title: High-dose venlafaxine treatment in a depressed patient with a genetic CYP2D6 deficiency.
abstract: A female patient (47 years) who suffered from a severe episode of a recurrent depression with psychotic symptoms (F33.3) firstly underwent several unsuccessful treatments. She was then submitted to a combined treatment with 2×300 mg/day extended-release venlafaxine (VEN) and lithium (0.7 mmol/l). She responded within 7 weeks and, after 9 weeks, she showed full remission. Moreover, she tolerated this medication well. Steady-state plasma concentrations of VEN and its metabolites and their enantiomers were measured. The concentrations of VEN and its metabolite O-demethyl-VEN (ODV) were 1024 and 234 ng/ml, respectively. The unusually high concentration of the parent compound in comparison to the metabolite is mainly explained by an impaired metabolism of R-VEN in this patient, who by genotyping was shown to have a genetic deficiency of CYP2D6. In conclusion, in patients suffering from non-response to an antidepressant treatment, an individualised treatment strategy should be developed, and stereoselective therapeutic drug monitoring and genotyping may be recommended.
authors.affiliation: Hauptstrasse, 83, CH-5734, Reinach, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Haller-Gloor
authors.forename: Chin B
authors.initials: CB
authors.lastname: Eap
authors.forename: Jacques
authors.initials: J
authors.lastname: Turgeon
authors.forename: Pierre
authors.initials: P
authors.lastname: Baumann
keywords: CYP2D6; depression; enantiomers; non-response, lithium; pharmacogenetics; plasma concentrations; venlafaxine