Imipramine Treatment for Patients With Multi-organ Bodily Distress Syndrome (Stress-3)

• SF-36 [ Time Frame: At 1 and 13 weeks ] [ Designated as safety issue: No ]
  Questionnaire, patient-rated. Assessment of physical, social and mental functioning
• Visual Analogue Scale for pain and worst symptom [ Time Frame: At 1 and 13 weeks ] [ Designated as safety issue: No ]
• Symptom Checklist (SCL) [ Time Frame: At 1, 3 and 13 weeks ] [ Designated as safety issue: No ]
• Functional Illness Checklist (FIC) [ Time Frame: At 1, 3 and 13 weeks ] [ Designated as safety issue: No ]
• WHODAS II [ Time Frame: At 1 and 13 weeks ] [ Designated as safety issue: No ]

• SF-36 [ Time Frame: At 1 and 13 weeks ] [ Designated as safety issue: No ]
  Questionair, patient-rated. Assessment of physical, social and mental funtioning
• Visual Analogue Scale for pain and worst symptom [ Time Frame: At 1 and 13 weeks ] [ Designated as safety issue: No ]
• Symptom Checklist (SCL) [ Time Frame: At 1, 3 and 13 weeks ] [ Designated as safety issue: No ]
• Functional illness Checklist (FIC) [ Time Frame: At 1, 3 and 13 weeks ] [ Designated as safety issue: No ]
• WHODAS II [ Time Frame: At 1 and 13 weeks ] [ Designated as safety issue: No ]

The aim of this study is to test the effect of the tricyclic antidepressant Imipramine in patients with longlasting health problems with no known medical explanation, defined as multi-organ Bodily distress syndrome (BDS). Pharmacological treatment of patients with BDS have never been tested, and Imipramine i low dosage (10-75 mg) has the potential of reducing both pain and other symptoms of bodily distress for patients with BDS. Control conditions are pill placebo. Study duration is 19 weeks for each of the 140 patients.

The aim of this study is to test the effect of Imipramine in patients with multi-organ Bodily distress syndrome (BDS). BDS is a unifying diagnosis that encompasses a group of closely related conditions such as somatization disorder, fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome. The project consists of a double-blinded placebo controlled trial of treatment with the tricyclic antidepressant Imipramine in dosages of 25-75 mg. Primary outcome is patient-rated improvement measured by Clinical Global Improvement Scale (CGI-I). Secondary outcome is functional level (physical, mental and social) measured by the SF-36 Physical Component Summary (PCS). The study requires 140 participants and study duration is 19 weeks for each patient.

• Somatisation Disorder
• Somatoform Disorders

• Drug: Imipramine treatment
  Dosages is 10-75 mg Imipramine/placebo tablets pr. day in a period of 12-19 weeks.
• Drug: Placebo
  placebo tablets pr. day in a period of 12-19 weeks.

• Experimental: Imipramine treatment
  Intervention: Drug: Imipramine treatment
• Placebo Comparator: Placebo
  Intervention: Drug: Placebo

Inclusion Criteria:

1. First time refered patients fulfilling diagnostic criteria for BDS multi-organ type with symptoms for more than 3 of 4 symptom categories
2. Moderate or severe impact on daily life
3. Symptoms lasting for at least 2 years
4. Age 20-50 years
5. Born in Denmark or have Danish parents. The patient understands, speaks, writes and read Danish.

Exclusion Criteria:

1. Presence og other physical of psychiatric condition, if the symptoms of this condition can not clearly be separated from symptoms of BDS
2. Current moderate or severe depression, patients in continuous antidepressant treatment because of moderate or severe depression, and patients with other severe psychiatric disorder that demands treatment, or if the patient is suicidal.
3. A lifetime-diagnosis of psychoses, mania or depression with psychotic symptoms (ICD-10: F20-29, F30-31, F32.3, F33.3)
4. Abuse of alcohol, narcotics or drugs
5. Pregnancy, breastfeeding or current pregnancy wish. Fertile women must use effective anticonception, (hormonal contraception, contraceptive injection, implant or patches, intrauterine system and device, vaginal ring).
6. Treatment with all pain modulating drugs, e.g. all analgesics, antidepressants, antiepileptica and other types of medication with pain relieving properties must be discontinued at least two weeks before the treatment phase.
7. Imipramine treatment in sufficient dosage within the last year, i.e. 25 mg daily continuously for at least 8 weeks.
8. Allergy to study medication or excipients in study medication.
9. Patients with previous med myocardial infarction, congestive heart failure, signs of conduction defects or abnormalities on ECG (first degree AV-block, bundle branch block or prolonged QT-interval), narrow-angle glaucoma, porphyria, inherited galactose intolerance, epilepsy, hepatic insufficiency and severe renal impairment

10. Simultaneous use of:

    • antipsychotics
    • oral anticoagulants
    • diuretics
    • sympathomimetics and CNS-stimulating drugs (amphetamine-like drugs)
    • all serotonergic drugs, e.g. SSRI, SNRI and TCA, the dietary supplement hypericum perforatum, non-selective, irreversible or selective, reversible monoamine oxidase (MAO) inhibitors, triptans, tramadol, pethidin and tryptophan
    • the drugs cimetidine (H2-antagonist), quinidine (antiarrythmics), clonidine (antihypertensive), fluconazol (antimycotics), clindamycin, clarithromycin, erythromycin (antibiotics), droperidol (anaesthetic), levodopa (antiparkinson), mefloquine (antimalaria), phenytoin, barbiturates, carbamazepin (antiepileptica)
    • Bupropion (tobacco dependence), celecoxib (NSAID), cinacalcet (antiparathyroid drug), duloxetine (SNRI), flufenazin (antipsychotic), fluoxetin (SSRI), gefitinib (antineoplastic), moclobemid (MAO), paroxetine, Sertraline (SSRI), Terbinafine (antimycotics), Yohimbin (erectile dysfunction) samt fluvoxamin (SSRI), ciprofloxacin and enoxacin (microbiotic), because plasma concentration of Imipramine can increase with the simultaneous use of these potent CYP2D6- and CYP1A2- inhibitors