Fluoxetine for Clomipramine Withdrawal Symptoms

Mr. A, a 42-year-old man with major depressive and panic disorders, was in remission for 1 year with clomipramine, 150 mg/day, and clonazepam, 2 mg/day. He discontinued the dose of clonazepam over 3 months without problems. Then clomipramine was gradually discontinued over 3 weeks (112.5 mg/day for 7 days, 75 mg/day for 7 days, 37.5 mg/day for 7 days, then stopped). On the day after his last dose, he had dizziness, nausea, depressed mood, anxiety, sweating, and vivid dreams. Seven days later, with the symptoms persisting, the dose of clomipramine was restarted at 75 mg/day. His symptoms disappeared in 1 day. Two weeks later, clomipramine was discontinued again (37.5 mg/day for 5 days, then stopped), but it was replaced by fluoxetine, 20 mg/day, started 1 week before. After clomipramine discontinuation, Mr. A had no problems. One week later, fluoxetine was discontinued (10 mg/day for 5 days, then stopped). No discontinuation symptoms appeared during the following weeks.