A COMPARATIVE TRIAL OF IMIPRAMINE AND PHENOBARBITAL IN DEPRESSED PATIENTS SEEN IN GENERAL PRACTICE

It was concluded that the trial had not demonstrated a specific anti-depressant effect from imiprainine in these cases of neurotic depression, and better results were recorded in eases of shorter duration with phenobarbital, but not with imipramine.

Abstract

The paper describes a double blind trial between imipraminc and phenobarbital in neurotic depression in general practice, involving 170 patients. Patients were treated for a total of 8 weeks, with either a cross-over of drugs a t 4 weeks or continued administration of one drug throughout, the order of treatment being randomized. Results wcre assessed on a five-item symptom-rating scale, each item being assessed on four degrees of severity. These assessments were made initially and at 2-Week intervals throughout the trial. The results were expressed as a proportion of the total possible improvement, if all symptoms had been completely relieved at each assessinent period. Statistically there were no differences between the overall results with the two drugs at any period of the trial, with the exception of thc first 2 weeks, when phenobarbital was better than imipramine, at the 5 percent level of probability. There were no differences in the results in relation to the fire symptom groups. Dosage was adjusted in the range of 1 to 2 t.i.d. (imipramine, 25 mg; phenobarbital, 20 mg) and at the end of the trial, 56 percent of patients on imipramine were being treated with the smaller dose, as compared to 48 percent on phenobarbital. More side effects occurred with imiprainine in the earlier part of the trial and vice versa with phenobarbital, so that at the end of the trial there were no side effects in 81 percent of patients on imiprainine and in 72 percent on phenobarbital. The coininoilest side effect with imipramine was headache (9 percent), followed by dry mouth (6 percent) and tenseness (3 percent); the commonest side effect with phenobarbital was drowsiness (19 percent), followed by headache and vertigo (3 percent each). It was not found that the results were influeneed by the type of depression, the degree of the anxiety component or any other factor, except that better results were recorded in eases of shorter duration with phenobarbital, but not with imipramine. It mas concluded that the trial had not demonstrated a specific anti-depressant effect from imiprainine in these cases of neurotic depression.