Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP, Kontaxaki M-I V, Geronikola X, Armeniakos I, Papadimitriou GN. Low-dose clozapine monotherapy for recurring episodes of depression, hypersomnia and behavioural disturbances: a case report.

Case Report: We present a 27-year-old woman who manifested recurrent episodes of hypersomnia, compulsive hyperphagia, hypersexuality, impulsive behaviours, irritability and depressive mood since the age of 13 after a viral febrile infection. She had 3–4 episodes/year lasting from a few days to 2–3 weeks which were managed with various psychotropics. During her last episode, she was admitted because of persistent behavioural disturbances. Brain 99m-Tc-ethyl cysteinate dimer single-photon emission computed tomography scans showed bilateral mesiotemporal and thalamic hypoperfusion, more significant in the right hemisphere. While hospitalised, she developed neuroleptic malignant syndrome following haloperidol administration. She was discharged on clozapine 100 mg/day. Over the following 30 months, she remained symptom free on clozapine 50–100 mg/day.

Discussion: Differential diagnosis included either an atypical recurrent mood disorder with hypersomnia and behavioural disturbances or Kleine–Levin syndrome.

Conclusion: Low-dose clozapine monotherapy may worth being further investigated for the management of recurring episodes of depression, hypersomnia and behavioural disturbances.