Psychosomatics 5: 240-244, 1964
Copyright
© 1964 Academy of Psychosomatic Medicine
A Comparative Study of Antidepressant Agents In the Treatment of Gynecological Symptoms
S. FOSTER MOORE JR. M.D.
The physician must recognize that various gynecologic symptoms are often a somatization of underlying anxiety and depression. Even in organic disorders these symptoms are enhanced by emotional factors which impede the expected response to conventional therapy.
The common use of tranquilizers in such cases is often ineffective. Concomitant administration of an antidepressant is an essential part of treatment in many patients demonstrating psychosomatic disorders.
Two antidepressants were evaluated in a series of 58 patients with diverse gynecologic symptoms associated with anxiety and depression. Previous treatment with tranquilizers alone had produced no satisfactory response in any case.
Twenty-nine patients received 100 mg. imipramine, and 29 received 75 mg. desipramine (monomethyl analogue of imipramine) daily. Duration of dosage was two weeks to eight months, most patients being treated for at least two months. In addition, all received a tranquilizer (usually chlordiazepoxide), medication for organic disorders as indicated, and supportive psychotherapy.
An overall satisfactory response (excellent or good) of gynecologic symptoms, anxiety and depression, as well as improvement of organic disorders was noted in 18 patients (62.1 per cent) treated with imipramine and in 16 (55.2 per cent) of those treated with desipramine.
Comparison of the two antidepressants showed an insignificant difference in overall response, slightly favoring imipramine. Onset of response was somewhat faster with desipramine—one week compared to two weeks for imipramine. The incidence and intensity of side effects was decidedly less with desipramine.
Side effects, usually mild and transient, occurred in 24 patients (58.6 per cent) on imipramine; the drug was withdrawn in one case (3.4 per cent) of dermatitis. In the desipramine group, 15 side effects in 10 patients (35.5 per cent) resulted in withdrawal of the drug in two patients (6.9 per cent); in neither cases did the side effect seem to be drug-related.
In general, most patients who had not responded previously to tranquilizers alone, showed significant improvement after imipramine or desipramine was administered concomitantly. Both antidepressants were equally effective in relieving the underlying anxiety and depression, which seemed to have induced many of the gynecologic symptoms, when given with an effective anti-anxiety drug. As anxiety and depression decreased, patients became less aware of their symptoms, more cooperative, and increasingly capable of solving their problems. In many cases gynecologic symptoms disappeared promptly, and organic disorders required only minimal medication.
