Imipramine in the Treatment of Nocturnal Enuresis of Childhood

Abstract

A double-blind study of the use of imipramine in the treatment of nocturnal enuresis is reported. The subjects were twelve children aged six to 12 years in a children's psychiatric hospital. The drug (25 mg) or placebo was administered at 8.00 p.m. for two or four weeks at a time, the trial extending from 16 weeks to 32 weeks. For the group as a whole, the number of enuretic nights declined from 46.75% on placebo to 31.75% on drug, a reduction of 32.09%. The average enuresis per child declined from 47.25% to 30.75%, a reduction of 34.92%. Three children showed a significant response to placebo, one of these became virtually dry. Seven of the subjects showed a signficant response to the drug, with reduction of enuretic nights of 25% or more in all, of 50% or more in three and of 70% or more in two. Relapse occurred on discontinuing the drug. In addition to the fall in enuresis each time drug was given, an over-all decrease in enuresis occurred throughout the trial, not due to spontaneous improvement. It is suggested that this results from the full effects of the drug being somewhat delayed and taking some time to wear off. Observations on the time at which enuresis occurred showed that most commonly only incidents after 1 a.m. were reduced, suggesting that for this group earlier administration of the drug may be desirable. In only one subject was enuresis before 1 a.m. accompanied by an increase in incidents after 1 a.m. and for such cases an increased dosage may be effective. No side effects from the drug were observed. A consideration of the mode of action of the drug is presented and it is concluded that it may act by diminishing uninhibited bladder contractions by its autonomic diencephalic action. Previous reports on the treatment of enuresis by imipramine are reviewed together with a brief review of controlled studies of other drugs which have appeared in the past decade. It is concluded that imipramine is a useful drug in the treatment of enuresis in psychiatrically disturbed children.