Emergence of kleptomania during treatment for obsessive compulsive disorder with fluvoxamine

Sir,

Kleptomania-the inability to resist the impulse to steal objects, not for personal use or monetary gain-is currently classified in psychiatric nomenclature as an impulse control disorder. There is a comorbidity between mood disorders, eating disorders, anxiety disorders, personality disorders, and kleptomania.[1,2]

We describe a case of obsessive compulsive disorder (OCD) who paradoxically experienced kleptomaniac behavior during treatment with fluvoxamine 100 mg/day, and became normal in a week on stopping the drug.

Miss A, aged 12 years, a student of class 5^th presented with repetitive washing of hands, severe anxiety, disturbance in studies of 4-month duration. She was diagnosed a case of OCD and started on fluvoxamine 50 mg/day. For follow-up she came after 5 days with approximately 10% improvement in symptoms. Dose was increased to 100 mg/day and was told to follow-up after 10 days. After 10 days her obsession of contamination was much better; however, parents complained that she has developed a new symptom i.e., stealing the things from shop and school. She would feel urge to steal and if she would not do so, she would have anxiety. After stealing things, her anxiety was relieved. She was aware about her problem and tried to control it, but in vain. She never used stolen things for personal use. There was no history of conduct disorder, delusion, hallucination and manic episode in the present and past history.

Keeping in view of her family background and concerns of the family, she was stopped the drug (fluvaxamine). She stopped stealing things after 7 days of stopping the drug, but other symptoms of OCD flared up.

She was started on escitalopram 5 mg/day and increased gradually to 10 mg/day. Exposure and Response prevention therapy (ERP) was also performed. After 2 months her symptoms completely resolved. She was continued with escitalopram and ERP. The case was followed every month for 12 months. She is normal, performing well in school. No emergence of kleptomania symptoms were reported.

A number of drugs used in psychiatry have been reported to cause kleptomania. There is a study which reported three cases of depressed patients who paradoxically experienced kleptomaniac behavior during treatment with serotonin-selective reuptake inhibitors.[2] In this case, fluvoxamine was the only drug which was started and kleptomaniac symptoms disappeared after stopping the drug. Moreover there was no re-emergence of kleptomania symptoms even after 1 year follow-up.

Though kleptomania is an uncommon adverse effect, but kleptomaniac symptoms occurring during treatment with psychotropic drugs are reported, so psychological evaluation may be needed.