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July 15, 1988

Desipramine for Interstitial Cystitis

Author Affiliations

Loyola University, Stritch School of Medicine Maywood, Ill

Loyola University, Stritch School of Medicine Maywood, Ill

JAMA. 1988;260(3):341. doi:10.1001/jama.1988.03410030057022

To the Editor.—  The syndrome of interstitial cystitis, with its distressing urinary symptoms, has remained a diagnostic and treatment challenge since first recognized in 1907.1 Its etiology is unknown. Although nonspecific chronic inflammation, with mast cells in the interstitial tissue of the bladder, was once believed to be pathognomonic of interstitial cystitis, other connective-tissue diseases have been shown to have similar pathological changes. Cystoscopy shows reduced capacity (<450 mL), fissures, linear scars, glomerulations, and sometimes Hunner's ulcers or "splotchy" hemorrhages in the bladder wall. There is rarely infection on cultures or biopsy samples. It occurs six to 11 times more commonly in women, who report intense urinary frequency, urgency, suprapubic pain, and unpredictable incontinence. This may be embarrassing to the point of social withdrawal. Marked anxiety, despair, and even a clinical depression may occur after numerous physicians and urologists are consulted, many explanations are given, and treatments are followed without