Title: High Dose Venlafexine (Effexor) Use for Confirmed Peak Blood Level Tolerance, Journal of Neuropsychiatry and Clinical Neurosciences
Cook book dosing often fails. The dose that helps one person is 1/20th what another can tolerate. Others have livers that chew up a medication and make the FDA approved doses show up very low in blood level testing. People feel like they are taking water and have no benefit.
The bell curve applies here. Some individuals need less than the smallest manufactured amount of medication, and others need to go above the highest recommended range. We have found in some "impossible to treat patients" that merely getting a blood level of the medication -- usually done only by some research psychopharmacologists -- shows if you are a slow or super metabolizer.