One of my favorite things to share as a psych NP is a good prescribing tip. Most prescribing content out there tends to be either too basic, pulled straight from textbooks, or not particularly useful for real-world clinical practice. That’s why I’m excited to pass along this venlafaxine dosing tip—a clinical pearl I learned early on in my career that I still use today.
Venlafaxine (Effexor) is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI), but what’s lesser-known is how its effect on neurotransmitters changes depending on the dosage. These dose-dependent effects have been well-described in psychopharmacology literature—for example, Schatzberg’s 2018 review highlights how venlafaxine’s influence shifts from serotonin to norepinephrine and even dopamine as doses increase.
How Venlafaxine Works at Each Dose
This medication has dose-dependent effects that make it unique among antidepressants. Here’s a breakdown:
- At 75mg/day:
It mainly acts on serotonin, helping increase serotonin levels in the brain. This makes it helpful for anxiety and mild to moderate depression. - At 150mg/day:
It begins to inhibit both serotonin and norepinephrine reuptake. This combination can offer stronger relief for fatigue or more severe depressive symptoms. - At 225mg/day and above:
It also inhibits dopamine reuptake—at least partially—helping boost motivation, pleasure, and energy in patients with symptoms like anhedonia.
This venlafaxine dosing tip can help guide individualized treatment decisions for patients struggling with mood and anxiety disorders.
Why This Matters in Practice
Understanding how venlafaxine behaves at different doses gives you more precision when prescribing.
- At lower doses, it’s an excellent serotonin-targeted option for anxiety or depression.
- At moderate doses, adding norepinephrine helps with energy and physical fatigue.
- At higher doses, the added dopamine effect can be beneficial for motivation or treatment-resistant symptoms.
These nuanced effects also explain why some patients respond differently to the same medication depending on the dose. Having this knowledge can help you better manage side effects, anticipate responses, and fine-tune your treatment plans.
👀 For visual learners, check out this illustration on Instagram.
More Resources for Clinical Growth
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