Clomipramine Nocturnal cataclysms and *~ myoclonus: first report

A major depressive episode in a .+9 year-old woman with a history of dysthymic disorder was treated unsuccessfully with desipramine, phenelzine lithium, Isocarboxacld, alprazolam. ECT and protriptyline, however. the patient responded qUickly to clomipramine 125 mgjday.

After Increasing the clomipramine dose to 200 mgjday, the patient started waking 8-10 times a night from fright followed by anxiety and sometimes by insomnia. These episodes were more frequent when clomipramine was taken Just before bedtime and disappeared when treatment was stopped

All medications were stopped except lithium 600 mgjday. A sleep laboratory EEG revealed myoclonus and the patient experienced frequent movements at night and frequent daytime tWitches. Clonazepam 0.5mg at night stopped the nocturnal experiences promptly but they returned when treatment was stopped In error. The patient resumed clomipramine and clonazepam 1.5 mgj day was given to control the depreSSion and sleep disturbances Myoclonus decreased but perSisted

'The clear relationship to the dose and timing of clomipramine administration makes it fairly certain that the clomipramine was the source of the disorder,' Nocturnal catacylsms have " , , not been reported with any other antidepressant drug',

Myers BA. Klerman GL. Hartmann E American Journal of Psychialry 143 1490·t491 Nov 1986

0157·7271/87/0919-0005/0$0100/0 © ADIS Press REACTIONS· 19 September 1987 5