Status Cataplecticus Following Abrupt Withdrawal of Clomipramine

Abstract

Presentation This is a case of a 31 year old gentleman who suffered an attack of status cataplecticus following abrupt withdrawal of clomipramine. Diagnosis Clomipramine was temporarily discontinued in order to confirm a suspected diagnosis of narcolepsy using Multiple Sleep Latency Testing. This precipitated an episode of status cataplecticus which resolved with re-introduction of therapy. A diagnosis of narcolepsy was later confirmed with undetectable levels of hypocretin/orexin in the CSF. Treatment Re-introduction of clomipramine led to resolution of status cataplecticus. The patient now remains stable with regards to his cataplexy on clomipramine 30mg. Discussion There have been a total of 4 case reports of status cataplecticus following withdrawal of antidepressant therapy. In all cases, reintroduction of anti-cataplectic therapy led to resolution of attacks. The abrupt discontinuation of an SSRI is believed to precipitate cataplexy attacks due to reduction in noradrenergic tone.

• Authors: S Fullam, A Scott, J F Garvey
• Journal: Irish medical journal (Ir Med J) Vol. 112 Issue 8 Pg. 991 (09 12 2019) ISSN: 0332-3102 [Print] Ireland
• PMID: 31650824 (Publication Type: Case Reports)

Chemical References

• Orexins
• Serotonin Uptake Inhibitors
• Clomipramine

Topics

• Adult
• Cataplexy (etiology, physiopathology)
• Clomipramine (adverse effects)
• Humans
• Male
• Narcolepsy (cerebrospinal fluid, diagnosis)
• Orexins (cerebrospinal fluid)
• Selective Serotonin Reuptake Inhibitors (adverse effects)
• Substance Withdrawal Syndrome (etiology, physiopathology)