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January 13, 1984

Comparison of Alprazolam With Imipramine and Placebo

Author Affiliations

Affective Disorders Program Baystate Medical Center Springfield, Mass

JAMA. 1984;251(2):215. doi:10.1001/jama.1984.03340260023010

To the Editor.—  We refer to the article entitled "Comparison of Alprazolam, Imipramine, and Placebo in the Treatment of Depression" by John Feighner and associates.1 The authors reported that alprazolam is "at least as effective as imipramine hydrochloride in relieving depressive symptoms, significantly more effective in relieving somatic symptoms, and showed an earlier onset of activity in some measurements."We believe that these results may be misleading because of a serious methodological flaw in the study. The mean dosages of alprazolam and imipramine reported were the following:The authors stated that "previous clinical research indicates the mean doses of the two active drugs are equivalent." We dispute this. Most experts believe that a minimum of 150 mg of imipramine hydrochloride daily is necessary for an adequate therapeutic trial in most patients.2,3 Mean dosages of imipramine hydrochloride in this study were consistently below 150 mg daily. If adequate dosages