Clomipramine in the treatment of depression and phobic anxiety states

ABSTRACT

Clomipramine, a chlorinated tricyclic drug, was assessed in 2 groups of outpatients (i) 59 depressed patients in a double blind comparative trial with amitryptiline; and (ii) 7 patients with phobic anxiety states. (i) In the comparative trial no difference in anti-depressant action (assessed by serial Hamilton Rating scores) of clomirpramine and amitryptiline could be demonstrated. Both appeared to relieve depression effectively with maximal anti-depressant action in the second and third weeks of treatment. Patients taking clomipramine, however, had significantly more side effects (p<0.01) and more patients in this group had to be withdrawn for this reason. Postural hypotension was the most serious side effect and occurred in 25 percent of patients taking clomipramine as against 115 of patients taking amitryptiline. (ii) 7 patients with phobic anxiety state with predominantly agoraphobic symptoms ("the agoraphobic syndrome"), who had previously proved resistant to treatment by phenelzine, anxiolytic drugs, supportive psychotherapy and (in 4 cases) desensitisation, were treated with clomipramine orally. 2 patients developed side effects. Of the remaining 5, 3 showed a satisfactory response (in 2 complete alleviation of phobic symptoms with return to normal activities, and in 1 marked alleviation). The other 2 patients showed slight improvements but remained considerably handicapped. Clomipramine (i) has been shown to be an effective anti-depressant drug of comparable efficacy and speed of action to amitryptiline. The higher incidence of side effects, however, make it an anti-depressant of second choice. (ii) appears potentially very useful in the management of agarophobic patients (who are in general resistant to treatment (AU)