguments to be put.Szimonsays (talk) 17:52, 2 August 2008 (UTC)

Withdrawn Symptoms

Back in the beginning of last year, I went to this exact article and decided that Effexor was the pill for me. I generally enjoy getting information about things I dont know alot about from Wiki. I also engaged many other google hits as well. The other hits contained people describing their horrible withdrawl symptoms, but I discounted them, seeing as how it wasnt mentioned here. In November I went off Effexor. The next week I experienced horrible withdrawl effects. These things, now, are highly cited. There is even a Brain Shivers article which says that Effexor is one of the medications that cause it. Why, then, is there nothing here about them? As an encyclopedia, you do others like myself a great disservice by not mentioning these highly notable effects. You dont have to go into too much detail, just make a list, such as the regular side effects list. Queerbubbles (talk) 17:24, 26 February 2008 (UTC)

Procede with Extreme Caution

A scan of the discussion page would indicate some distress among those with an opinion about Effexor-Venlafaxine. As a former user I can add another tortured voice.It has been more than 2 years since I last took Effexor and only a few weeks ago I had the strong impression that it is still leaving my system.

The label on this medication states a dosage range from 75 to 150mg, I was quickly titrated to 600mg a day before my anxiety symptoms were finally relieved. My treatment for anxiety which began when I had a series of surgeries and was bedridden for 3 month, first valium, later Paxil and lastly Effexor.

After about 2 years on Effexor I found I was mismanaging my life, could not read, could barely speak, I had been a writer and now could do little more than play video games all day and not very well. Stopping Effexor was extremely difficult but once I got there being off of it was reminiscent of quitting tobacco, there was intense desire for it months later for the first year. My judgment was further impaired by withdrawal, I could not sleep, the writing I produced was written in a state like hysteria and I could not look at it with any critical detachment. What I thought was brilliant was barely intelligible.

The doctors I saw were not educated about this med or its need. Thanks to the American insurance system my doctors and health plan changed annually. Suffice to say the doctor who okayed my stopping Effexor was unaware of the likelihood I would need a replacement SSRI. Many of us who at some level benefit from Effexor should be taking either no more than the label dose or a different SSRI. This is as essential to the health of the patient as insulin is to a diabetic.

My struggle with Effexor made suicide seem more of a choice than ever before in my life. I have known 2 people who went from Effexor to suicide. Is it a statistical lie to say because they were not using Effexor at the time of death Effexor had no part? My strongest suicidal thoughts came a year after I stopped using the drug yet it was still in my mind.71.245.74.68 (talk) 13:12, 1 March 2008 (UTC)

I'm really sorry that you've had a lousy experience, but your story points to flaws in US healthcare and piss-poor MH treatment in general, not just flaws in venlafaxine. Dan Beale-Cocks 16:18, 1 March 2008 (UTC)

Efexor is an anti-depressant. In the UK it's not a 'first line' treatment - it's supposed to be used when other meds have failed. People with depression are more likely to commit suicide (and have suicidal ideation) than the general population. A bit of OR and SYNTH shows it's not surprising that some people being treated for depression kill themselves. Your "statistical lie" (your words, I don't agree with that label) ignore the number of people who's thoughts of suicide are stopped by taking venlafaxine. Dan Beale-Cocks 16:18, 1 March 2008 (UTC)

The fact remains that this crucial information is lacking in this article. There are sources that go to this very problem... and none of them are on here.Queerbubbles | Leave me Some Love 01:45, 2 March 2008 (UTC)

What are you talking about? It is right in the lead section: "Due to the pronounced side effects and suspicions that venlafaxine may significantly increase the risk of suicide, it is not recommended as a first line treatment of depression." Then there are two large chapters:

Venlafaxine#Suicide Ideation/Risk and Venlafaxine#Physical and Psychological Dependency. I happen to believe that venlafaxine is still hugely overprescribed, and most of the prescriptions for venlafaxine are inappropriate. I tried to make sure that as much as possible (while keeping impartiality) scientific data highlighting its side effects would make it into the article. You are welcome to add more if it is the data from the scientific peer reviewed sources. But also remember to keep the neutral point of view. Paul Gene (talk) 15:11, 2 March 2008 (UTC)

The wording is extremely clinical. It does not describe, easily, what we are talking about. Yes, at the top it says that people experience depression and suicidal thoughts, however further down it does not go into it in regards to withdrawl. Any SSRI has a chance of suicidal thoughts, however this medication is unique in that these feelings last a very long time in the withdrawl period. A general passerby would look at this and #1, be put off by the clinical language and #2, not see anthing further regarding the length of the withdrawl or the severity. All that is written is that there is severe withdrawn symptoms which come on quickly due to the half life. Then the article fails to describe how long that lasts barring another dose, and what those symptoms are. Queerbubbles | Leave me Some Love 10:32, 3 March 2008 (UTC)

Well, you are welcome to edit the article in regards to style. Remember, however, that WP imposes three important constraints - it has to be impartial, factual and you are not to bring in any interpretations or data that are not in the original publications.

While the language may be difficult at times (again, you are welcome to fix this), I think the following is simple enough for a lay reader to make the choice: "A study conducted in Finland followed more than 15,000 patients for 3.4 years. Venlafaxine increased suicide risk 1.6-fold (statistically significant), as compared to no treatment. At the same time, fluoxetine (Prozac) halved the suicide risk.[20] In another study, the data on more than 200,000 cases was obtained from the UK general practice research database. The patients taking venlafaxine had significantly higher risk of completed suicide than the ones on fluoxetine (Prozac) (2.8 times) or citalopram (Celexa) (2.4 times)."

Scientific literature reports that withdrawal symptoms with venlafaxine is generally severe but short-lived. There are likely to be cases with prolonged symptoms but I am not aware of any research publications on that. If you can find one, please add it to the article. Cheers Paul Gene (talk) 11:44, 3 March 2008 (UTC)

Would you support a new subsection entitled withdrawl? I can do some research and put in a prelim paragraph for that subsection, however I will say right now that I am still horrible with adding references. I'd most likely write up the paragraph, put it here, and then list the sites for the refs. Let someone smarter and longer involved than I play with that stuff. Queerbubbles | Leave me Some Love 12:10, 3 March 2008 (UTC)

'Withdrawal' is a word that has two meanings; an every day use (which is how people coming off venlafaxine use it) and a medical one which is about addiction. Venlafaxine doesn't fit the classic addtion profile, thus withdrawal (medical sense) isn't suitable. So, sure, call the sub-section withdrawal, but please make sure to mention that it's "discontinuation effects" that you're talking about. Dan Beale-Cocks 14:27, 3 March 2008 (UTC)

Comments by Queerbubbles are very much to the point. I found that I had been blocked for "disruption" by expressing my concerns about the ongoing blocking of information such as the Effexor Petition. I am a very polite and respectful person in my dealings with all others, but I do get upset when my views are called a "rant".. i.e. as in rant and rave.. I have asked for a review of Wiki guidelines pertaining to information such as surveys, polls and online petitions. I simply do not agree that an online petition with thousands of people telling of their experience is either unreliable or unverifiable. The sheer preponderance of numbers of personal experience gives weight to common experience. It is not meant as scientific evidence, but it has validity. It would be as reliable as if someone had put out a questionaire on effects with specific questions, and if a researcher had the time, the data in the petition could certainly be extracted into common elements to give a "snapshot" of experience of users. In that regard, I believe it should have stature and I have asked for a review of the guidelines to look at this. I will be appealing my block. Szimonsays (talk) 06:56, 31 May 2008 (UTC) szimonsays

"phenylthylamine" class of modern chemicals

The article reads as follows: "Venlafaxine hydrochloride is in the phenylthylamine class of modern chemicals, which includes amphetamine, methylendioxymethamphetamine (MDMA), and methamphetamine. This chemical structure likely lends to its activating properties, however some patients find Venlafaxine highly sedating despite its more common stimulatory effects."

I'm not sure why this belongs in an encyclopedia article. And if it should be here then why is it in the Off Label/Investigational uses instead of the chemical structure section? "Phenylthylamine" should be spelled phenylethylamine anyways. There are hundreds and hundreds of chemicals in this class that could be named, so why did this person choose to put venlafaxine solely in the company of drugs of abuse? I don't think it adds anything to the article, and increases the chance that readers will draw incorrect conclusions from the information.

The second sentence refers to the relationship between the chemical's structure and its effects on the CNS. The author does not cite a source for this information. The author also did not provide a reference for the fact that venlafaxine's stimulatory effects are more common. According to the official prescribing information, incidence of insomnia and somnolence were equal (17%), so I'm not sure this could be described as stimulating (unlike the amphetamines mentioned earlier). (Anecdotally, I know one person who complains of great fatigue from this medication.)

I would change this but unfortunately don't have the time to do so. I recommend moving this to the Chemical structure section and removing the references to other phenylethylamines, if it is to be kept at all. --Navicular (talk) 14:48, 17 March 2008 (UTC)

"Phenylthylamine" should be spelled phenylethylamine anyways. If you want to get particular... there is no such word as "anyways". If there is a typo, it is easily fixed. Even by yourself. Queerbubbles | Leave me Some Love 15:15, 17 March 2008 (UTC)

Related chemicals

It is mentioned in the article that venlafaxine allows dopamine to bind with D2 receptors. Are there other, possibly stronger, chemicals that do this? 914ian915 (talk) 22:01, 28 July 2008 (UTC)

Andrea Yates

No I haven't read the article in full, the article discussion in full and nor do I have the time right now. However seeing as wikipedia holds a fairly high search engine weighting and is often the choice for many people seeking information due to it's accessibility and organisatio of articles it is the responsibility, in my opinion, that wikipedia editor's have a responsibility to cover the events of Andrea Yates and link them properly. The drug mentioned in this article played a role with the Andrea Yates events and the Homicidal warning on the Efexor label should be mentioned and indeed have it's own section in this article. Although this is only my opinion on the matter and a wikipedia veteran should look over it please.

Here is the wikipedia article concerning Andrea Yates http://en.wikipedia.org/wiki/Andrea_Yates

Thankyou. —Preceding unsigned comment added by 121.222.119.67 (talk) 03:52, 2 September 2008 (UTC)

Disputed claim of Norepinephrine Reuptake Inhibition

The statement "although some authors dispute the claim that it inhibits norepinephrine reuptake" used the following citation: http://mbldownloads.com/0408PP_Liang_CME.pdf

I don't see in this article where that claim is disputed. The article even calls Venlafaxine an SNRI:

Therefore, “cleaner” drugs were sought and MAOIs and TCAs were largely replaced by selective serotonin reuptake inhibitors (SSRIs; eg, fluoxetine, paroxetine, sertraline) and serotonin norepinephrine reuptake inhibitors (SNRIs; eg, venlafaxine, duloxetine).

The authors also used venlafaxine as the basis of their research into "triple-reuptake inhibitors". Jwesley₇₈ 14:05, 23 November 2009 (UTC)

Challenge Editor DocJames to a Debate

DocJames has repeatedly blocked any and all attempts to put the opioid method of action for Venlafaxine at the top of this article. The related opioid Tramadol lists SNRI activity at the top despite Tramadol not being officially classified as an SNRI. Venlafaxine lists opioid methods of action three times in the body but not at all in the top section. DocJames is appealing to Western Medical dogmatic thinking which suggests that only the classified use of a drug needs be mentioned. Perhaps DocJames is unaware that there are other methodologies for medicine besides Western Medicine? Perhaps DocJames is aware that not only doctors interact with medications but patients do as well? Why can't patients edit Wikipedia? Maybe patient input is important? Why are these (non-medical) editors being blocked?

The debate... DocJames is lording his medical degree over the rest of us (as advertised on his wiki page). If his medical training is so good (he's an emerg doc, according to wiki page), let him debate the issue publicly and not hide behind repeated bans of my account.

Debate question: Codeine and Morphine differ by 1 carbon atom. The extra carbon of Codeine is demethylated in the liver. This extra processing step makes codeine the 'weaker' opioid because it is less immediately bioavailable. Note that I was able to provide a clear and concise biochemical explanation as to the difference between Codeine and Morphine.

Please review: https://www.researchgate.net/profile/Justin_Barber3/publication/50998428/figure/fig1/AS:394259501993984@1471010198062/Molecular-Structures-of-venlafaxine-and-tramadol-From-Venlafaxine-Tramadol.png

Tramadol and Venlafaxine also differ by 1 carbon atom. What is the exact biochemical explanation (like the one I provided for Codeine/Morphine) which explains why Venlafaxine is neither a mu1 binding opioid nor an NMDA antagonist whereas Tramadol is both?

(p.s. here's why this debate matters: https://www.ncbi.nlm.nih.gov/pubmed/31637686 ) — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:C8B4:976A:437B:B56 (talk) 07:03, 23 January 2020 (UTC)

Answer me here DocJames, stop hiding behind user bans. — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:C8B4:976A:437B:B56 (talk) 06:50, 23 January 2020 (UTC)

The main body states in the pharmacology section that venlafaxine’s affect on the opioid system is indirect, so that alone would suggest that it is not an opioid drug. Also, an opioid mechanism would need to be significantly strong and occur at therapeutic doses to describe it as an opioid, especially in the article lead.

Actually, Doc James medical credential carry zero weight on Wikipedia in content disputes, and venlafaxine is a psychiatric drug so Doc James is not editing within his area of expertise anyway. The reason your edits are getting reverted is because they are of poor quality — you are using old sources, single case reports, individual animal studies and other primary sources. Instead you should be obtaining high quality and recent sources for your edits, e.g., review articles, systematic review articles and meta-analyses etc., per WP:MEDRS. Doctors do tend to interpret medical literature better than lay editors, such as yourself, by nature of their training etc., but layperson editors with better sources will always win the argument. You should read more about how Wikipedia works if you want to progress here.--Literaturegeek | T@1k? 02:02, 24 January 2020 (UTC)

Poor resources? https://books.google.ca/books?id=sEFyDwAAQBAJ&pg=PA73&dq=venlafaxine+opioid&hl=en&sa=X&ved=0ahUKEwiFvJWS4_fmAhVsp1kKHUE1DZkQ6AEIKTAA#v=onepage&q=venlafaxine%20opioid&f=false A textbook?

Literature Geek: Venlafaxine and Tramadol differ by only one carbon atom. What is the exact biochemical reason that Venlafaxine is neither a mu1 binding opioid nor an NMDA antagonist whereas Tramadol is both?

EveryoneElse: Notice that I've received a non answer to my question (Venlafaxine vs Tramadol) This will occur over and over again with pretentious Wikipeia editors who know nothing about nothing. Will anyone answer my question? If you can't you're injuring patients by concealing Venlafaxine's opioid method of action. — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:247F:54CF:D553:4D05 (talk) 02:15, 24 January 2020 (UTC)

Drugs work like keys in a lock, you can change one small detail in a key and it might still open the door or the change in pattern may mean it no longer opens that door but might open a different door. Trying to predict the effects of a drug based on chemical diagrams is not ideal, to say the least, for the reasons I have just explained. There needs to be rigorous studies. So that is your “debate questions” answered.

Please provide a high quality source for your edits that specifically classifies venlafaxine as an opioid. Do you have a high quality source that says: venlafaxine is an opioid? At the moment your edits do not have supporting sources that classify venlafaxine as an opioid so your edits are being reverted, per WP:NOR and WP:WEIGHT.--Literaturegeek | T@1k? 02:44, 24 January 2020 (UTC)

Yes, your text book source is a better source, when I first clicked on it I got a message saying the page was not available but it is available to me now.--Literaturegeek | T@1k? 02:49, 24 January 2020 (UTC)

"The antinociceptive properties of venlafaine and mirtazapine in mice have been attributed to opioid receptor activation with vanlafaxine's effects mediated via MOP (mu1 opioid), KOP and DOP"

https://books.google.ca/books?id=sEFyDwAAQBAJ&pg=PA73&dq=venlafaxine+opioid&hl=en&sa=X&ved=0ahUKEwiFvJWS4_fmAhVsp1kKHUE1DZkQ6AEIKTAA#v=onepage&q=venlafaxine%20opioid&f=false

Page 73

"OPIOID RECEPTOR ACTIVATION" That's it! You can't argue further. A textbook lists venlafaxine as working via opioid receptor activation, not indirectly, not downstream... opioid receptor activation. That's an opioid. Period. — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:247F:54CF:D553:4D05 (talk) 03:22, 24 January 2020 (UTC)

>> Drugs work like keys in a lock, Absolutely false. Any nitrogen center 2 or 3 atoms away from a phenol group will likely indicate opioid activity. Don't trust me. Google H.H. Hennies... the inventor of Tramadol. It's his quote You absolutely did not answer my debate question. — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:247F:54CF:D553:4D05 (talk) 03:25, 24 January 2020 (UTC)

https://www.researchgate.net/publication/20306198_Receptor_binding_analgesic_and_antitussive_potency_of_tramadol_and_other_selected_opioids page 877, first line..

"Despite the ample variability in the structure of opioids, most compounds that behave as narcotic analgesics contain an aromatic ring system spaced from a basic nitrogen center by a group of 2 or 3 atoms..."

Not lock and key. False. Please stop editting articles you don't know anything about. — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:247F:54CF:D553:4D05 (talk) 03:36, 24 January 2020 (UTC)

“Will likely” not “will definitely”, “most compounds...” not “all compounds” so I did answer your question accurately, anyway please also see, WP:NOTFORUM. Working in (probably venlafaxine mega overdosed) mice via opioid mechanism, but what about humans at normal dosage? Venlafaxine actives many serotonin receptors without touching them via blocking the reuptake of serotonin (serotonin itself activates serotonin receptors) so just because venlafaxine activates opioid receptors does not mean that it does so directly. You seem to only partially understand what you are writing. In fairness it is indeed plausible that venlafaxine will work similarly to tramadol in opioid activity, at least the mechanism of action. The key question is do you have a source to say that venlafaxine actives opioid receptors at therapeutic doses and do you have a source that classifies venlafaxine as an opioid? No source means no edit. Your original research of synthesising sources might be correct but original research is against Wikipedia rules, see WP:NOR, particularly WP:SYN.--Literaturegeek | T@1k? 03:44, 24 January 2020 (UTC)

I have provided a source for LiteratureGeek which flat out says that Venlafaxine works by OPIOID RECPTOR ACTIVATION. LiteratureGeek is doing what all wiki editors do, engage in semantic battles when they've lost on logical bases.

LiteratureGeek says drugs are lock and key. I blew that out of the water (see above). Then he said I didn't have a good source... I blew that out of the water (see above). He's now Bill Clintoning and saying that Venlafaxine goes to the opioid receptors but perhaps it doesn't inhale. I will engage in no more conversation with LiteratureGeek because he isn't engaging in debate... he's engaging in "I'm right, you're wrong".

The question remains: Venlafaxine and Tramadol differ by one carbon atom only. Thanks to LiteratureGeek we know that structurally similarity is hugely important in opioid activiy. What is the exact biochemical reason that Venlafaxine is neither a mu1 binding opioid nor an NMDA antagonist whereas Tramadol is both? If you can't answer, don't answer, keep quiet. Lesson for wikikedia editors, keep your mouths shut, you open them too often and are always in error.

Who will debate me next, someone who edits veterinary pages? — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:247F:54CF:D553:4D05 (talk) 04:46, 24 January 2020 (UTC)

It does not matter what you think or I think. Wikipedia goes by what sources say. If you do not have a source that specifically classifies venlafaxine as an opioid then it does not get added to Wikipedia. You are doing ignoring of arguments yourself. I pointed out the opioid effect of venlafaxine might only occur at very high doses (overdoses) and that a single mouse study does not cut it. You have not provided a source saying that this effect occurs at therapeutic doses in humans. You can create a blog and add your WP:SYN there, just not here.--Literaturegeek | T@1k? 05:11, 24 January 2020 (UTC)

LiteratureGeek is making up the rules as he goes along. I've provided a source, a TEXTBOOK!!! Again it says: "OPIOID RECEPTOR ACTIVATION". This is unambiguous. It only means one thing. The fact that it refers to a mouse model is inconsequential. It refers to multiple studies if you had bothered to read it. Not just one mouse study. It is in a Academic Text that says "Opioids are good targets for depression" and this is the chapter about how Effexor(Venlafaxine) is one of them! READ!

By the way, mice studies are how opioids are tested. Is LiteratureGeek going to volunteer for a human opioid study where they dissect his brain after a few weeks of exposure? LiteratureGeek needs to go to the Tramadol page. There he'll discover that it lists Tramadol's SNRI activity right up top. He'll then follow the links and realize that it's the same level of 'proof' or verifiability that I've provided for Venlafaxine being an opioid. Is LiteratureGeek going to remove the SNRI activity from the top of Tramadol because it was done on mice?

The question remains: Venlafaxine and Tramadol differ by one carbon atom only. Thanks to LiteratureGeek we know that structural similarity is hugely important in opioid activiy. What is the exact biochemical reason that Venlafaxine is neither a mu1 binding opioid nor an NMDA antagonist whereas Tramadol is both?

(a) the added carbon of Venlafaxine masks the activity of the phenyl group and hence it doesn't bind

(b) the added carbon of Venlafaxine changes the polarity of the molecule such that it no longer binds

(c) the added carbon of Venlafaxine causes Venlafaxine to mirror a known antigen and is removed by the immune system when close to opioid receptors

(d) the added carbon of Venlafaxine causes a 'folded chair' configuration of the cyclohexane ring and blocks binding.

(e) there is no significant difference between Venlafaxine and Tramadol. Both bind similarly. This wasn't detected due to dogmatic thinking and silo'ed development of both drugs and silo'ed approval and safety measures.

— Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:247F:54CF:D553:4D05 (talk) 06:41, 24 January 2020 (UTC) 

The pharmacology section already mentions an opioid mechanism, so I do not see why you are having such a problem. Venlafaxine is not prescribed nor licensed as an opioid and it is not classed as an opioid so, per WP:WEIGHT it should not be added to the lead. You should find something else to do with your time, a day out fishing, a nice stroll down the beach or another area of research perhaps.--Literaturegeek | T@1k? 16:16, 24 January 2020 (UTC)

Observers Note: Literaturegeek won't answer any of my questions but only dictates terms and rules which I utterly ignore. Wikipedia is the encyclopedia that can be editted by anyone... not only when Literaturegeek and DocJames approve. Note the insults. That's typical of wikipedia editors after they are defeated logically and have no legs to stand on.

(Directed at LiteratureGeek only, in retort to his rude comments made to me... I can't walk on a beach, Venlafaxine induced a suicide attempt and then left me fully disabled. F you Literaturegeek for your cute f'ing comments. When your grandmother dies of this poison because doctors give her tapentadol for her broken hip and then venlafaxine for her mood, the double opioid action will make her sick and possibly kill her. Don't blame me when it happens. LiteratureGeek, why don't you go walk into the ocean and take a deep breath. https://www.ncbi.nlm.nih.gov/pubmed/31637686 This is why the debate matters. I mentioned it above LiteratureGeek but you're daft for reading. F you.. f you very very hard.)

LiteratureGeek(who never reads): 1) Examine this book: https://books.google.ca/books?id=sEFyDwAAQBAJ&pg=PA73&dq=venlafaxine+opioid&hl=en&sa=X&ved=0ahUKEwiFvJWS4_fmAhVsp1kKHUE1DZkQ6AEIKTAA#v=onepage&q=venlafaxine%20opioid&f=false It is published by Elsevier Academic Press. Is this book a text book? YES/NO

2) Does this book on page 73 read: "The antinociceptive properties of Venlafaxine ... have been attributed to Opioid Receptor Activation"? YES/NO

3) Is Venlafaxine Prescribed for pain? https://www.mayoclinic.org/pain-medications/art-20045647 https://www.health.harvard.edu/pain/drugs-that-relieve-nerve-pain YES/NO

4) Should all uses and modes of a drug be placed in the article lead where prescribers and patients can see them quickly? YES/NO

5) Does Tramadol list SNRI activity in the article lead, despite it not commonly being prescribed as such? YES/NO

6) Given that Venlafaxine is prescribed for pain, and that mechanism is explained in a textbook, does it not belong in the article lead that Venlafaxine exhibits antinociception via Opioidergic activity? YES/NO

7) For patient safety, to avoid situations like this one: https://www.ncbi.nlm.nih.gov/pubmed/31637686 Don't you want the opioid activity of Venlafaxine front and center? YES/NO

And finally, for ALL EDITORS.

Don't edit this article unless you can answer: Venlafaxine and Tramadol differ by one carbon atom only. Thanks to LiteratureGeek we know that structural similarity is hugely important in opioid activiy. What is the exact biochemical reason that Venlafaxine is neither a mu1 binding opioid nor an NMDA antagonist whereas Tramadol is both?

(a) the added carbon of Venlafaxine masks the activity of the phenyl group and hence it doesn't bind

(b) the added carbon of Venlafaxine changes the polarity of the molecule such that it no longer binds

(c) the added carbon of Venlafaxine causes Venlafaxine to mirror a known antigen and is removed by the immune system when close to opioid receptors

(d) the added carbon of Venlafaxine causes a 'folded chair' configuration of the cyclohexane ring and blocks binding.

(e) there is no significant difference between Venlafaxine and Tramadol. Both bind similarly. This wasn't detected due to dogmatic thinking, silo'ed development of both drugs, silo'ed approval and indadequate safety measures. — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:ADFF:E27D:2CEE:47ED (talk) 01:04, 25 January 2020 (UTC)

Before answering each question individually, if venlafaxine is truly a classical opioid (not some drug that has a trivial indirect or possibly direct subtle effect on the opioid system) then why does it have very few reports of abuse and no addiction potential? How on earth could one of the most commonly prescribed drugs escape law enforcement agencies attention? Why is it not scheduled as a controlled drug? Your previous edit (calling venlafaxine an opioid) was basically telling people this is a drug of abuse but it is not scheduled. As far as your edit preventing harm I suggest it could mislead certain people into trying to abuse this drug at high dosage in search of an opioid effect that is minimal, and high doses of venlafaxine is much more likely to induce mania, agitations and resultant suicidal ideation. I could understand if you wanted to add to the lead that venlafaxine can cause paradoxical psychiatric reactions and withdrawal reactions that can include suicidal ideation. Why the fixation with the opioid system? How does adding “is an opioid” help a layperson with virtually no medical knowledge connect that to suicidal attempt (opioids are far less likely to induce suicide attempt than say a paradoxical reaction to a serotonergic drug, again why the fixation with opioid system)?--Literaturegeek | T@1k? 02:23, 25 January 2020 (UTC)

I have not removed your current edit to the lead as I want to think about it and because it did not add back in “is an opioid” but rather just the mechanism or possible mechanism.--Literaturegeek | T@1k? 02:29, 25 January 2020 (UTC)

Regarding: >>How on earth could one of the most commonly prescribed drugs escape law enforcement agencies attention? Answer: In 1988 (Effexor initial research) the method of opioid activity testing was displacement testing. The methodology is that you administer an opioid of known strength. Subsequently you administer the suspected opioid. If the suspected opioid displaces the known opioid, you know your suspect opioid has a strength greater than that of the known opioid.

Venlafaxine was displacement tested against a Wyeth proprietary opioid known as Ciramadol which has never ever seen the light of day clinically. Ciramadol is a mixed opioid agonist/antagonist. It is also very very similar to Tramadol and Venlafaxine. Chances are Venlafaxine is just 5% less powerful than Ciramadol and hence didn't displace it. Also Ciramadol being a mixed agonist/antagonist makes it a poor choice for opioid displacement testing at all.

The FDA, just like the FAA allows drug companies to self select the materials it presents and typically allows the drug companies to self certify. Since the FDA knows less about medicine than either you or DocJames knows, they said "sure, great, sound like a solid study, where's our fee?"

Tramadol was developed in Germany (Gruenthal) in 1977. It's possible Wyeth chemists knew of it but if they did, Tramadol was NOT scheduled at the time. Tramadol was not introduced to the US market until 1995, two fully years after Venlafaxine(Effexor) was approved. To your original point... it took from 1977 until 2014 for Tramadol to be scheduled. Also to your original point, Codeine is an opioid that isn't used for kicks at parties (commonly) and doesn't get you particularly high. Venlafaxine is available only in extended release (due to the typical short half life of Tramadol and Venlafaxine) and hence doesn't give you a 'buzz'.

Did you know that you can no longer purchase codeine containing pain relievers over the counter here in Canada? Wanna know why? They were causing too many addictions. It doesn't have to be a strong opioid to cause problems.

Since the opioid nature of Venlafaxine was unknown it was originally prescribed for children and considered safe during pregnancy. Huge massive lawsuits compelled the FDA to reverse this decision only after 10's of 1000's of deaths.

You shouldn't be shocked that an opioid has escaped the detection nets. It's common: https://www.nature.com/articles/tp201430 Paxil is also an opioid.

As for no one at all abusing venlafaxine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871746/ http://www.dusunenadamdergisi.org/ing/fArticledetails.aspx?MkID=906 https://journals.lww.com/psychopharmacology/Citation/2019/03000/Venlafaxine_Abuse_in_a_Patient_With_a_History_of.16.aspx https://www.nejm.org/doi/full/10.1056/NEJM200302203480822 https://link.springer.com/article/10.1007/s40278-014-3581-8 https://www.tandfonline.com/doi/abs/10.1080/10550887.2013.849974?scroll=top&needAccess=true&journalCode=wjad20 https://www.researchgate.net/publication/280533116_Venlafaxine_as_the_'baby_ecstasy'_Literature_overview_and_analysis_of_web-based_misusers'_experiences

I realized I rambled on about ciramadol and displacement testing without citing resources. Find the original certification of Venlafaxine on Pubmed for the citations. — Preceding unsigned comment added by 2607:FEA8:3CA0:3CD:ADFF:E27D:2CEE:47ED (talk) 04:17, 25 January 2020 (UTC)

Thanks for links, I will read them and respond later.--Literaturegeek | T@1k? 08:02, 25 January 2020 (UTC)