Clomipramine

Inhibition of orgasm Three patients, a 34-year-old male and 2 females aged 24 and 30 years, suffered inhibition of orgasm while taking clomipramine fOf severe depression. The first patient took clomipramine (50mg at bedtime) initially, later reduced to 25mg at bedtime, due to hypotensive side effects. Subsequently the dose was gradually increased to 73mg at bedtime. At this time, although his libido had improved he was having difficulty achieving orgasm. As depression persisted the dose of clomipramine was altered once more to 25mg in the morning plus 75mg at bedtime. This resulted in dramatic clinical improvement. One month later, however, the patient was unable to ejaculate, but had no difficulty achieving an erection. Clomipramine was reduced to 50 mg/day and the patient was started on lithium 600 mg/day initially later increased to 1200 mg/day. Sexual function returned partially. However, with withdrawal of clomipramine, full sexual function was restored. Subsequent treatment with desipramine (50mg initially later increased to 150mg) caused no sexual dysfunction. The second patient (whose T4 was subnormal) was started on lithium carbonate 600 mg/day, thoridazine 25mg and clomipramine 75mg at bedtime, as well as sodium L-thyroxine 0.1 mg/day. About I month later she began to sutTer from galactorrhoea and inability to achieve orgasm. Thoridazine was withdrawI1 and lithium carbonate increased to 900 mg/day. L-thyroxine was also withdrawn due to complaints of poor sleep, lack of energy and headache. About 3 months later, of her own accord, the patient stopped taking clomipramine and normal sexual function returned, but when the drug had to be restarted due to return of depression, she was once again unable to achieve orgasm. When desipramine (25mg tid), was substituted for clomipramine, an increase in libido was noted. The third patient experienced difficulty achieving orgasm within 1 month of starting clomipramine 50mg at bedtime. As depression persisted, the dose was raised to 100mg at bedtime, and the patient was told of the probable relationship between the drug and sexual dysfunction. By taking the daily dose in the evening, after sexual activity she was able to minimise the drug's etTect on sexual performance ..... the cholinergic h/ocking {Jropertv of clomipramine may hare been at least partially responsible for tlie inhibit/oil of orgasm by blockade 0/ sacral neuronal pathways .. VUlrk, K.(, and hnar",oll. T.R: Canadian Journal 01 P!t~Chjalr) .:!7: 22~ (.1.pr 1982)

4 Reactions 17 Sep 1982 0157·7271/82/0917~OOO4/0$O1.00/0 © ADISPress