Imipramine

Anorgasmia A 48-year-old woman with a 7-year history of psychiatric illness showed improvement of her symptoms (anxiety and depression, low energy and sex drive) on desipramine 125 mg/day (blood level 136 ng/m!). The patient viewed sex as a positive experience, and found her sex drive greatly improved on this regimen even compared with predepression times (the woman was anorgasmic while her depression was untreated). In an attempt to further improve her depressive symptoms desipramine was increased to 250 mg/day. All symptoms except interval insomnia remitted but orthostatic hypotension and sedation developed. The blood level of desipramine at this time measured 294 nglml. Decreasing her desipramine dosage to 200 mg/day eliminated these side effects and maintained therapeutic response. Imipramine 200mg was substituted for desipramine in an attempt to eliminate the persistent interval insomnia. After 17 days on imipramine alone (total tricylic blood level 398 ng/ml) she reported anotgasmia, despite normal sexual arousal. Decreasing the imipramine dose to 150 mg/day did not eliminate this side effect. Six days after desipramine was substituted for imipramine, the patient resumed her normal pattern of orgasm. She continued to be orgasmic and <,ulhymic during a 7-month course of desipramine. Imipramine-induced anorgasmia may be due to its action of blocking the eNS neuronal reuptake of seronlinin. This action is absent with desipramine. S",ne<. R.: Journal ofC"Jinic.J Psyrhjalry 44: 345 (Sep IQXll

6 Reactions 4 Nov 1983 0157-7271/83/1104-0006/0$01.00/0 ." ADIS Press