Withdrawal Symptoms after Abrupt Termination of Imipramine

Abstract

The reports and clinical experience cited illustrate the physiological withdrawal reaction which follows abrupt imipramine withdrawal. Many such reactions have probably gone unreported or have been misinterpreted as incipient exacerbations of the process under treatment. It is suggested that the patient reported here meets the W.H.O. criteria of a true addiction (31). These findings are discussed in terms of life situation and personality predisposition contributing to development of addiction in this patient at this time. He was in a heightened state of anxious oral dependency and wished to make drug therapy almost a way of life. The following conclusions are drawn: 1) A drug's specific psychopharmacologic effect cannot be considered without reference to the emotional significance of drugs to the psychiatric patient, i.e. to each patient's characteristic way of responding to the drug experience. 2) Withdrawal phenomena may interfere with the evaluation of change due to treatment, or may seem to produce a clinically worse patient. This possibility should be considered when a trial without drugs produces symptoms like those which led to treatment. 3) Imipramine and most psychotropic drugs should be withdrawn gradually, especially following prolonged treatment, and in addicted patients. If abstinence symptoms develop, the dosage should be increased and then gradually withdrawn again over a longer period. 4) The imipramine withdrawal syndrome appears to be non-specific and morphine-like. This suggests the speculation that imipramine belongs to the group of physiological C.N.S. ‘depressants’.