The Desmethyl Metabolite of Imipramine (G-35020) in the Treatment of Depression: Further Clinical Experience

The desmethyl metabolite of imipramine (DMI) was used to treat 103 depressed patients, standard dosage being 50 mg. thrice daily orally. Seventy patients recovered or were much improved. The indication for DMI and its activity spectrum were of the same order as imipramine. Side effects were less frequent and less severe. Average onset of definitive improvement was three days; earliest changes noted were in facies, motility, and relief of guilt feelings. Besides the classical straightforward response, seven patients improved early but relapsed, and 12 showed a "plateau effect". Absence of favourable response after seven days necessitated reevaluation and/or substitution of other approaches. DMI may be the drug of choice in initiating treatment of depression, but seemed insufficient alone to deal with agitated, acutely suicidal patients. Although DMI appeared an effective, fast-acting antidepressant, there is still no panacea for this ubiquitous syndrome, whose proper management calls for flexibility and awareness of its multifactorial etiology.