Implications of restrictive diagnosis for compliance to antidepressant drug therapy: alprazolam versus imipramine.

Early dropouts from a double-blind comparison of the therapeutic efficacy of alprazolam and imipramine were examined. The dropout rate across the total sample of 99 analyzable outpatients with major depression was 3 times higher in the imipramine treatment group. Although essentially all patients met DSM-III criteria for major depressive episode, only two thirds of the total sample met the restrictive Feighner criteria for primary depressive disorder. Early termination in the imipramine group was concentrated in the group of depressed outpatients who failed to satisfy the Feighner criteria. Implications of these and other recently reported results for choice of drug treatment for depressed psychiatric outpatients are discussed.