Reactions 572 - 14 Oct 1995

SClomipramine

Suicidality following serotonin syndrome: casereport

A 17-year-old girl developed extreme suicidality after shewas treated with clomipramine for depression.

The girl had developed serotonin syndrome while she hadbeen treated with lithium, phenelzine and dothiepin; thesyndrome resolved within 2 weeks of stopping these agents.However, severe depression returned and 6 weeks after theserotonin syndrome, clomipramine 25 mg/day, increasing to50 mg/day, was started. After 7 days’ treatment withclomipramine, she developed suicidality, to the extent that sherequired continuous physical restraint by nursing staff.

The patient’s suicidality persisted for 6 weeks. At this time,clomipramine was discontinued and she made a full recoveryafter she was treated with a course of electroconvulsivetherapy.

Author comment: ‘This case suggests that, followingserotonin syndrome, increased sensitivity to even cautiousreinstatement of a drug with serotonergic properties(clomipramine), may occur. Although the serotonin syndromeis rare, careful study of patients in the aftermath of TSS [toxicserotonin syndrome] is indicated.’Serfaty MA, et al. Extreme suicidality following serotonin syndrome. BritishJournal of Psychiatry 167: 410, Sep 1995 - England 800391722

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Reactions 14 Oct 1995 No. 5720114-9954/10/0572-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved