Letter to the Editor Augmentation of Paroxetine with Clocapramine In

Psychiatry and Clinical Neurosciences (2007), 61, 449 doi:10.1111/j.1440-1819.2007.01690.x

Letter to the Editor Chlorpromazine (25 mg daily) was added to paroxetine when the patient was 33 years old, which resulted in a reduction in the frequency of the attacks to Augmentation of paroxetine approximately once a month. When the patient was 34 years old, chlorpromazine with clocapramine in was switched to clocapramine (CCP) at a daily dose of panic disorder 30 mg. Since then she has not suffered from any panic attacks. Three months after it was started, CCP was reduced to 20 mg daily because of the development of slight akathisia. Clocapramine (CCP) is an iminodibenzyl antipsy- At present the patient has not experienced any panic chotic drug with psychomotor stimulant activity.1 attacks for more than 14 months, although she has suf- To the authors’ knowledge there are few papers fered from occasional palpitations and a persistent fear concerning the use of CCP for disorders other than of recurrence of the attacks. schizophrenia. Reported herein is a case of panic dis- Although we sometimes encounter patients with order successfully treated by the addition of CCP to panic disorder who respond to the combination of an paroxetine. antidepressant and chlorpromazine, we chose CCP for The patient, 35 years old at the time of writing, pre- the present patient because she complained of loss of sented with a history of panic disorder since the birth of volition after being started on chlorpromazine. It is of her first child at the age of 16 years. From the age of special interest whether carpipramine, the first iminod- 20 years the patient had been on regular treatment ibenzyl antipsychotic drug,2 is also effective for panic with alprazolam (0.8 mg daily); nonetheless, she suf- disorder. fered from panic attacks almost every week. The patient consulted Kitasato University East hos- pital when she was 26 years old. The results of routine tests were all normal. The treatment with alprazolam was combined with psychotherapy but the attacks per- REFERENCES sisted, although they occurred only once every several 1. Yamagami S. A crossover study of clocapramine and halo- weeks. The patient had had to be taken to emergency peridol in chronic schizophrenia. J. Int. Med. Res. 1985; 13: services for severe attacks approximately twice a year. 301–310. When the patient was 27 years old, add-on therapy 2. Deniker P, Loo H, Zarifian E, Verdeaux G, Garreau G. Un with imipramine (max. 30 mg daily) was started but this nouveau medicament psychotrope: la carpipramine, proved to have no effect. Later, amoxapine (max. compose de transition entre deux classes therapeutiques. 105 mg daily), instead of imipramine, also proved to be Encephale 1977; 3: 133–148. ineffective. MASANORI SAITO, md, phd When amoxapine was switched to paroxetine (20 mg HITOSHI MIYAOKA, md, phd daily) at the age of 30 years, a general decrease in the Department of Psychiatry, Kitasato University School of severity of the attacks was noted, and since then she has Medicine, Kanagawa Japan never had to call for ambulance services. Nonetheless, the attacks still continued to occur once every several weeks. Correspondence address: Masanori Saito, md, phd, Department of After the patient delivered her second child when Psychiatry, Kitasato University School of Medicine, 2-1-1 Asamizo- she was 32 years old, the panic attacks began to occur dai, Sagamihara, Kanagagawa 228-8520, Japan. Email: 7n2ecx- almost every week. Paroxetine (40 mg daily) had only [email protected] been partially effective. Received 9 January 2007; accepted 4 March 2007.