Imipramine Mania on withdrawal

Increased energy and libido, rapid speech and inappropriate euphoria were noted in a 57-year-old man with a history of recurrent unipolar major depressive disorder for which he had received 12 years' treatment with imipramine 150 mg/day. The manic symptoms, which persisted untreated for 6.5 months, had developed 2 days after the patient completed an 11 month schedule for withdrawal of imipramine. The patient's mania, which resolved over a 2 week period, was followed 1 month later by a depressive episode. The man, who had not experienced a depressive episode (or mania) during the 12 years he was treated with imipramine, was prescribed amitriptyline 150 mg/day and lithium. He remained well over the next 9 months.

The authors concluded that ' ... one can presume that the phenomenon observed is related not only to the withdrawal from tricyclics but to the long-term administration as well'. Gupta R. Narang RL Ameflcan Journal of Psychiatry 143 260. Feb 1986

0157-7271/86/1026-{)007/0S01.00/0 © ADIS Press Reactions® 22 Mar 1986 7