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Status Cataplecticus Following Abrupt Withdrawal of Clomipramine
S Fullam1, A Scott1, J F Garvey1
1St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
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.
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