Dysarthria: an unusual side effect of tricyclic antidepressants.

four days and, before this, diazepam 5-10 mg thrice daily and nitrazepam 5 mg at night for seven months. Although fits may occur when larger doses of benzodiazepines are withdrawn, their occurrence after withdrawal of therapeutic doses of this kind is extremely rare.3 A review of published reports has shown only one other case of fits possibly induced by viloxazine; this also occurred during a clinical trial.3 In this study a second patient also had an epileptic seizure but was already known to be epileptic. By contrast, Brion4 found no increase in the frequency of fits among the four depressed epileptic patients included in his trial. Several psychotropic drugs, including tricyclic antidepressants and monoamine oxidase inhibitors, can precipitate grand mal seizures in people with low convulsive thresholds due to genetic susceptibility or previous brain damage, so it is essential to carry out electroencephalographic studies during the early clinical evaluation of new psychotropic drugs. In the case of viloxazine these were carried out by Pichot et al' and Floru et al6 during the course of their double-blind comparisons with imipramine. The incidence of abnormal tracings was similar for both drugs. Although a causal connection between viloxazine and convulsive seizures cannot be established with certainty, this case suggests the possibility that viloxazine has epileptogenic properties. I hope that any other cases of seizures occurring in patients receiving this drug will be reported.