Clomipramine (Anafranil) in Intractable Obsessional Depression

Abstract

One of the most difficult and unrewarding groups of patients who present for psychiatric treatment is the chronically depressed with somatic symptoms without overt organic cause. These individuals, in whom women predominate, tend to be regular long standing hospital or family doctor attenders. They have had, as a rule, many medical and other advisers, undergone many examinations and show a disturbing lack of organic pathology. In a previous paper (Graham 1971) the treatment of such a group was described and it was found that 20 % of our unselected group fell into that category and had between them a total of 140 years medical attendance. The cost of treatment and the distress caused to marriage partners and families in general is staggering. This 2 0 % seem to be typical of chronic depressives in general and their distinctiveness comes to notice because of their remarkable response to oral clomipra­ mine. A recent follow-up shows that in the seven contacted well-being is well maintained and five find that continued treatment (albeit a lower dosage of clomipramine) has revolu­ tionized life. One young woman, previously almost housebound, has learned to drive a car, married, has had an uncomplicated pregnancy and a healthy infant. She was previously terrified of childbirth.