Positives

• Patients with co-occurring Long COVID and POTS sometimes choose venlafaxine for both depression and orthostatic symptoms, since some report it modestly stabilizes their blood pressure on standing in addition to lifting mood The Journal of Clinical Psychiatry.

Negatives

• A Long COVID patient on Mayo Clinic Connect described being prescribed several antidepressants over the course of a year for Long COVID symptoms and not tolerating any of them, with concerns about ear-related side effects driving discontinuation Mayo Clinic Connect.
  
  
• Venlafaxine has a notoriously difficult discontinuation syndrome: the same patient reported significant dizziness, brain zaps, and irritability during taper, which were prolonged compared with other antidepressants PubMed.
  
  

Hurdles & Side Effects

• Among 491 Effexor reviews on Drugs.com, brain zaps come up in 36 of them and patients describe “horrible nausea, brain zaps, and shakiness” any time they miss a dose because the parent drug has a five-hour half-life, the shortest of any SNRI Drugs.com.
• The FDA label warns the taper may need to play out “over a period of several months,” and patients using a 2023 hyperbolic-tapering protocol still report only about a 70 percent success rate even with that slow approach; some Long COVID/POTS patients on the Drugs.com Effexor XR withdrawal page report protracted discontinuation symptoms lasting up to a year Drugs.com.