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Tijdschrift voor Psychiatrie 48 (2006) 5, 405 - 408

Case report

Unipolar depression suddenly switches to hypomania in a patient who has just started taking venlafaxine. A case study

D.G.H. Krol, W.A. Nolen

A woman with a recurrent episode of a depression that hitherto had been unipolar developed a hypomania the day after her treatment with paroxetine 20 mg/day was switched to venlafaxine 75 mg/day. The hypomanic symptoms subsided gradually as the dosage was reduced and the patient thereafter remained in a euthymic state while on venlafaxine at a dose of 18.75 mg/day. Three possible explanations are discussed for the patient's response: there was a pharmacokinetic interaction between paroxetine and venlafaxine, the patient had an idiosyncratic reaction to venlafaxine or venlafaxine inhibited the re-uptake of norepinephrin.

keywords depression, hypomania, paroxetine, venlafaxine