Parraga H C, Cochran M K
J Child Adolesc Psychopharmacol. 1992 Fall;2(3):227-34. doi: 10.1089/cap.1992.2.227.
ABSTRACT Two children with major depression experienced the emergence of motor and vocal tics after 2-3 weeks on imipramine at doses of 75-100 mg daily. The tics did not show any sign of subsiding for 9-10 days following the discontinuation of imipramine, but subsequently responded to treatment with haloperidol. Case 1 involved an 8-year-old child with depression, attention-deficit hyperactivity disorder (ADHD), other behavioral problems, and a history of a single febrile seizure. His family history was positive for tics, depression, anxiety, and seizures. He was found to have a toxic plasma level of the tricyclic antidepressant. Case 2 involved a 13-year-old child with depression, ADHD, behavioral problems, obsessive compulsive symptoms, intellectual deficit, developmental delays, grand mal seizures, and concomitant use of phenytoin. The child had previously developed tics while receiving methylphenidate. The family history was positive for tics, depression, obsessive compulsive symptoms, suicide, and alcohol abuse. The child had a subtherapeutic plasma level of the antidepressant. It is suggested that tricyclic antidepressants may precipitate tics consistent with the symptoms of Tourette's syndrome in genetically vulnerable children. Although this possibility has been suggested in the literature, these are the first two documented cases of this phenomenon. Speculating from these two cases, ADHD may be a risk factor for the appearance of imipramine-induced tic symptoms in depressed children.
两名患有重度抑郁症的儿童在服用丙咪嗪，每日剂量为75 - 100毫克，2 - 3周后出现运动性和发声性抽动。在停用丙咪嗪后的9 - 10天内，抽动没有任何减轻的迹象，但随后对氟哌啶醇治疗有反应。病例1是一名8岁儿童，患有抑郁症、注意力缺陷多动障碍（ADHD）、其他行为问题，并有单次热性惊厥病史。他的家族史中抽动、抑郁、焦虑和惊厥呈阳性。发现他的三环类抗抑郁药血浆水平有毒性。病例2是一名13岁儿童，患有抑郁症、ADHD、行为问题、强迫症状、智力缺陷、发育迟缓、癫痫大发作，并同时使用苯妥英钠。该儿童之前在服用哌甲酯时曾出现抽动。家族史中抽动、抑郁、强迫症状、自杀和酒精滥用呈阳性。该儿童的抗抑郁药血浆水平低于治疗剂量。提示三环类抗抑郁药可能在基因易感性儿童中诱发与妥瑞氏综合征症状一致的抽动。尽管文献中曾提及这种可能性，但这是该现象的首例两份记录病例。从这两个病例推测，ADHD可能是抑郁症儿童出现丙咪嗪诱发抽动症状的一个危险因素。
