Imipramine Plus Cognitive-Behavioral Therapy in the Treatment of School Refusal

Mar 14, 2000Journal of the American Academy of Child and Adolescent Psychiatry

Combining Imipramine and Cognitive-Behavioral Therapy to Treat School Refusal

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Abstract

Over 8 weeks, the imipramine group achieved a mean school attendance rate of 70.1% compared to 27.6% for the placebo group.

School attendance improved significantly for the imipramine group, while the placebo group did not show significant improvement.
The rate of improvement in school attendance was significantly faster for the imipramine group compared to the placebo group.
More than half (54.2%) of the imipramine group achieved remission (75% school attendance) after treatment, versus only 16.7% in the placebo group.
Both groups experienced a reduction in anxiety and depression symptoms, but the imipramine group showed a significantly faster decrease in depression symptoms.

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OBJECTIVE: To investigate the efficacy of 8 weeks of imipramine versus placebo in combination with cognitive-behavioral therapy (CBT) for the treatment of school-refusing adolescents with comorbid anxiety and major depressive disorders.

METHOD: This was a randomized, double-blind trial with 63 subjects entering the study and 47 completing. Outcome measures were weekly school attendance rates based on percentage of hours attended and anxiety and depression rating scales.

RESULTS: Over the course of treatment, school attendance improved significantly for the imipramine group (z = 4.36, p < .001) but not for the placebo group (z = 1.26, not significant). School attendance of the imipramine group improved at a significantly faster rate than did that of the placebo group (z = 2.39, p = .017). Over the 8 weeks of treatment, there was a significant difference between groups on attendance after controlling for baseline attendance; mean attendance rate in the final week was 70.1% +/- 30.6% for the imipramine group and 27.6% +/- 36.1% for the placebo group (p < .001). Defining remission as 75% school attendance, 54.2% of the imipramine group met this criterion after treatment compared with only 16.7% from the placebo group (p = .007). Anxiety and depression rating scales decreased significantly across treatment for both groups, with depression on the Children's Depression Rating Scale-Revised decreasing at a significantly faster rate in the imipramine group compared with the placebo group (z = 2.08, p = .037).

CONCLUSIONS: Imipramine plus CBT is significantly more efficacious than placebo plus CBT in improving school attendance and decreasing symptoms of depression in school-refusing adolescents with comorbid anxiety and depression.

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Imipramine Plus Cognitive-Behavioral Therapy in the Treatment of School Refusal

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