...I did convince him to try trazodone, another antidepressant with fewer side-effects than chlomipramine. I increased his dosage gradually to 400 milligrams per day, which is a high dose, but after two weeks at this dosage there was not the slightest change in his depression scores or life. I tapered the trazodone down, stopped it, and then started chlomipramine after a difficult negotiation period with him and with an assurance that unacceptable side-effects would result in stopping the medication.

I slowly built the chlomipramine dosage up until he had reached a therapeutic blood level and all of a sudden it was as if someone had thrown a switch. His Beck Depression score dropped to a 10. He reduced his walking from fifteen miles a day to three. He had not binged once in a week, he no longer felt panicky or driven at any time in the day, and he was actually thinking about returning to work. The only problem was that he was having six to eight petit-mal seizures a day...