Symptoms of delusion: the effects of discontinuation of low-dose venlafaxine.
OBJECTIVE
We report a patient who experienced delusional symptoms during gradual discontinuation of low-dose venlafaxine and required antipsychotic treatment.


METHODS
Case report.


RESULTS
A 31-year-old woman with major depression had been treated abroad with venlafaxine before returning to Japan. Since venlafaxine is unavailable here, we supplemented her regular venlafaxine dosage of 37.5 mg/day with clomipramine 20 mg/day. After 5 weeks we reduced venlafaxine to 18.75 mg/day and uptitrated clomipramine to 40 mg/day. Four days later she developed delusions of reference, palpitations and nausea. Clomipramine was increased to 60 mg/day, and her symptoms subsided. Eight weeks later her supply of venlafaxine ran out, and within 4 days her condition deteriorated into more severe symptoms that required 4 months' antipsychotic treatment.


CONCLUSIONS
We speculate that her symptoms were discontinuation syndrome, including psychotic symptoms and physical symptoms, caused by (i) venlafaxine-clomipramine interaction and/or (ii) the serotonin reuptake inhibitor-like effects of low-dose venlafaxine.
Koga
M
M
Department of Psychiatry, Machida Municipal Hospital, Tokyo, Japan. mi-na@pd5.so-net.ne.jp
Kodaka
F
F
Miyata
H
H
Nakayama
K
K
D000328:Adult; D002997:Clomipramine / Q000627:therapeutic use; D003511:Cyclohexanols / Q000008:administration & dosage / Q000009:adverse effects*; D003702:Delusions / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005260:Female; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000209:etiology*; D000069470:Venlafaxine Hydrochloride
D002997:Clomipramine; D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride