There are no obvious data to sustain that the association of venlafaxine and mirtazapine would produce for the resistant depression patients the conversion to a manic-like episode.

DSM-IV TR describes the manic-like episodes produced after the anti-depressive treatment.

The case occurrence is not strong, but the clinical implications are important.

Case Report: 63 years old patient, with repeated hospitalization for severe depression episodes from 2000; he never had manic episodes; the precedent episodes were treated with venlafaxine or mirtazapine (not in combination) producing partial remissions.

This case report brings additional information about venlafaxine and mirtazapine association in treating a depressive resistant episode. The patient has been hospitalized before and treated with two different clases of antidepressants without therapeutic response When admitted the patient had severe depressive episode with strong psychomotor retard .

The treatment with venlafaxine 300mg associated with mirtazapine 30 mg was initiated; the clinical evolution turned rapidly to a maniacal clinical appearance, after 20 days; there were no adverse reactions .

The antidepressant treatment discontinuation was necessary as it was also the beginning of the manic-like episode treatment.

For a MDD severe episode, treatment resistant, venlafaxine associated with mirtazapine had the power to induce a manic-like episode in a nonbipolar patient