Unusual Side Effects of Clomipramine Associated with Yawning

Abstract

Although there have been previous reports of decreased sexual capacity as a side effect of antidepressants (1-3), the authors know of no previous records of increased capacity of the type described in the following reports, or of reports of side effects associated with yawning. Observation of unusual yawning-associated side effects is now reported, in order to alert clinicians to a possible side effect that can influence patient-compliance with the prescribed medication regimen.

Persistent Sexual Arousal Syndrome: A Case Report and Review of the Literature

“…Ellmore and Quattlebaum (1997) described three cases of women with complicated depressive illnesses who responded to fluoxetine, paroxetine, and methylphidate hydrochloride with increased sexual desire, arousal, or activity. Other drugs cited in the literature and thought to induce a hypersexual state include levodopa (Harvey, 1988), carbamapazine (Myers & Carrera, 1989), fluvoxamine (Myers & Carrera, 1989), fluoxetine (Smith & Levitte, 1993), moclobemide (Lauerma, 1995), clomipramine (McLean, Forsythe, & Kapkin, 1982) and trazadone (Sullivan, 1988). The hypersexual states described in the above reports differ from PSAS because they include heightened desire or libido in addition to increased physical arousal, whereas the defining symptom of PSAS is that it is limitated to heightened physical arousal only (Leiblum & Nathan, 2001).…”

Yawning in Diseases

“…Unfortunately, this is only rarely reported to pharmacovigilance agencies and there are neither statistics to assess the frequency of this iatrogenic effect, nor any studies showing that it is revealed by association with another psychotropic drug [38]. Curiously, while tricyclic antidepressants have atropinic side effects, thus being inhibitors of yawning, and are reputed to lead to impotence, there have been reports regarding excessively frequent salvos of yawning that accompany involuntary orgasms with clomipramine [39, 40]. …”

Sexual Dysfunction Associated with Antidepressant Therapy

“…Dopaminergic neurotransmission has been shown to have a facilitating effect on sexual behavior. Consistent with this hypothesis is the observation that bupropion has a positive effect on sexual function and the anecdotal reports that dopaminergic agents, such as amphetamines, reverse SSRI-induced sexual dysfunction [44]. Elevation of prolactin has been suggested as another mechanism by which SSRIs could cause sexual dysfunction.…”