There is evidence that
panic disorder and major depression might share some common neurobiological factors. This would be consistent with the fact that most
antidepressant drugs are effective in preventing
panic attacks. This is a case report of a 40 year old woman who was suffering from a
panic disorder. Following the discontinuation of a long-term
lorazepam treatment, she developed severe depressive symptoms. The
depressive syndrome improved rapidly with
amitriptyline (150 mg/day), but the
panic attacks persisted. Twelve weeks later,
amitriptyline was replaced by
clomipramine (150 mg/day), the dosage of which was increased to 225 mg/day three weeks later. The patient remained anxious with no resolution of her
panic attacks. Two weeks later,
lithium carbonate (900 mg/day) was added to
clomipramine. Sixty hours later, a dramatic improvement was observed. The
lithium plasma level was 0.8 mEq/L. Because of some
tremors,
lithium was discontinued five days later. Within four days, the anxiety as well as the
panic attacks reappeared.
Lithium carbonate (600 mg/day) was then resumed. Forty-eight hours later, the patient was showing a clinical improvement similar to that observed following the first addition of
lithium. She remained symptom free with the maintenance of the
drug combination. To date, several reports have confirmed the beneficial effect of adding
lithium to a
tricyclic antidepressant drug in resistant major depression. However, we believe that the present case report is the first one documenting the augmentation of a
tricyclic antidepressant drug by
lithium in a patient suffering from a
panic disorder.