Symptoms of delusion: the effects of discontinuation of low‐dose venlafaxine

M Koga,H Miyata,F Kodaka,K Nakayama

doi:10.1111/j.1600-0447.2009.01433.x

M Koga, H Miyata + Show 2 more

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https://doi.org/10.1111/j.1600-0447.2009.01433.x

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Abstract

Objective:We report a patient who experienced delusional symptoms during gradual discontinuation of low-dose venlafaxine and required antipsychotic treatment.Method: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.Conclusion: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.

Highlights

Venlafaxine, a serotonin-norepinephrine reuptake inhibitor, is known to carry a risk of discontinuation syndrome due to its relatively short half-life
The patient exhibited prolonged delusional symptoms and fear of death as well as palpitations and nausea after discontinuation of venlafaxine. Her condition was diagnosed as venlafaxine discontinuation syndrome because she experienced psychotic symptoms and physical symptoms [5]
She experienced these symptoms during gradual discontinuation of an extremely low dosage of venlafaxine combined with clomipramine, and they required long-term antipsychotic treatment

Summary

Objective

We report a patient who experienced delusional symptoms during gradual discontinuation of low-dose venlafaxine and required antipsychotic treatment. 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 monthsÕ antipsychotic treatment. Conclusion: 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

Introduction

Discussion