Imipramine*

Vasospasm: first report Although imipramine-induced vasospastic phenomena have been reported in children, such events have not been previously described in adult patients. The medication of a 37-year-old woman with a history of major depression was changed from amitriptyline (50-150 mg/ day) to imipramine (150 mg/day). She received no other medications. Within 10 days she noticed marked improvement in her depression, but her hands and feet became cold and turned blue several rimes a day, each episode lasting from 5 min to several hours. She also complained of severe pain radiating up both arms. During these vasospastic episodes her radial pulse was found to diminish. Imipramine was changed to doxepin (150 mg/day). Unfortunately, depression returned and vasospasms continued to occur. Doxepin was stopped and imipramine (ISO mg/day) restarted. Once more there was dramatic relief from her depression but the vasospasm and pain worsened. Imipramine was therefore discontinued after 3 weeks and she was kept free of all medications except for the occasional use of fIurazepam for sleep. The pain and vasospastic episodes continued unabated 2 weeks after the discontinuation of imipramine. A subsequent thorough medical workup revealed no abnormality. Interestingly, the pain and vasospastic episodes continued to decrease in frequency and intensity over a 3-4 month period until they disappeared completely at the end of 4 months. In the face of recurrent depressive episodes, imipramine (75 mg/day) was started with the patient's consent. Five days after initiating therapy the patient reported 3 episodes of painless vasoconstriction each lasting 10 min. The episodes were characterised by cyanosis of the hands and feet. Imipramine was ~tupped immediately. and 4 weeks later, there were no vasospastic episodes. "'ppdbaum. P.S. and Kapoor. W. "'merican Journal of P,ych,.try 140: "7 {Jul 19831

0157·7271/83/0826-0005/0$01.00/0 OJ ADIS Press Reactions 26 Aug 1983 5