[A French experiment: a law for alcoholics presumed to be dangerous]. / Une expérience française: la loi sur les alcooliques présumés dangereux.

In France the complexity of the problems of alcoholism lie in its magnitude as well as its socio-economic implications. Countermeasures are conducted on essentially four levels: (i) social and educational; (ii) economic; (iii) repressive; (iv) health measures; all of which are embodied in the law of April 15th, 1954 concerning 'alcoholics presumably dangerous to others'. After a historical introduction the authors delineate the ante-delinquent character of the 1954 law and compare it to similar 'ante delictum' laws elsewhere. They describe the various modalities of its application and analyze its concept and actual application under positive as well as negative aspects. In an era of widely advocated, though not always sufficiently financed and endorsed, preventive approaches it appears worthwhile reflecting on a law which is opposed in principle by some and is difficult to apply because of limited resources, but has the merit of existing and allowing for an analysis of the reality.

First clinical experience with ifoxetine, a new 5-HT reuptake blocker with particular emphasis on the side-effect profile of the 5-HT-uptake inhibiting drugs.

Ifoxetine (CGP 15 210 G) is a novel and unusual drug. It specifically and selectively blocks the 5-HT reuptake in the brain without affecting the 5-HT uptake processes in the periphery (blood platelets). In the first, open and explorative trials its tolerability and effectiveness were studied in 33 patients suffering from endogenous (n = 25) or other types of depressive disorders. In daily doses of 50 to maximally 300 mg mental condition considerably improved in 17 patients. As assessed by HAMD 7 patients out of 17 became asymptomatic (HAMD Score less than 10) whereas 10 other patients markedly improved (decrease in HAMD by greater than or equal to 50%) in the course of 3 to 4 weeks of treatment. Eleven patients improved only slightly, in 3 patients no particular change in condition could be observed and 2 patients deteriorated. This deterioration was due to psychotic decompensation after the second week of the treatment (75-100 mg/d). Apart from this, ifoxetine was well tolerated particularly at doses of 50-150 mg/day, which also appeared to be the optimal therapeutic range of doses. There were no changes in cardiovascular function or laboratory values and almost no somatic or other complaints of major concern. These preliminary results indicate that ifoxetine has antidepressant properties with possibly an advantageous side-effect profile, in comparison to other 5-HT uptake inhibitors.

Des-enkephalin-gamma-endorphin in the treatment of schizophrenia.

Ninety-three patients with an exacerbation of chronic schizophrenia were included in a 4 week trial comparing placebo with 1, 3 and 10 mg des-enkephalin-gamma-endorphin (DE gamma E; beta-lipotrophin 66-77; Org 5878) per day (i.m.). Maintenance antipsychotic and other medications were continued unchanged. Treatment effects were assessed by means of the Comprehensive Psychopathological Rating Scale--subscale schizophrenia (CPRS-S), Brief Psychiatric Rating Scale (BPRS) and Global Assessment Scale (GAS) rating scales at weekly intervals. Safety data, i.e. laboratory investigations, vital signs and ECG recordings, were assessed before and during the trial. Side-effects were evaluated by means of a Record of Symptoms Emerging. Sixty-eight patients completed the trial, the reason for drop-out mainly being inadequate treatment effects and refusal of medication administration. One patient violated the protocol. After 4 weeks of treatment the mean CPRS-S score of the group receiving 10 mg DE gamma E daily had decreased statistically significantly more than the corresponding score of the placebo group (p less than 0.01). The same trend was apparent with BPRS (p = 0.08) and GAS (p greater than 0.1) scores. Therefore, the study should be considered inconclusive. No clinically relevant side-effects attributable to DE gamma E were observed.

[Oral contraception and induced depressive states]. / Contraception orale et états dépressifs induits

PIP: Cultural, psychological, and biochemical explanations for depression in users of oral contraceptives are discussed. The suppression of taboos against sexuality cannot be expected to bring about instant psychological adjustment, as shown by the large numbers of women who are afraid to take the pill or who develop psychosomatic disorders and depression. Incidence of depression as reported in the literature ranges from 5% to 45%. Some authors attribute psychogenic causes for depression associated with the pill, such as temporary castration, instant sexual liberation, or womens' undeniable maternal instinct. Others present evidence for biochemical causes of depression. General explanations for pill-related depression include imbalance of hypothalamic amines and consequently of releasing factor, prolactin-inhibiting factor, decreased brain serotonin due to inhibition of tryptophan hydroxylase by progestagens, or diminished brain biogenic amines because of lowered pyridoxal levels. From clinical work with neuroleptic drugs it is known that drugs, stress, or anxiety can disturb the biochemical balance and result in amenorrhea. High progestin levels may be responsible for premenstrual anxiety and headaches.^ieng

Citalopram versus maprotiline: a controlled, clinical multicentre trial in depressed patients.

In a double-blind trial, comprising 96 depressed patients, citalopram was compared with maprotiline. The trial period was 6 weeks with ratings (MADRS, CGI) and side effects recordings taking place at Weeks 0, 1, 2, 4, and 6. Both drugs were administered as a single evening dose, 40 or 60 mg for citalopram, and 75 or 150 mg for maprotiline. MADRS total scores and CGI scores showed a highly significant reduction in both groups with no significant difference between them, whether the groups were considered as a whole or whether they were subdivided into endogenously/non-endogenously depressed or melancholic/non-melancholic patients. Side effects were not significantly different, but the maprotiline group showed more anticholinergic side effects, whereas the citalopram group showed more nausea, increased sweating and headache. Two patients on maprotiline were withdrawn because of side effects (hypotension and somnolence in the one case; tremor and insomnia in the other). One patient in each group was withdrawn because of increased transaminases, the citalopram-treated patient having increased values, however, already at baseline. Apart from this, no cardiovascular side effects and no pathological laboratory values related to treatment were observed. The authors conclude that citalopram is a safe antidepressant drug and as effective as maprotiline.