Neuropathy associated with tricyclic antidepressants

✍ Scribed by Franco Benazzi; Gabriele Ciucci

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 61 KB
• Volume: 12
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/(sici)1099-1166(199708)12:8<868::aid-gps662>3.0.co;2-3

✦ Synopsis

Dear Editor

A woman with chronic depression developed a painful neuropathy related to tricyclic antidepressant treatment.

A 55-year-old woman with DSM-IV chronic major depressive disorder, and sporadic alcohol abuse, did not respond to trials of ¯uoxetine, venlafaxine and alprazolam. Next, she was treated with desipramine 175 mg/day, nortriptyline 50 mg/ day, haloperidol 1 mg/day (for a few weeks) and alprazolam 1 mg/day. Because laboratory examinations revealed an elevated TSH level with normal thyroid hormones (subclinical hypothyroidism), levothyroxine was added. During the following 2 months the clinical picture improved signi®cantly. She then noted bilateral, distal paresthesias. Citalopram 10 mg/day was added, and the dose of desipramine was reduced to 75 mg/day. During the following 2 weeks bilateral, distal pain appeared, which rapidly became very severe. She also noted some diculty with limb movements. A neurological examination showed distal symmetric sensory loss, weak deep tendon re¯exes and mild weakness of limb muscles. Electromyography with nerve conduction studies con®rmed the clinical diagnosis of polyneuropathy, showing axonal type abnormalities. Cerebrospinal ¯uid was normal. Other causes of neuropathy were not found, apart from antidepressant treatment.

Psychopharmacological treatment was discontinued, and she was treated with carbamazepine and non-steroidal anti-in¯ammatory drugs for pain relief. During the following weeks, pain and weakness gradually improved.

Her sporadic alcohol abuse and subclinical hypothyroidism, treated with levotyroxine, are unlikely causes of this acute neuropathy (Dyck et al.