A 27-year-old man walked into a psychiatry outpatient clinic in New Delhi with a complaint that most clinicians will never hear in their careers. For six months, he had been clapping, whistling, and bursting into laughter without wanting to, several times an hour, in front of whoever happened to be nearby. It was causing him considerable social distress.
He had no history of a tic disorder. Neither did his family. What he did have was a prescription, started eight months earlier at another facility, for bupropion XL, titrated to 300 mg a day, alongside a low dose of clonazepam. The involuntary movements and sounds had begun roughly two months after the bupropion started.
