High dose tranylcypromine withdrawal with delirium and thrombocytopenia, effect of physostigmine

A 37-year-old male with a history of polyvalent drug abuse (heroin, amphetamines, alcohol), but abstinent for six years, was prescribed 40 mg tranylcypromine daily because of migraine by his neurologist. Tranylcypromine relieved the migraine, but had an additional "peculiar effect" in that he could "concentrate better", "think more clearly" and felt "less distracted by daily worries." He increased the dose to 240 mg daily. After twelve weeks of this high dose consumption and several collapses he stopped the consumption and became delirious. He was admitted to psychiatry. Within two days the delirium worsened, he became combative and was transferred to our facility after sedation with diazepam. On arrival, he talked to imaginary policemen in English language (although a native German speaker) before he started to sing.