The following post is an amalgamation of research and draws from a variety of sources. Clinical resources are subject to regular updates as scientific understanding improves. This post is for informational purposes, but it is not a peer-reviewed, controlled clinical document and should NOT be taken as medical information nor clinical guidelines. Instead, it is provided for informational purposes and should serve as a useful prompt to do your own research, review appropriate clinical sources and seek qualified medical advice when making your own decisions.

 

When opening your capsules, it is worth exercising caution. Pharmaceutical manufacturers, when asked in the past, have stated that they guarantee a dosage based on the whole capsule, not individual beads, this is why bead averaging is applied in the methods discussed below. Of course, any altering of doses done by a patient is at their own risk and is not being done by a licensed, controlled pharmacy or drug manufacturer.

 

However, some authoritative psychiatric bodies are starting to recommend bead-counting as a tapering method, such as the RCPsych: Stopping antidepressants  (under "other forms of tapering" as of April 2026).

 

Tapering Capsules That Contain Beads

Some antidepressants, such as Effexor/Venlafaxine and Cymbalta/Duloxetine,  come in capsules that are filled with tiny beads. When tapering one of these drugs, a different approach to normal is needed.  Some of these drugs are specially coated to gradually release the drug into the blood stream. Therefore, they should not be crushed or dissolved in water.

 

How to Do It - Counting Beads

First, twist and open the capsule, pour out the beads and note whether the beads are of uniform size or differing sizes.

If the beads are of uniform size, open 4 capsules, count the total number of beads and divide that number by 4. This number will be your average number of beads per capsule.

 

You will use this number moving forward to calculate your taper and dose drops.

 

For example:

37.5mg Effexor XR Capsule

Capsule 1 – 128 Beads

Capsule 2 – 129 Beads

Capsule 3 – 143 Beads

Capsule 4 – 135 Beads

Total number of beads – 535 Beads

 

Next divide the number of beads by the number of capsules counted:

535/4=134 Beads (rounded) average per capsule.

 

Now divide the mgai of your capsule by the average number of beads:

37.5mgai/134=0.2799mgai* per bead. 

 

Then Calculate the dose of your next drop:

37.5mgai x 0.9= 33.75mgai (10% reduction, this is just an example, 10% is often too much for people, particularly at lower doses).

 

To calculate the number of beads required for this drop, divide the new dose by the amount of ai in one bead: 33.75mgai/0.2799mgai=121 Beads (rounded).

Place beads back into the original capsule or buy capsules for this purpose.

It is best to discard any beads which are unusually big or small to help with accuracy.

 

*mgai stands for mg of active ingredient.

 

If the beads are of differing sizes?

If the beads are of differing sizes, divide the beads according to sizes and count how many beads there are of each size per capsule. Do this for 4 capsules. 

 

You can either sort each capsule by hand using a ruler/tweezers or similar tools into the four sizes and count them, or you can buy lab-grade sieves to make this process faster and possibly more accurate.

 

For example:

With brand name Effexor XR (Venlafaxine), each capsule contains beads of one of 4 sizes. Each size actually has an increasing amount of coating on it which gives the drug its extended-release properties

 

37.5mg Effexor XR Capsule (The numbers shown here are for example only, amount of beads per capsule can vary greatly)

Capsule 1 – 128 Beads (4 XSmall, 18 Small, 63 Medium, 43 Large)

Capsule 2 – 129 Beads (6 XSmall, 16 Small, 85 Medium, 22 Large)

Capsule 3 – 143 Beads (8 XSmall, 34 Small, 84 Medium, 17 Large)

Capsule 4 – 135 Beads (5 Ex Small, 30 Small, 82 Medium, 18 Large)

Total number of beads – 535 Beads (23 XSmall, 98 Small, 314 Medium, 100 Large)

 

Ratio of beads

23 XSmall

98 Small

314 Medium

100 Large

 

To calculate the dose using the same ratio of beads as the original average capsule, simply take each bead size total, multiply it by the required % reduction, then divide it by the number of capsules counted: 

 

New Reduced Ratio

XSmall 23 x 0.9/4=5.175 (-10% reduction)

Small: 98 x 0.9/4=22.05 (-10% reduction)

Medium: 314 x 0.9/4=70.86 (-10% reduction)

Large: 100 x 0.9/4=22.5 (-10% reduction)

120.585 beads (121 beads rounded)

(10% reduction above, this is just an example, 10% is often too much for people, particularly at lower doses).

 

Now each time you make up your dose you simply need to make sure it contains that ratio of beads each time to ensure the amount of bead sizes in each dose is in line with the original capsule ratio.

 

How to make further reductions keeping the size ratio correct?

You simply take the new reduced ratio from your first reduction (see above) and apply the desired % reduction to each size to get the new updated ratio for your next drop.

 

New updated ratio

XSmall: 5.175 x 0.9 =4.658  (-10% reduction)

Small: 22.05 x 0.9 =19.845 (-10% reduction)

Medium: 70.86 x 0.9 =63.774 (-10% reduction)

Large: 22.5 x 0.9 =20.25 (-10% reduction)

108.527 beads (109 beads rounded)

(10% reduction above, this is just an example, 10% is often too much for people, particularly at lower doses).

 

Repeat this step each time you make a further reduction.

 

Weighing the dose

It is also recommended you weigh each dose to check it is consistent with the previous, making slight adjustments if needed by taking one of the beads out at a time and replacing it with a different one from the same size of beads you have stored, until the doses are uniform in weight. For those with particularly sensitive nervous system, and certainly those on the lower doses, this has been seen as a critical step.

Weighing only technique (Same size beads capsules only)

If you are stable, and on a higher dose of a drug, that all the beads are the same size, you may wish to weigh your dose only, to save having to count so many beads on a daily basis.

To do this, weigh all the beads from 4 capsules, divide that by 4, and you have the average weight of the beads from one capsule.

You can then remove your desired % from that weight inline with our Tapering Information

Getting to Zero

When tapering a drug with beads of differnt sizes, the lower you go the more difficult it is to keep the ratio of beads consistent, the smaller the number of beads you get in each group, the less coverage you have for that part of the day. When you drop below 4 you will start to have 0 coverage in certain areas, many drop from 3 to 0 and some try to drop 3-2-1-0 with holds in between.

As with the end of all bead tapers, same sized or not, it is not unusual to need longer holds on the final few beads, due to the proportionally high drops in dose each beads reduction gives. Listen to your body, it knows best.

It is possible to dissolve Effexor XR into water to make up a liquid solution, this then becomes IR, so you would need to dose yourself with it 2 times a day and continue to reduce the rest of the way in liquid form to zero. It is important to crush the beads first before adding them to the liquid.

 

Cross Over

If switching to immediate release (available for venlafaxine) or changing manufacturers, remember the number of beads in each capsule actually varies from brand to brand, drug to drug, batch to batch and even dose to dose. When tapering it is important to not change brand or capsule size mid taper. If you do have to do this, you should hold your taper and perform the cross over procedure shown below. Follow the steps above to get the correct average for a new size capsule or manufacturer.

 

Then use this schedule to cross over:

- For 4-7 days, ¼ of your dose of the new dose/ ¾ of your old dose.

- For 4-7 days, ½ of your dose of the new dose/ ½ of your old dose.

- For 4-7 days, ¾ of your dose of the new dose/ ¼ of your old dose.

- Full dose in the the new format.

A BIG thankyou to @FindRest for inspiring this post, with all her knowledge, gained through years of trial and error and lived experience, as well as advising on the edit behind the scenes. And of course @LostinCanada you are amazing, and thank you too, for your support in producing this, and many other posts on here! You are both amazing!😀