Venlafaxine Is of Variable Effectiveness in Severe Major Depression, Depending on Patient Treatment Response Expectation.

OBJECTIVE

The importance of contextual factors, such as the patient treatment response expectation for the effectiveness of antidepressants (AD), in the treatment of major depressive disorder (MDD) is still underestimated.

METHODS

This is a report on the surprising course of treatment of a 47-year-old woman suffering from severe melancholic MDD with pronounced somatic symptoms.

RESULTS

The first attempt at treatment with venlafaxine (300 mg/d) failed. During this treatment, the patient was not yet convinced of the effectiveness of an AD for her illness. She did not believe that she had MDD at all. In a second pharmacological treatment period, venlafaxine (150 mg/d) worked excellently. In a special psychoeducative run-up to this second treatment, the patient was able to gain a deeper understanding that she was indeed suffering from MDD. Now she could consider the possibility that AD might be helpful against her severe complaints ("experienced insight").

CONCLUSION

The role of treatment response expectation should be given greater consideration in the event of nonresponse to medication.