Bertschy G, Vandel S, Sechter D, Bizouard P
Service de Psychiatrie et Psychologie Médicale, CHU Saint-Jacques, Besançon.
Encephale. 1991 Nov-Dec;17(6):515-7.
We report two cases of a singular side effect induced by clomipramine, one in a man, the other in a woman (both patients were beninese). This consisted of the occurring of the association of very frequent yawning and sexual excitation (sexual excitation with vaginal lubrification for the woman and hypogastric feeling of sexual pleasure for the man). It appeared after a few days of ambulatory treatment of a depression with clomipramine 75 mg/day. Clomipramine and demethylclomipramine blood levels were respectively 85 and 95 ng/ml and 70 and 80 ng/ml for the two patients. Three similar cases had been reported in the literature with this same tricyclic antidepressant. Recently a first case has been reported with fluoxetin. On this basis, it could be suggested that serotoninergic mechanisms are involved in the development of such clinical manifestations. But it seems reasonable to consider that serotoninergic mechanism could interact with a dopaminergic one. In favour of this hypothesis is the implication of dopaminergic mechanisms in yawning in man or in the association yawning--penile erections in the rat. Some others clinical arguments are discussed.
我们报告两例由氯米帕明引起的罕见副作用，一例为男性，另一例为女性（两名患者均来自贝宁）。这种副作用表现为频繁打哈欠与性兴奋同时出现（女性出现阴道润滑的性兴奋，男性出现下腹部性快感）。在以每日75毫克氯米帕明进行门诊治疗抑郁症几天后出现。两名患者的氯米帕明和去甲氯米帕明血药浓度分别为85和95纳克/毫升以及70和80纳克/毫升。文献中曾报道过三例使用同一种三环类抗抑郁药出现类似情况。最近有首例使用氟西汀出现类似情况的报道。基于此，可以推测血清素能机制参与了此类临床表现的发生。但认为血清素能机制可能与多巴胺能机制相互作用似乎是合理的。支持这一假设的是多巴胺能机制在人类打哈欠或大鼠打哈欠与阴茎勃起关联中的作用。还讨论了其他一些临床论据。
