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Published on: November 21, 2013
Imipramine compliance in adolescents
G A Bernstein1, L K Anderson, J M Hektner
1Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis 55454-1495, USA.
Summary
Adolescents taking imipramine experienced more side effects than placebo but adherence was not affected. Oppositional defiant disorder and family issues were linked to noncompliance, highlighting the need for blind evaluators in drug trials.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Anxious-depressed adolescents often face challenges with medication adherence.
- Understanding the relationship between side effects, compliance, and perceived treatment assignment is crucial in pediatric psychopharmacology.
Purpose of the Study:
- To assess side effects, medication compliance, and perceived drug assignment in adolescents treated with imipramine versus placebo.
- To identify factors influencing medication noncompliance and the accuracy of blinded assessments.
Main Methods:
- An 8-week double-blind study involving 63 anxious-depressed adolescents receiving imipramine or placebo with cognitive-behavioral therapy.
- Evaluation of side effects, global improvement, family functioning (FACES II), pill counts for compliance, and blind guesses of drug assignment.
Main Results:
- Imipramine group reported significantly higher side effects than placebo (p = .001).
- Oppositional defiant disorder (ODD) and specific family functioning patterns (low adaptability/cohesion) were associated with medication noncompliance.
- Psychiatrists accurately guessed drug assignments (79.5%), influenced by side effects and global improvement.
Conclusions:
- Side effects did not correlate with noncompliance.
- Medication nonadherence in adolescents is linked to ODD and family dynamics.
- High accuracy in blinded assessments suggests the necessity of independent evaluators to mitigate expectancy bias in clinical trials.
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