Hepatitis caused by antidepressive therapy with maprotiline and opipramol

There are few published reports of antidepressive therapy induced hepatotoxicity. In most cases antidepressants cause only slight elevation of liver enzymes without clinical relevance. However, our patient with recidivation of unipolar depressive disorder developed severe laboratory abnormalities and clinical symptoms during therapy with maprotiline (Ludiomil) and opipramol (Insidon). To our knowledge, this is the first case report of bioptically proven severe acute hepatitis caused by these antidepressants. After their withdrawal, the patient's fatigue symptoms, scleric jaundice, and marked increase of liver enzymes completely disappeared. Hepatic side effects should be considered during antidepressive therapy with maprotiline and opipramol especially when additional clinical symptoms emerge.