A patient who has been taking venlafaxine (Effexor) for major depressive disorder with melancholic features says that suddenly he can't sleep and spends hours writing to his congressman with his ideas of how to reduce the national debt. The psychiatric advanced practice nurse considers all of the following but selects which one as the most likely explanation for the change in his clinical presentation:

Question

Quizplus · Accepted Answer

The sudden onset of insomnia and increased energy with grandiose ideas can indicate the emergence of symptoms of hypomania, which can be a potential side effect of antidepressant therapy. Nonadherence with medication, emergence of symptoms of a personality disorder, or increasing severity of depression may also be considered but are less likely to explain this sudden change in presentation.

A Patient Who Has Been Taking Venlafaxine (Effexor) for Major