Hi Fuzzy. I don't think Effexor is considered a "last resort" med. I took it for about 5-6 years and now I take Cymbalta, which is in the same drug class (SNRI).

What I don't like about the SNRI class of antidepressants is that they cause physical dependence and are very difficult to taper off of if you want to stop them and you have to be very careful not to let your prescription run out. (I think it usually takes a few months before this dependence occurs.)

On the other hand, they often help people who don't get help from SSRIs.

If you have tried all the SSRIs, Wellbutrin, & Remeron and haven't been helped by those, then taking Effexor is very reasonable.

Pristiq is another SNRI medication. It's basically the newer, "cleaner" version of Effexor, but it's not available in a generic yet, so it's not as widely used.

I haven't looked at the side effects list for Cymbalta lately. I don't think I take any meds that don't have terrifying possible side effects.

The one that I take for my autoimmune arthritis says that it "may cause your heart to stop".

I'm not sure if that means skip a few beats or what exactly. That side effect got added to the list after I had been taking the med for a couple of years.

I think it does boil down to side effects vs. benefits. I took Effexor for a short while a couple of years back. I had to switch to something else because it made me too sleepy to function.

Definitely not a last resort. Most people don't have side effects, and of the ones that do most are mild and go away within a few weeks. For me it was night sweats and sexual dysfunciton. The sweats went away in 2 weeks, the other took some months. My pdoc said nausea was the most common.

Keep in mind that with ALL antidepressants, a "high" incidence of side-effects is 10%. It seems higher if you're reading people's personal stories because no one goes on line to write about how they didn't have side-effects.