Neonatal convulsions caused by withdrawal from maternal clomipramine

Abstract

Clomipramine is a tricyclic antidepressant particularly useful in treating depression with obsessive or phobic features. Although its use is not recommended in the first trimester, there has been no contraindication to its use in later pregnancy. We describe two infants who developed convulsions due to withdrawal from maternal clomipramine, the second of whom was treated with reducing doses of clomipramine. Both infants presented with convulsions on the first day of life. In the first case the timing of the convulsions coincided with the initial steep decline in concentrations of clomipramine and its metabolite desmethylclomipramine in the infant's serum. In the second case convulsions were controlled by administration of clomipramine, thus permitting a more gradual decrease in serum concentrations of clomipramine and its metabolite. Our experiences of neonatal convulsions after maternal treatment with clomipramine suggest that this drug is best avoided during pregnancy. If tricyclic antidepressants must be prescribed we suggest that the maternal dose is regulated by monitoring serum concentrations. Should withdrawal convulsions occur in the neonatal period they may be controlled by administration of clomipramine.