Clomipramine is the drug of choice in the treatment of unipolar affective disease, that is endogenous depression called phasic depression.1,2 Affective disorders have usually recurrent course, in the form of phases. If the phases include only depressions, this condition is then called unipolar affective disease.2 Much evidence point to the role of genetic factors in affective diseases.3

Clomipramine is an antidepressant drug with tricyclic structure, a dibenzoazepine derivative, and has been introduced to treatment by Kuhn in 1963. It strongly inhibits the intraneuronal uptake of serotonin and, weaker, than that of noradrenaline.4,5 It is indicated mainly in depressions with psychomotor inhibition with low level of anxiety and aggression, with very intense obsessive-compulsive symptoms.6,7 The onset of therapeutic action is observed usually after seven days of drug administration.8 In the so called major depression (endogenous depression), clomipramine significantly increase prolactin level.9

Some authors demonstrated dysfunction of serotoninergic and noradrenergic neurotransmission in experimental depression model in rats, where clomipramine proved to be the drug of choice.10

Other authors studied sexual behaviour of rats, induced by clomipramine. They demonstrated that clomipramine therapy in doses higher than 20 mg/kg daily caused significant impairment of sexual behaviour in adult male rats.11

Yet others proved that therapeutic effectiveness of clomipramine was very similar to that of moclobemide. Anticholinergic effects, body weight gain and hypotensive effect developed more frequently in the group treated with clomipramine.12,13 Some authors suggested a high similarity between the effects of clomipramine and imipramine on monoamine levels, mainly noradrenaline and serotonin levels in synaptic cleft. It was shown that in some endogenous depressions, amitriptyline, noxiptiline, imipramine and dibenzepin proved slightly more effective than clomipramine.14

In drug- refractory depressions the administration of clomipramine and maprotiline in intravenous infusions was very effective.15

Other authors administered clomipramine to patients with major depression and alcohol-addiction syndrome. A significant improvement of psychic condition was obtained in about 40% of the patients.16 Adverse effects were observed during administration of thymoleptics, mainly clomipramine. The total number of 84 patients were treated. In more than 50 subjects adverse effects developed. The studied thymoleptics exerted no effect on the haemopoietic system, parenchymal organs and also on hypothalamic mechanism of baseline thyreotropin, prolactin and cortisol secretion.17

In depression treatment, the daily therapeutic dose is within 150-200 mg range, the maximal dose being 300 mg. In the prophylaxis of unipolar affective disease, the dose is upto 150 mg daily. The maximal ambulatory dose should not exceed 150 mg daily.8

The aim of the study was an attempt at the assessment of therapeutic effectiveness of clomipramine in endogenous depression, depending on selected demographic factors.

Clomipramine was administered in treatment of outpatients in the Health Care Institution, Warszawa-Zoliborz and in patients discharged from the Department of Neurosurgery, Clinical Hospital in Warsaw, 128 Szaserow st. The drugs were given to 50 patients. Only persons with the diagnosis of “major depression” were included into the study. These were patients in whom endogenous depression syndrome occurred at least for the third time and in whom manic episodes were never observed. The studied subjects were treated with clomipramine and systematically monitored for six weeks. The drug was administered in doses from 50 mg to 150 mg daily, only orally in the form of 25 mg tablets. All studied persons met the criteria of endogenous depression syndrome according to DSM III and DSM IV classifications. During successive studies, mental and somatic status of the patients was assessed. Basic laboratory blood tests and chest radiograms were also performed. All patients were treated by the same doctor - the author of the paper. The observations were noted in case record. In the choice of the drug, clinical condition of the patient and most recent reports from international literature were taken into account. The data for the study were collected from case records of the patients. In each case record, the history taken from patient’s family was also presented. Each patient underwent detailed multiple tests by 24-point Hamilton Depression Assessment Scale and Beck Depression Self-Assessment Inventory and Mongomery-Asberg Scale. The author evaluated the therapeutic effects on the basis of the above mentioned scales and CGI scale and also on the basis of clinical examination of the patients. Depression intensity was assessed by clinical examination and on the basis of ICD-10 classification. The author used a number of statistical methods. He utilized contingency tables, Student’s t-test, Kendall tau correlation coefficient, Pearson correlation coefficients, Cronback alpha coefficients and chi2 statistical method.18-22

Beck Depression Self-Assessment Inventory - In the Tables 1-20 the per cent values of patients before and after treatment with clomipramine are presented.
Sadness, depression - The results are presented in Table 1.

In patients with the greatest mood lowering, clomipramine exerted outstandingly good effects with complete remission of symptoms after the treatment, since the number of patients with this option decreased fourfold (option B3). In patients with moderately intense mood lowering clomipramine produced cure in over half of the subjects.

Looking into future - The results are presented in Table 2.

The number of patients looking into their future with great or medium pessimism decreased about threefold after treatment with clomipramine. The drug exerted virtually unfavourable effect in patients evaluating their future with pessimism, but not very intense pessimism.

Negligence - The results are presented in Table 3.

Clomipramine exerted very favourable effects in patients with very intense belief that they are negligent in their work and they do everything bad (option B2, B3). The drug was of low usefulness in the treatment of patients evaluating their activity not very negatively.

Satisfaction with activity - The results are presented in Table 4.

The drug exerted very favourable effects in patients completely deprived of satisfaction with their activity (option B3), slightly less favourable effects in patients only partially satisfied with their activities (option B2). Clomipramine proved completely useless in the treatment of patient with the lowest intensity of the symptom (option B1).

Feeling of guilt - The results are presented in Table 5.

Clomipramine exerted outstanding effects in patients with severe depressive feeling of guilt, taking the form of depressive delusions (option B3). It was therapeutically slightly less effective in feeling of guilt of moderate intensity (option B2) and least effective in patients with low intensity of feeling of guilt (option B1).

Deserving punishment - The results are presented in Table 6.

Clomipramine exerted outstanding therapeutic effects in cases of the highest intensity of this symptom, that is in typical depressive delusions of punishment (option B3). The drug proved completely useless in patient with milder forms of this symptom.

Self-Satisfaction - The results are presented in Table 7.

Clomipramine was fairly effective in the treatment of patients with medium and high intensity of this symptom, i.e. feeling animosity against themselves or hating themselves (option B2, B3). The drug was slightly less effective in the treatment of patients not satisfied with themselves (option B1).

Feeling of value - The results are presented in Table 8.

The drug was outstandingly effective in patients with the highest intensity of the symptom, that is in developed typical depressive delusions of guilt (option B3), slightly less effective in the treatment of patients with delusions of condemnation (option B2) and least effective in patients regarding themselves only as incompetent (option B1).

Suicidal tendencies - The results are presented in Table 9.

The drug proved therapeutically effective only in patients with medium intensity of this symptom, that is in such persons who just want to commit suicide (option B2).

Weeping - The results are presented in Table 10.

The drug proved very useful in the treatment of patients with medium and high intensity of this symptom, that is in such persons who are constantly tearful (option B2) and in those who are completely unable to weep (option B3).

Nervousness

Clomipramine proved outstandingly good in the treatment of patients with medium and high intensity of this symptom, that is in patients constantly nervous (option B2) and completely not nervous and indifferent (option B3). The drug was particularly useless in patients with mild intensity of this symptom, that is slightly more nervous than before (option B1).

nterest in people - The results are presented in Table 11.

The drug proved most useful in patients with the most severe option of this symptom, that is in those who completely isolate themselves from other people (option B3). The drug was less effective in patients with moderately intense symptom (option B2) and completely ineffective in patients with low intensity of the symptom (option B1).

Easiness of decision making - The results are presented in Table 12.

he drug proved outstandingly therapeutically effective in patients with the highest intensity of the symptom, i.e. those who cannot make any decision (option B3). The drug was less effective in patients with less intense symptom, that is having great difficulties in making decisions (option B2). The drug proved completely therapeutically ineffective in patients with mild intensity of the symptom, that is those delaying making decisions more frequently than before depression (option B1).

Assessment of own appearance - The results are presented in Table 13.

The drug proved superbly effective in patients with medium and high intensity of this symptom, that is in patients feeling that their appearance is ever worse (option B2) and patients convinced that their appearance is awful and odious (option B3), respectively. Unfortunately, the drug was completely ineffective in patients with low intensity of the symptom, that is those worrying that they look old and inattractive (option B1).

Ability to work - The results are presented in Table 14.

The drug proved highly useful in patients with the highest intensity of the symptom, i.e. those unable to do anything (option B3), slightly less useful in patients with medium intensity of the symptom, that is those forcing themselves with great effort to activity (option B2). The drug was completely ineffective in patients with low intensity of the mentioned symptom, that is patients starting any activity with great difficulty (option B1).

Sleep - The results are presented in Table 15.

The drug proved quite effective in patients with low grade insomnia (option B1) and with high grade insomnia (option B3). It was completely therapeutically ineffective in patients with medium grade insomnia (option B2).

Fatigue - The results are presented in Table 16.

The drug proved outstandingly effective in the treatment of patients with the highest intensity of the mentioned symptom, that is patients feeling so intense fatigue that they were unable to do anything (option B3). The drug was relatively effective in patients with moderately intense symptom, i.e. those who were getting tired by all activities performed by them (option B2). The drug was completely ineffective in the treatment of patients with mild intensity of the mentioned symptom, that is those who were getting tired significantly more than before depression (option B1).

Appetite - The results are presented in Table 17.

The drug proved outstandingly effective in patients with the highest grade of appetite loss, that is in patients who completely lost appetite (option B3). It was slightly less effective therapeutically in patients with medium intensity of the mentioned symptom, that is in patients with significantly poor appetite (option B2). The drug proved completely ineffective in patients with low intensity of the symptom, i.e. those with slightly impaired appetite (option B1).

Body weight loss - The results are presented in Table 18.

The drug proved relatively therapeutically effective in least emaciated and least cachectic patients (option B1).

Concern about own health - The results are presented in Table 19.

The drug was therapeutically effective in patients with highest intensity of hypochondria (option B3).

Sexual interest - The results are presented inTable 20.

The drug proved evidently effective in the treatment of patients with medium intensity of the mentioned symptom, that is in patients whose problems interested them significantly less than before depression (option B2).

Many authors8 regard clomipramine as the drug indicated mainly in depressions with psychomotor inhibition with anxiety symptoms. The results of treatment in depressions with high restlessness, psychomotor agitation, hypochondriac features are less good. The experiences of the author of the paper are partially in agreement with these reports. clomipramine is very useful in most severe depressions. Very good effects are observed in the treatment with the drug of depressions with psychomotor inhibition, frequently near stupor. A moderate improvement is observed in depressions with hypochondriac features. In depressions with manifestations of anxiety, restlessness, motor agitation, the treatment with clomipramine produces moderate or weak effects. Clomipramine frequently can be regarded as the drug of choice in the treatment of severe endogenous depressions with very intense obsessive-compulsive manifestations.