2 The existing case reports regarding the aforementioned combination are, to our knowledge, speciﬁcally aimed at the treatment of treatment-resistant depression [13, 14]. It has been suggested that randomised double-blind trials are “almost impossible” when evaluating treatment for psychotic major depression due to diﬃculty in obtaining informed consent [4]. Such trials are no longer ethically justiﬁed due to a patient’s high risk of suicide; therefore, studying the eﬀects of combining new drugs in single patients may prove useful. As a result we have chosen to present three case reports involving patients suﬀering from psychotic unipolar major depression, all of whom were admitted into a women’s psychiatric ward and all of whom were successfully treated with a combination of venlafaxine and olanzapine. Case A. Mrs. A is 65 years old, suﬀering recurrent major depression, which began 10 years ago following her retire- ment, and which has since led to repeated hospitalisations in a psychiatric clinic as a result of severe depressive episodes with melancholic psychotic symptoms. The patient has followed diﬀerent psychopharmacolog- ical treatments, with the prescription of SSRIs and typical neuroleptics, which, over time, have resulted in an onset of extrapiramidal iatrogenic symptoms, at present unresolved. The current hospitalisation was determined by a depres- sive episode which was characterised by depressed mood, psychomotor retardation, complete loss of autonomy, and recurrent thoughts of suicide. Delusions including perse- cution and inappropriate guilt were also present as well as auditory and visual hallucinations. At admission, the patient had a HAM-D score of 30 and presented cognitive impairment and slowdown. An MMSE was administrated, with a score of 29. Routine blood tests, including thyroid tests, did not show any relevant change and the patient’s ECG was normal. The patient was aﬀected by essential hypertension which was being controlled with tiazidic diuretics. Results from a cerebral TC scan were negative. During the initial phase of the patient’s two-month treatment, she received a daily dose of diazepam (8 mg), clomipramine (maximum dose of 250 mg) and haloperidol (6 mg). There was no positive response shown to this initial phase of treatment, rather the patient worsened to a complete psychomotor arrest which in turn led to enteral nutrition and urinary catheterisation. After one-month a new daily treatment was, there- fore, administered, this consisted of intravenous lorazepam (8 mg), and venlafaxine (150 mg) in association with olanza- pine (10 mg). After 10 days the patient had begun to show her ﬁrst signs of a progressive improvement, returning to feed herself and carrying out bodily functions independently. After four weeks of the patient’s second phase of trea- tment her HAM-D scale score went down to 7 and the patient was discharged. The combination of venlafaxine and olanzapine (which was maintained following the patient’s discharge) was well tolerated, with the exception of nausea during the ﬁrst three Case Reports in Medicine days of treatment which spontaneously disappeared. No changes in the patient’s blood pressure were noted. The patient was discharged from this particular period of hospitalisation two years ago. Since that discharge she has had only one other brief admission on account of a voluntary suspension of therapy. She continues to maintain a satisfactory clinical balance at follow-up assessments. Case B. Mrs. B is a 72 years old, admitted for the ﬁrst time in her life at a psychiatric division. The patient’s symptoms included depressed mood, insomnia, anhedonia, fatigue, decreased appetite (with weight loss) and heightened obses- sive traits. The most troubling symptom for the patient was the occurrence of simple auditory hallucinations, such as unde- ﬁned, though alarming, noises. Delusional ideas of ruin and feelings of helplessness were also present. The initial diﬀerential diagnosis at the clinical exam had to take into account the possibility of an onset of dementia, despite the absence of memory or orientation disorders, as the patient had no prior history of mood disorders. However, the results of a cerebral TC scan (with contrast enhancement) showed no sign of cerebral atrophy nor any signiﬁcant vascular lesions. The patient’s MMSE and HAM- D scores were reported as 25 and 20, respectively. The HAM-D showed the highest scores for items such as weight loss, anxiety/somatisation, motor retardation and sleep disturbances. Routine blood tests were within range, including thyroid function. The diagnosis was a severe depressive episode with mood-congruent psychotic features. We decided to administer a daily treatment of venlafaxine (150 mg) and olanzapine (5 mg). We also chose to include a daily dose of mirtazapine (15 mg) in order to improve the patient’s loss of appetite, and delorazepam (0.5 mg) to treat her insomnia. Within the ﬁrst days of hospitalisation the patient’s psy- chotic symptoms had disappeared alongside her insomnia. The patient’s mood showed some improvement following the second week of treatment, allowing for the patient’s discharge after only 16 days. One month after discharge the patient’s follow-up assessment showed a HAM-D score of 10. This included a 50% decrease in all areas with the exception of anxi- ety/somatisation for which there was a minimal decrease. The patient’s MMSE score was 28. Case C. Mrs. C is a 59 years old, who has had several admis- sions to hospital for recurrent major depression disorder. After a long period of hospitalisation in a diﬀerent psychiatric division, the patient was discharged with medical therapy consisting of high doses of sertraline (300 mg per day), alprazolam (2 mg per day), trazodone (75 mg per day) and ﬂurazepam (30 mg per day). After only seven days the patient was again admitted to hospital for attempted suicide (lacerated veins) this time to our psychiatric clinic. The motivation for the suicide attempt was a reported worsening of mood, as well as delusions of poisoning and auditory