A case of unexpected ecchymosis associated with a high dose of venlafaxine

Abstract

Selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs) are antidepressants that are widely used for many psychiatric conditions, including generalized anxiety disorder, depression, panic disorder, and obsessive compulsive disorders.1–3 Venlafaxine is an SNRI with a dual mechanism of action on both serotonin (5-HT) and (at higher doses) norepinephrine (NE) pumps.4,5 Furthermore, it acts as a dual 5-HT and NE reuptake inhibitor, especially at doses of 225 mg/d or more.6 The adverse effects of venlafaxine at 75 mg/d are similar to an SSRI (ie, vomiting, weight gain nausea, sleep and gastrointestinal disturbances, and sexual dysfunction). However, at higher doses, its effects are similar to those of an NE uptake inhibitor (ie, dry mouth, tachycardia, and hypertension).4,7