EFFECT OF IMIPRAMINE ON MOOD AND ENUMERATIVE MEASURES OF IMMUNE STATUS IN DEPRESSED-PATIENTS WITH HIV ILLNESS

Objective: The authors' first objective was to ascertain whether imipr amine is superior to placebo in treating axis I depressive disorders i n the context of HIV illness. Supplementary questions were whether sev erity of immunodeficiency is associated with antidepressant response a nd whether patients with greater immunodeficiency can tolerate standar d doses of imipramine. Second, the authors sought to determine whether imipramine treatment is associated with changes in immune status. Met hod: A double-blind, randomized placebo-controlled trial of imipramine was conducted in a university-affiliated research outpatient clinic. After 6 weeks of treatment, responders were maintained double-blind fo r another 6 weeks and nonresponders were removed from the study and tr eated openly. All patients were offered 2 6 weeks of treatment. Of the 97 patients who were randomly assigned to placebo or imipramine, 80 c ompleted the 6-week phase. Main outcome measures included the Clinical Global Impression, the Hamilton Depression Rating Scale, the Brief Sy mptom Inventory, and CD4 cell count. Results: Among study completers, 31 (39%) bad AIDS. The response rate to imipramine was 74% and the res ponse rate to placebo was 26%. There was no difference in depression r esponse between patients with more or less severe immunodeficiency, no r was there a difference in medication dose or side effects. Neither t ype nor duration of treatment influenced CD4 cell count during the cou rse of treatment. Conclusions: Depressed patients with HIV illness res pond to imipramine at the same rate as medically healthy depressed pat ients. Severity of immunosuppression is not associated with imipramine treatment outcome. There is no evidence that imipramine has negative effects on enumerative measures of immune status.