Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 856903, 4 pages doi:10.1155/2011/856903 Case Report Combined Venlafaxine and Olanzapine Prescription in Women with Psychotic Major Depression: A Case Series Lucio Ghio, Werner Natta, Paola Rossi, Laura Peruzzo, Elisa Zanelli, Simona Gotelli, and Filippo Gabrielli Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, 16100 Genova, Italy Correspondence should be addressed to Lucio Ghio, lu.ghio@libero.it Received 2 August 2010; Accepted 9 February 2011 Academic Editor: Hitoshi Okamura Copyright © 2011 Lucio Ghio et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Patients with psychotic major depression suﬀer prolonged duration and greater severity of illness, including an increased likelihood of recurrent episodes and resistance to conventional pharmacotherapies. They do not respond to placebo and respond poorly to antidepressant or antipsychotic monotherapy. On the other hand, as has been demonstrated, they do respond well to antidepressant and antipsychotic combination therapies. Diﬀerent combinations of drugs were studied, but little is known up to now with regard to the combination of venlafaxine and olanzapine. The following paper presents three separate case studies of female patients suﬀering from psychotic unipolar major depression, all of whom were admitted to a psychiatric ward and successfully treated with a combination of venlafaxine and olanzapine. 1. Introduction Psychotic major depression aﬀects approximately 20% of patients hospitalised for major depressive disorder [1, 2] and although it is predominantly higher in elderly patients it has also been known to aﬀect young people [3]. Patients with psychotic major depression suﬀer pro- longed duration and greater severity of illness [2, 4], as has been conﬁrmed by their higher total scores on the Hamilton Rating Scale for Depression (HAM-D), and in particular their depressive symptoms scores [5]. They have a shorter symptom-free interval, an increased likelihood of recurrent episodes, are at a higher risk of suicide, and show resistance to conventional pharmacotherapies [2]. Compared with nonpsychotic major depression, patients with psychotic major depression do not respond to placebo and respond poorly to antidepressants or antipsychotics alone. On the other hand, as has been demonstrated, they do respond well to the combination of antidepressants and antipsychotics [6]. This combination is, at the moment, the strongest rec- ommendation regarding psychotic major depression patients by the American Psychiatric Association Practice Guidelines [7]. Early studies of the eﬀectiveness of this combination of antidepressants and antipsychotics were related to the combination of tricyclic antidepressants and conventional antipsychotics. Despite the positive results obtained, the use of these molecules has been reduced due to an undesirable high rate of adverse eﬀects [8, 9]. Recent data suggests that the combination of SSRI anti- depressants and atypical antipsychotics could prove as eﬀec- tive as the combination of tricyclic antidepressants and con- ventional neuroleptics [2, 6, 10]. Among atypical antipsychotic drugs olanzapine is the most studied in cases of major depression with psychotic symptoms. Results show eﬃcacy in such cases, suggesting that olanzapine may have antidepressant properties [11–13]. With regard to new generation antidepressants, the majority of studies undertaken have focused on SSRIs, particularly ﬂuoxetine [2]. We are not aware of any current study which has pre- viously considered the combination of olanzapine and ven- lafaxine where psychotic depression is concerned.