Reactions 571 - 7 Oct 1995

Imipramine

Musical hallucinations: case reportA 40-year-old man with no hearing loss or brain disease

reported hearing musical hallucinations during periods ofreduced external auditory stimuli after he was treated withimipramine for dysthymia.

The patient was initially treated with imipramine 75 mg/dayfor 18 months, this was then increased to 100 mg/day andlithium 800 mg/day was added. However, when his dysphoricmood persisted, lithium was discontinued and his imipraminedosage was increased to 150 mg/day. He was also givenlevomepromazine 10mg and flunitrazepam 2mg at night totreat insomnia.

Although the man’s symptoms improved, after 1 week’streatment with this regimen he experienced musicalhallucinations which occurred during periods of reducedexternal noise. He also noted a dry mouth and forgetfulness.His imipramine dosage was decreased to 100 mg/day and themusical hallucinations improved. However, the patientdeveloped psychomotor retardation, so his imipramine dosagewas again increased to 150 mg/day. After 2 days, heexperienced musical hallucinations. Six weeks later, hisimipramine dosage was decreased to 100 mg/day, and then to50 mg/day. His hallucinations disappeared. The dosages oflevopromazine and flunitrazepam remained unchanged.

Author comment: Musical hallucinations have beenassociated with other tricyclic antidepressants, such asamitriptyline, nortriptyline and clomipramine. It is speculatedthat in this patient, musical hallucinations may be related toanticholinergic adverse effects.’Terao T. Tricyclic-induced musical hallucinations and states of relative sensorydeprivation. Biological Psychiatry 38: 192-193, 1 Aug 1995 - Japan 800392210

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Reactions 7 Oct 1995 No. 5710114-9954/10/0571-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved