Sm: We wish to add five more cases of paroxetine withdrawal syndrome to those reported by other authors (Barr et a!, 1994; Pyke, 1995).All of our cases occurred in young women (aged 26-39 years), without concurrent organic illness, diagnosed with major depression. Paroxetine was started at a dose of 10 mg/day in the first week and increased to 20 mg for the rest of the treatment period (12â€"14 months). The drug was well tolerated and laboratory tests were always normal through out the period. A benzodiazepine was used during the first 2â€"3 months as an adjunct to manage anxiety but paroxetine was, thereafter, the only maintenance treatment. In three cases paroxetine was discontinued by alternating 20 mg one day and 10 mg the other day during a week. After that, 10 mg/day was main tained for 15 days, then patients were prescribed 10 mg every other day for one more week, before stopping medication. In two patients the tapering was done directly from 20 to 10 mg and after 2 weeks on this dose they stopped the medication.All patients complained of vertigo, light headedness or gait instability during withdrawal. Three patients referred to the symptoms in their next planned out-patient consultation, but two demanded urgent treatment and were prescribed lorazepam 1 mg/day for one week. In all five cases, the symptoms persisted for approximately 7 days. Very similar withdrawal syndromes have been described with other serotonin selective reuptake inhibitors including fluvoxamine, fluoxetine and sertraline, and muscarinic and serotonergic factors have been implicated in the production of these symptoms but what is striking from a clinical point of view is the fact that a conservative tapering regime was unable to prevent symptoms appearing. As a result of this experience we are now applying a dosage reduction of 5 mg per week in an attempt to avoid this withdrawal syndrome. B@x, L. C., GOODMAN, W. K. & PRICE, L. H. (1994)Physical symptoms associated with paroxetine discontinuation (letter).American Journal of Psychiatry. 151, 289. L. PACHECO P. MALO E. ARAGUES M. ETXEBESTESm: There is clinical evidence that yohimbine has an effect in restoring erectile capacity in men with erectile dysfunction (ED) but may be accompanied by side-effects. Case reportA 59-year-old man described a 3 year history of erectile dysfunction. After discussing treatment options he chose oral medication. A trial of yohimbine 5.4 mg tid. was initiated. Three days after starting medication he developed pain and discomfort above both eyes which he described as like ‘¿ a thick head cold'. The area was tender to touch but there were no other symptoms to suggest sinus problems, influenza or an anxiety state. There was no change in his mental state. He stopped medication and symptoms resolved within 24 hours. A week later he re-exposed himself to the tablets and symptoms returned after three days, and again resolved within 24 hours of stopping. During each treatment period, no success was noted with sexual function. The patient refused a third trial of...

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with a regimen of venlafaxine 150 mg daily. Light therapy quickly reduced the somatic symptoms and augmented the antidepressant therapy success in this patient (2). The reduction rate of the somatic symptoms was highest for the first 3 days of light therapy. Beyond the antidepressant effects, this case report suggests that light therapy could be useful for treating SD. SD patients with concurrent seasonal affective disorder (SAD) may be most likely to respond to light therapy and bright light, which may act as a strong zeitgeber to synchronize their circadian rhythms.