2026 ECNP Congress

EP01-1059

Venlafaxine in treatment-resistant adolescent depression: a case report

Andrea Carrillo — C. Terrón García, T. Gómez Escribano, T. Peironcely Arenas, E. García Domingo, I. Baltasar Tello · Hospital General Universitario Gregorio Marañon, Psiquiatría de la infancia y la adolescencia, Madrid, Spain

2026 ECNP Congress

CLINICAL CASE:A 15-year-old adolescent was admitted to our inpatient adolescent psychiatric unit due to depressive symptoms and self-injurious behavior. The patient presented a 6-month history of depressive symptomatology characterized by persistent low mood, anhedonia, progressive social withdrawal, reduced food intake, and functional impairment in academic and social domains. No psychotic symptoms, manic features, or other relevant clinical conditions were identified during the assessment. Treatment with fluoxetine had been initiated 6 months prior and titrated up to 20 mg/day, with no significant clinical response after 4 weeks of treatment, despite adequate adherence and tolerance. Due to lack of improvement, treatment was switched to venlafaxine up to 150 mg/day, combined with aripiprazole 5 mg/day, resulting in an initial favorable response, including partial improvement in mood and behavioral activation. During hospitalization, residual depressive symptoms persisted, particularly low mood and reduced motivation, leading to an increase in venlafaxine to 225 mg/day. This adjustment resulted in significant clinical improvement, with remission of core depressive symptoms, good tolerability, and no relevant adverse effects observed during follow-up period in the inpatient setting.

DISCUSSION

The pharmacological management of depression in children and adolescents remains a complex and evolving field, with ongoing debate regarding the balance between efficacy and safety. The National Institute for Health and Care Excellence (NICE) guidelines advise against the use of venlafaxine in this population due to an unfavorable risk–benefit profile, particularly concerning an increased risk of suicidal ideation and behavior [1]. In contrast, the American Academy of Child and Adolescent Psychiatry (AACAP) guidelines consider serotonin–norepinephrine reuptake inhibitors (SNRIs), including venlafaxine, as potential second-line options in treatment-resistant depression, particularly after insufficient response to selective serotonin reuptake inhibitors (SSRIs) and appropriate psychotherapeutic interventions [2]. A 2021 systematic review conducted by Cochrane evaluating new-generation antidepressants in children and adolescents found only modest differences in efficacy between medications. However, low-certainty evidence suggested a higher incidence of suicide-related outcomes associated with venlafaxine compared to placebo. At the same time, moderate-certainty evidence indicated that venlafaxine may offer some advantages over other agents, such as desvenlafaxine and escitalopram, in certain clinical contexts [3].

CONCLUSIONS

Venlafaxine may be considered a therapeutic option in adolescents with treatment-resistant depression after failure of multiple SSRIs and adequate psychotherapeutic interventions. However, its use should be approached with caution, requiring careful risk–benefit assessment, close clinical monitoring, and ongoing evaluation of suicidal ideation, given the potential increased risk in this population. These findings highlight the need for individualized treatment decisions, particularly in cases of treatment-resistant depression, where therapeutic options are limited and clinical response may justify cautious deviation from first-line recommendations. This is especially relevant in child and adolescent populations, where there is comparatively less evidence available in the literature and clinical guidelines are less clear and consistent than in adults, requiring increased clinical vigilance and multidisciplinary decision-making in complex cases.

References

  1. National Institute for Health and Care Excellence. Depression in children and young people: identification and management (NG134). 2019 (updated 2024).
  2. American Academy of Child and Adolescent Psychiatry. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Major and Persistent Depressive Disorders. J Am Acad Child Adolesc Psychiatry. 2022.
  3. Cochrane. Hetrick SE, et al. New generation antidepressants for depression in children and adolescents. Cochrane Database Syst Rev. 2021; CD013674. https://doi.org/10.1002/14651858.CD013674.pub2