Effexor taper question

After many failed medications (either due to side effects or ineffectiveness), including amitriptyline, nortriptyline, cymbalta, gabapentin, and depakote, I am retrying Effexor. I had tried it previously, but I had severe side effects (headache, nausea, general dizziness) trying 1/3 of a 37.5mg capsule. My doctor has suggested that I try a slower taper by literally increasing my dose 1 pellet at a time. I am having rather miserable side effects (the same ones - headache, nausea, dizziness), and I am only taking 2 of the tiny pellets in the capsule. (!).

Here is my question. Has anyone had side effects at that low of a level, toughed it out, and then were eventually able to tolerate the Effexor at a therapeutic level? Although miserable, I’m willing to tough it out a bit longer, but I really feel like it may be pointless to do so if I am reacting to such an incredibly small dosage. Any thoughts?


Other than Scott, I’ve never heard of anyone reacting to such a tiny, tiny dose of med. If I had to guess, I would think ur hyper tuned into ur body and looking for signs of effect. I’ve done the same thing. It’s actually well documented that this hypervigilance us a sign of low serotonin. It’s the same thought processes in anxiety disorders, and migraine falls into line with depression/anxiety… Which is why the antidepressants work for this condition.
What are some if the other side effects from the other meds you’ve tried?
For nausea, you can take it with food and possibly take some Ginger with it. Do the side effects last all day?

It certainly crossed my mind that I was “imagining things” with this low dose, but now that the drug has worn off (24 hrs later), I am feeling SO much better. Ginger / sea bands did nothing for the nausea, but the phenergan helped a bit. The headache and dizziness were still really bad though.

I tolerate amitrityline and nortriptyline fine (some dry mouth/eyes)…my cardiologist just made me go off of them because they were complicating my low blood pressure / orthostatic intolerance too much. Cymbalta also lowered my blood pressure too much and caused nausea.

I tolerated the depakote fine for a couple of days until I had an anaphlactic-type allergic reaction.

Gabapentin made me completely drugged - even at small doses.

I’m tolerating a low dose of nadolol fine - it lowers my blood pressure, but my tachycardia got so severe that we had to try it.

Topamax gave me the cognitive side effects, but I tolerated it fine until I developed severe gastritis. I stopped and then re-started it to make sure that it was really the topamax that caused the stomach issues, but it definitely was.

I do have a complicated medical history and do seem to be very sensitive to some medications, but I feel like I give medications a fair shot.

Thanks for your reply!

Did you ever try an ssri?
What about benzos?
Can you look into lamictal?

I am on valium. I haven’t tried any SSRI’s - my doctors skipped straight to SSNRI’s, so that might be a good thing to ask them about - thanks!

I consult with Dr Hain in addition to working with my local doctors. Dr Hain was kind enough to answer an email this weekend about the Effexor tapering. He said that he has had several patients react to very small doses of Effexor and, when that has happened, they generally have not been able to get up to a therapeutic level. So, he suggested stopping the Effexor for now and switching to a new medication.

We’ll see…


Another thing abut migraine, besides what Kelly said in her post above, is that migraine dislikes ANY change…so by adding in something or taking away something or any change in routine, migraine symptoms will flair…So I would also chalk it up to the adding in of something. I have been on 75mg Effexor for 4 years as part of my daily preventative. Not one side effect, so hang in there, I know most docs think this is a good migraine preventative.


I recently tapered back down to 75 mg/day from 150 mg/day. The 150 mg was fine except that I didn’t think it helped at all. The tapering period was really hard even though I watched the clock and tried to gradually space the doses, so my brain wouldn’t notice. I barely made if without taking time off work (took every ounce of willpower to move). My neurologist doesn’t like the idea of opening the capsules. Maybe you don’t have the extended release capsules?

Anyway, have faith that things will even out.