Trimipramine (Surmontil) is a largely forgotten tricyclic anti-depressant now available as an inexpensive generic.  It was found to be as good as other tricyclics, but had little evidence of superiority and was never that widely used.  Some international research in Germany is still being done.  Treatment may go up to 200 mg/d, but starting dosage is 75-100 mg/d with full treatment at 150 mg/d.  HS dosing is fine even in the elderly.  Trimipramine is unusual for anti-depressants in that it has an anti-psychotic effect as well, although the effect is not as powerful as a typical anti-psychotic. 

Trimipramine Helps Schizophrenia Some: A Univ. of Essen DB study of 95 acute schizophrenic patients comparing trimipramine 300-400 mg/d to perazine 450-600 mg/d for 5 weeks. With trimipramine, psychotic BPRS scores decreased 23% vs. 28% with perazine.  Antipsychotic efficacy of the antidepressant trimipramine: a randomized, double-blind comparison with the phenothiazine perazine. Bender S, Olbrich HM, Fischer W, Hornstein C, Schoene W, Falkai P, Haarmann C, Berger M, Gastpar M; Trimipramine Study Group. Pharmacopsychiatry. 2003 Mar-Apr;36(2):61-9

Trimipramine Helped Insomnia in DB: This DB PC study of 55 patient using trimipramine 100 mg HS vs. lormetazepam HS vs. placebo for 4 weeks. Trimipramine helped sleep efficiency without increasing sleep time or affecting REM sleep. There was no rebound insomnia. Univ. Freiburg. Trimipramine in primary insomnia: results of a polysomnographic double-blind controlled study. Riemann D, Voderholzer U, Cohrs S, Rodenbeck A, Hajak G, Ruther E, Wiegand MH, Laakmann G, Baghai T, Fischer W, Hoffmann M, Hohagen F, Mayer G, Berger M. Pharmacopsychiatry. 2002 Sep;35(5):165-74

Trazodone Better than Trimipramine for Sleep in DB: Six healthy young adults were compared in a DB PC study. Only trazodone increase sleep. It did not affect REM or sleep architecture. Increased deep sleep after trazodone use: a double-blind placebo-controlled study in healthy young adults. Ware JC, Pittard JT. J Clin Psychiatry. 1990 Sep;51 Suppl:18-22

Trimipramine Better for Sleep in Depressed than Imipramine; Unrelated to Depression: A DB study found that trimipramine helped sleep the first week but that sleep improvement did not parallel improvement in depression. E. Virginia Med School. Effects on sleep: a double-blind study comparing trimipramine to imipramine in depressed insomniac patients. Ware JC, Brown FW, Moorad PJ Jr, Pittard JT, Cobert B. Sleep. 1989 Dec;12(6):537-

Trimipramine = Amitriptyline in Short DB: A DB study of 34 depressed patients for just 3 weeks at 100 mg bid found both medicines equally effective. A comparative double-blind controlled study of trimipramine and amitriptyline in major depression: lack of correlation with 5-hydroxytryptamine reuptake blockade. Cournoyer G, de Montigny C, Ouellette J, Langlois R, Elie R, Caille G, le Morvan P.J Clin Psychopharmacol. 1987 Dec;7(6):385-93

Trimipramine Helped Rheumatoid Arthritis Pain: Similar to amitriptyline, this 36-patient, 12-week DB PC study of low dose trimipramine (25-75 mg/d) found trimipramine helped although interestingly, there was no impact on depression scores. Trimipramine in rheumatoid arthritis: a randomized double-blind trial in relieving pain and joint tenderness. Macfarlane JG, Jalali S, Grace EM. Curr Med Res Opin. 1986;10(2):89-93

Trimipramine = Doxepin in Small, Short DB: In a 4-week, 25-patient study of depression with both medicines at 150 mg HS, there were a few tests favoring trimipramine, but little overall difference. A comparative trial of the antidepressant, anxiolytic, and cardiovascular effects of trimipramine and doxepin in depressed hospitalized patients. Assalian P, Rosengarten MD, Phillips R. J Clin Psychiatry. 1985 Mar;46(3):90-4

Trimipramine Helped Depressed Medically Ill in DB: In a 6-week, 42-patient DB PC study of major depression, trimipramine was better than placebo and improvement in depression occurred without an impact on the medical illnesses. Trimipramine in physical illness with depression. Rifkin A, Reardon G, Siris S, Karagji B, Kim YS, Hackstaff L, Endicott N. J Clin Psychiatry. 1985 Feb;46(2 Pt 2):4-8

Trimipramine Helped Irritable Bowel in Very Large DB: In a DB PC study of 428 adults with irritable bowel, trimipramine 50 mg HS patients did better. A double-blind study of the effect of trimipramine in patients with the irritable bowel syndrome. Myren J, Lovland B, Larssen SE, Larsen S. Scand J Gastroenterol. 1984 Sep;19(6):835-43