Psychotic Symptoms Possibly Associated with an Increase in the Dose of Venlafaxine: A Report of a Rare Case
DOI:
https://doi.org/10.51338/rppsm.718Keywords:
Antidepressive Agents, Second‑Generation/adverse effects, Delusions/chemically induced, Hallucinations/ chemically induced, Psychotic Disorders Selective/chemically induced, Serotonin Reuptake Inhibitors/adverse effects, Venlafaxine Hydrochloride/adverse effectsAbstract
Venlafaxine, a serotonin–noradrenaline reuptake inhibitor (SNRI), predominantly inhibits serotonin reuptake at lower doses, while noradrenergic effects become more prominent at higher doses. At higher doses, a modest dopaminergic effect has also been described, particularly in the prefrontal cortex. Although generally well tolerated, venlafaxine has been associated with rare neuropsychiatric adverse effects, including psychotic symptoms.
We report the case of a 55-year-old woman with recurrent depressive disorder who developed auditory verbal hallucinations with commenting and imperative content following an increase in venlafaxine dose from 150 mg/day to 225 mg/day. Symptoms remitted following dose reduction of venlafaxine to 150 mg/day and short-term antipsychotic treatment. After seven months of follow-up, she remained free of psychotic symptoms.
The close temporal relationship between venlafaxine dose escalation and the onset of psychotic symptoms, together with their resolution following dose reduction and the absence of recurrence during follow-up, suggests a possible association between venlafaxine and the observed psychotic symptoms. However, the concomitant use of antipsychotic medication limits definitive attribution of causality.
This case highlights the importance of monitoring for perceptual disturbances and other psychotic symptoms following venlafaxine dose increases, even in patients without a previous history of psychosis.
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