Dr. Bob's Psychopharmacology Tips

Sensitivity to antidepressant side-effects

From: Donald Franklin Klein <dfk2@columbia.edu>
Date: Mon, 20 Mar 1995 18:41:09 -0500
Subject: Sensitivity to antidepressant side-effects

For unusually speedy sensitivity to antidepressants I start with a homeopathic dose (eg 2.5 mg fluoxetine) and make no changes for 3-4 weeks. Then I escalate slowly. Patients usually can tolerate this.

I had one nurse who said she was overreacting to .01 mg/d imipramine. I told her that her nervous system was conditioned and this was not a pharmacological reaction. She agreed to take liquid placebo I would supply and knew that at some time I would add active ingredient without telling her. After 3 weeks I added small doses of desipramine and she eventually tolerated 200 mg/d well with excellent results.

Interestingly, almost all such patients have panic histories.

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