Venlafaxine dependence in a patient with a history of alcohol and amineptine misuse

Background: Venlafaxine is an inhibitor of neuronal serotonin and noradrenaline re-uptake and a weak inhibitor of dopamine re-uptake. There was no indication of problems of abuse/dependence during the clinical trials. Case description: A 53-year-old client with a history of alcohol and amineptine misuse and a long history of recurrent depression, for which he was prescribed venlafaxine tablets. Over time, he increased the dosage to 50 tablets daily (3750 mg). Large venlafaxine dosages produced amphetamine-like effects, due possibly to the related increase in dopamine turnover. Once hospitalized for detoxification, the patient had a symptomatology which was consistent with a serotonergic discontinuation syndrome. Conclusions: Physicians should be aware that patients with a history of drug and alcohol abuse might develop venlafaxine dependence.