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.