Psychodynamic and psychotherapeutic problems in connection with imipramine (Tofranil) intake.
The effect of imipramine on depressive states was presented and a hierarchical methodology outlined, where the drug action was studied at three levels: phenomenological, psychodynamic and psychotherapeutic. From a psychodynamic point of view the following events seem to occur concomitant with imipramine: (1) A change in the mood of depression either to the pre-morbid state, or towards elation and mania. (2) A decrease in guilt feelings and a change from an undue preoccupation with internal object relations to external object relations. (3) A primary change in the direction of aggressive tendencies from inward to outward. (4) Secondary reorganization of libidinal tendencies.

The mode of action of imipramine could be conceptualized as the induction of an economic shift in the aggressive cathecting energies of internalized systems of control (super-ego components) resulting in a primary reorganization of aggressive object relations, a secondary reorganization of libidinal object relations, and subsequent relief of depressive state.

Based upon the above conclusions the drug was given to 5 not overtly depressed patients on a predictive level and the following conclusions reached: (1) Imipramine is useful in the initial stages of psychoanalysis of severe depressions; (2) it is useful in depressive episodes occurring during psychoanalysis; and (3) it may be used beneficially in “latent depressions” where intense guilt feelings prevent the setting in of psychoanalytic processes.