Desipramine First report of testicular swelling with hypomania: 2 case reports *

Case 1.· A 45-year-old man with a major depressive disorder received desipramine 150 mg/day after several months ' unsuccessful treatment with amoxapine. Affective symptoms improved and the patient slept 7 hours/night. Two months later, he had painful testicular swelling, repeated involuntary ejaculations and was loquacious. Desipramine was discon tinued and the testicular swelling and pain remitted over several days withou t treatment. Pressured speech also resolved but his depressive symptoms recurred after several weeks. Within 1 day of rechallenge with desipramine , scrotal swelling and pain developed but disappeared on treatment withd rawal. Amitriptyline successfully treated the depressive symptoms with no adverse effects .

Case 2: On admission for complex depressive symptoms, a 59-year-old man with a history of bipolar affective disorder began treatment with desipramine 100 mg/day. After 10 days his depressive symptoms had improved and after 14 days pressured speech and intrusive, demanding behaviour was noted . Lithium carbonate 300 mg/day was begun for his hypomanic symptoms and after 2 days (16 days ' desipramine treatment) swollen and painful testicles were reported. On discontinuing desipramine, pain abated after 48 hours and swelling disappeared within 5 days. Amitriptyline treatment was begun, li thium was continued and the patient improved and was discharged with outpatient follow-up after 2 weeks.

Al though testicular swelling is recognised as an adverse reaction to desipramine by the manufacturer, no previous reports of this adverse effect in association with hypomania have been published . Thlenhaus OJ . Vogel N. Journal of Clinical Psychiatry 49· 33-34, Jan 1988

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