Venlafaxine-induced complex visual hallucinations in a 17-year-old boy.

Sir: Emslie et al. recently reported results of 2 controlled studies of venlafaxine in children and adolescents. In one study, 2 of 169 subjects experienced hallucinations as an adverse event. In the other study, 1 of 86 patients experienced hallucinations. The nature of these hallucinations was not specified in either article. The adult literature describes antidepressants with serotonin reuptake–inhibiting properties that are known to cause visual hallucinations. Complex visual hallucinations can be defined as “organized and clear images of animate items, objects, and scenes over which the subject has little control.” In adults, these hallucinations are most often associated with withdrawal of serotonin reuptake inhibitors or with serotonin syndrome. However, there are descriptions in adults of drug-induced complex visual hallucinations as a result of serotonin reuptake inhibitors. To date, only 1 case report exists of a patient with venlafaxine-induced visual hallucinations not due to a serotonin syndrome or a withdrawal reaction; the patient in that report had a posterior cerebral artery infarction. The following case report describes a depressed and anxious adolescent patient on venlafaxine immediate release (IR) treatment who developed complex visual hallucinations.