NOCTURNAL ENURESIS - A PLACEBO-CONTROLLED TRIAL OF 2 ANTIDEPRESSANT DRUGS

A multicentre, randomised, double blind treatment trial was set up com paring imipramine (a tricyclic antidepressant with anticholinergic act ion), mianserin (a quadricyclic antidepressant without anticholinergic activity), and placebo, (a) possibly to identify an effective alterna tive drug and (b) to elucidate the action of imipramine in enuretic ch ildren. Eighty children (65 boys, 15 girls) aged 5-13 years, wet three or more nights a week, were studied. Exclusions were a urinary tract infection or abnormality, other organic illness, or severe emotional d isorders. After a four week assessment, 25 children were randomised to eight weeks' treatment with imipramine 25 mg, 26 to mianserin 10 mg a nd 29 to placebo, followed by four weeks without treatment. Dry nights and a wetness score were recorded throughout. During treatment, imipr amine was superior to both placebo and mianserin (p < 0.001) in achiev ing dry nights and reducing wetness scores. It led to a definite impro vement in 72% of children. Mianserin produced a mildly beneficial effe ct that was not superior to placebo. No side effects were recorded. Mi anserin would not be a satisfactory alternative treatment for nocturna l enuresis. The efficacy of imipramine is unlikely to be the result of its antidepressant activity.