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Controlled evaluation of imipramine, isocarboxazide, dextroamphetamine-amobarbital, and placeboAn evaluation of imipramine, isocarboxazide, dextroamphetamine-amobarbital, and placebo was carried out in 204 patients with depressive syndromes in thirty-two Veterans Administration Hospitals. Treatment with a fixed dosage schedule was followed for 3 weeks, the dosage becoming flexible during an ensuing 9 week period. Evaluation of responses was made by three rating scales specially derived for depressed patients.After 3 weeks of treatment, imipramine was significantly more effective than the other three treatments as measured only by a thirty-one item expert clinician's scale derived from the Inpatient Multidimensional Psychiatric Scale. Favorable responses to imipramine were often prompt, leading to loss of such patients from the study before the full 12 week treatment period had been completed. After 12 weeks of treatment, the patients who remained in all four treatment groups were significantly improved when each group was compared with its pretreatment level, but there were no statistically reliable differences between treatments at the end of the study. These results emphaSize the need for controlled 5tudies in depreSsive syndromes subject to spontaneous improvement.

An episode of total paralysis (from medication) with full consciousness is described and its relation to death terror is discussed.