Transient mood elevation associated with antidepressant drug decrease

: The development of hypomania, mania and transient mood elevation within 2-3 days of antidepressant discontinuation, and lasting days to several weeks has been reported in unipolar depressed patients. Imipramine and desipramine are the antidepressants most frequently associated with the above phenomena. A reported case of transient mood elevation following abrupt reduction but not discontinuation of desipramine therapy in a woman with unipolar depression is described. The phenomenon was observed and documented on two separate occasions. Mood elevation occurred despite decreased plasma levels of the drug. Relapse followed despite maintenance of dose and similar drug plasma levels. Factors which could account for the transitory improvement of mood are examined. It is suggested that the patient's improvement in mood may have occurred due to a rebound paradoxical therapeutic effect. The features of the presented case history which appear to support this hypothesis are discussed. Also the clinical implications of this phenomenon are reviewed.