Status Cataplecticus Following Abrupt Withdrawal of Clomipramine

Ir Med J. 2019 Sep 12;112(8):991.

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.

Publication types

  • Case Reports

MeSH terms

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

Substances

  • Orexins
  • Serotonin Uptake Inhibitors
  • Clomipramine