CLOMIPRAMINE AND INITIAL WORSENING IN PANIC DISORDER - BEYOND THE JITTERINESS SYNDROME

The time course and the phenomenology of the initial response to clomi pramine (10-20 mg/day) was investigated in 70 patients with panic diso rder with or without agoraphobia. Nineteen (27.1%) patients reported w orsening of their clinical state which, on average, began 28 h after t he first dose and lasted for 5 days. Increase in the frequency and sev erity of panic attacks was the most frequent finding (14 patients), fo llowed by psychostimulant (jitteriness; n=9), depressive (n=8) and ton ic anxiety symptoms (n=7). This pattern of initial worsening is differ ent from the 'jitteriness syndrome' described for other antidepressant s. Its implications for the understanding of the pathophysiology of pa nic disorder are discussed.