Flu-like illness after discontinuance of imipramine

Withdrawal symptoms following discontinuance of tricyclic antidepressants have been described by several authors (Anderson and Kristiansen 1959; Mann and MacPherson 1959; Kramer et al. 1961; Shatan 1966; Sathhananthan and Gerson 1973; Brown et al. 1978; Gualtieri and Staye 1979; Dilsaver and Feinberg 1982). These symptoms frequently occur within 24-48 hr after the cessation of therapy with these compounds. The common symptoms reported are general somatic malaise (muscle aches, coryza, excessive sweating), gastrointestinal (nausea, vomiting, diarrhea, and abdominal pain), and neuropsychiatric (drowsiness, apathy, irritability, agitation, and recurrence of depressed mood). Some studies (Anderson and Kristiansen 1959; Kramer et al. 1961) involving adult patients reported that 21%-55% of the patients developed some symptoms after imipramine was discontinued. It is hypothesized that these symptoms are due to cholinergic overdrive or overactivity and can be successfully treated with anticholinergic agents (Dilsaver and Feinberg 1982; Dilsaver et al. 1983). In the course of research programs where the abrupt discontinuation of antidepressant drugs was required, we observed several patients with withdrawal symptoms of different degree. These will be reported here.