A comparative study of phentermine and diethylpropion in the treatment of obese patients in general practice.

A study was carried out in general practice to compare the effectiveness and tolerance of phentermine and diethylpropion in helping patients more than 20% above their desirable weight to lose weight. Patients were allocated at random to receive either one 30 mg capsule of phentermine (50 patients) or one 75 mg tablet of diethylpropion (49 patients) daily over a period of 12 weeks. They were also asked to restrict their calorie intake to 1500 calories per day. The results showed that there was a significantly greater weight loss in patients treated with phentermine which was particularly marked during the last 4 weeks of the study. There were significant reductions in blood pressure and heart rate in the phentermine group and of heart rate in the diethylpropion group. These were almost certainly related to weight loss rather than to a direct effect of drug treatment. Side-effects were generally minor in nature and the incidence and nature of them were comparable in the two groups.

Doctor's versus patient's judgement in the assessment of mixed anxiety/depressive illness. Implications for measurement of therapeutic response.

The relationship of doctors' assessments to their patients' self-assessments was examined in a double-blind comparison of Motipress and Anafranil in patients suffering from mixed anxiety/depressive states. Significant differences between doctors' ratings were revealed which were largely parallelled by their patients' self-ratings done independently, suggesting differences between subgroups of patients within the whole population. Appropriate statistical analyses eliminated these factors in the data and showed that they did not affect the conclusions of a conventional statistical analysis of the two treatment groups as a whole; there were no significant differences between the major improvements associated with each treatment.

A double-blind study comparing cefaclor and amoxycillin in the treatment of respiratory tract infections in general practice.

A prospective double-blind study was carried out to compare the efficacy of intermittent versus continuous levels of beta-lactam antibiotics. Two hundred and ninety-eight patients attending their general practitioner and requiring treatment for respiratory tract infections were randomly allocated to receive either 250 mg cefaclor 3-times daily (intermittent) or 500 mg amoxycillin 3-times daily (continuous). By most of the parameters used to assess outcomes, the group on cefaclor did better than the group on amoxycillin, although in no case was the difference statistically significant. This result confirms previous studies which have shown that the maintenance of continuous levels of antibiotic is not a necessary objective when using beta-lactam antibiotics.

Anxiety states in family practice: an evaluation of the need for antidepressant as well as anxiolytic therapy.

Patients attending their family practitioner with emotional disturbance manifesting predominantly as anxiety were treated once daily for 4 weeks with either a pure anxiolytic, potassium clorazepate, or a formulation of a specific antidepressant together with an anxiolytic, fluphenazine/nortriptyline, in accordance with a double-blind, completely randomized design. After the first week the patients receiving fluphenazine/nortriptyline were showing a better response in terms of total symptomatology as well as anxiety, tension and depression taken separately, and after 4 weeks treatment this trend reached statistically significant levels on both the physicans' ratings and the patients' self-ratings for overall symptomatology (p less than 0-05) as well as anxiety and tension on the physicians' scale (p less than 0-01). Side-effects were infrequent, with the exception of drowsiness which was complained of by 42% of the patients receiving clorazepate. Although simple and convenient to take, a once daily benzodiazepine formulation of fixed dose is likely to be too inflexible to achieve optimal therapeutic effect in many patients. These results are in accord with accumulating evidence for the importance of a depressive aetiology underlying the majority of so-called anxiety states in family practice. Anxiolytic, in the absence of specific antidepressant, therapy is unlikely to be adequate for these patients, and may lead to long-term palliative use of benzodiazepines incurring a risk of dependence.

Once daily administration of a fluphenazine/nortriptyline preparation in the treatment of mixed anxiety/depressive states.

A study of 223 patients diagnosed as suffering from mixed anxiety/depressive states was carried out in general practice to compare the effectiveness of treatment with a once-daily tablet preparation containing 1.5 mg fluphenazine plus 30 mg nortriptyline, taken either at night or in the morning, with the same total daily dose taken as 1 tablet t.d.s. Patients were randomly assigned to 4-week's treatment with one of the three drug schemes, and patients' self-ratings as well as physicians's ratings were used to assess symptoms. Both rating assessments showed that there were highly significant improvements in each of the three treatment groups over the 4-week period. Although there were no clinically important differences between improvements in the night-time dose and t.d.s. groups, there was a higher incidence of drowsiness and tablet defaulting among patients taking the single morning dose.

Anxiety/depression in elderly patients. A double-blind comparative study of fluphenazine/nortriptyline and promazine.

A double-blind study involving sixty-two patients, aged 65 years or over, treated for twenty-eight days, showed that fluphenazine 0-5 mg/nortriptyline 10 mg three times daily was superior to promazine 50 mg three times daily in relieving symptoms of anxiety and was associated with a lower incidence of side-effects. The results are discussed in the light of the nature of anxiety/depression syndromes in the elderly and it is suggested that since symptoms of anxiety in these disorders are often manifestations of an underlying depressive illness, the antidepressant effect of the nortriptyline may have enhanced the 'anxiolytic' advantage of fluphenazine/nortriptyline.