In Reply.— These letters suggest the need for explicit clarification of certain issues implicit in my editorial entitled Depressives, Doctors, and Antidepressants. Doubtless there would be general agreement that chlordiazepoxide is [not] preferentially indicated compared with imipramine in patients who have been depressed for at least three months, with a Hamilton test score of 25 or higher, probable or definite endogenous syndrome, and required admission as inpatients. The question is how faithfully this description, the sample studied by Keller et al, and the patients seen by investigators in tertiary-care centers generally represent depressed persons in the community who do not contact the medical care system or who are seen by primary care physicians. Systematic information about this point apparently is not yet available. Conversations with research psychiatrists who have long experience in working with family physicians suggest that depressed persons seen in primary care settings tend to be less severely
R Byck: History and osciology of cocaine use and research: three histories J H Woods, G D Winger and C P France: Dependence-producing properties of cocaine: a behavioural analysis C Kornetsky and G Bain: Neuronal bases for hedonic effects of cocaine and opiates G F Koob, F J Vaccarino, M Amalric, N R Swerdlow: Neural substrates for cocaine and opiate reinforcement R M Post, S R B Weiss, A Pert, T W Uhde: Chronic cocaine administration: sensitization and kindling effects F H Gawin, H Kleber: Issues in cocaine abuse treatment research T H Crowley: Clinical issues in cocaine abuse R E Schultes: Coca and other new world psychoactive plants: magical/religious roles in primitive societies.
Despite a sharp decline in the prescription of benzodiazepines during the past decade, reservations about their use have continued to escalate. This article presents converging data from three diverse sources: national survey data from consumers, laboratory data on the drug preferences of normal subjects, and a controlled clinical study of long-term diazepam treatment and withdrawal. These data suggest that (1) the risks of overuse, dependence, and addiction with benzodiazepines are low in relation to the massive exposure in our society; (2) benzodiazepine addiction can occur when doses within the clinical range are taken regularly over about 6 months; (3) many patients continue to derive benefit from long-term treatment with benzodiazepines; and (4) attitudes strongly against the use of these drugs may be depriving many anxious patients of appropriate treatment.
Rapid growth in the production and prescription of minor tranquilizers has stimulated increasing concern that we live in an "overmedicated" society. Data regarding drug use from a health survey in Oakland, Calif, show that (1) 20% took a minor tranquilizer or sedative during the previous year, 10% daily for a week or more; (2) use was related directly to the amount of distress and dysfunction, to psychologic more than to other types of disturbance, but not to situational stress alone; and (3) taking tranquilizers was only one aspect of a complex pattern of coping behaviors including the almost universal use of some medication, most often a "nonpsychotropic" type.
Abstract The discriminative stimulus (DS) and subjective effects of d ‐amphetamine (AMP) were examined in male and female normal healthy adults. Subjects were trained to discriminate between oral AMP (10 mg) and placebo. Of the 100 subjects who underwent discrimination training, 53 reliably learned the discrimination. These “discriminators” (Ds) were compared with the 47 “nondiscriminators” (NDs) on a variety of measures. Ds and NDs did not differ qualitatively in their response to AMP. As a group Ds were more certain than NDs of their ability to discriminate between AMP and placebo and were more accurate in labelling AMP as a stimulant. AMP also had a greater effect for Ds than for NDs on ratings of drug liking and general activity level during the day. Although Ds generally showed a stronger subjective response to AMP, Ds differed significantly from NDs on only 4 of 18 mood scales affected by AMP (2 anxiety scales and analog ratings of “stimulated” and “high”). Ds did not differ from NDs on any of the following measures: body weight, gender, current or lifetime drug use, baseline mood state, subjective response to placebo, or a variety of personality traits. The results demonstrate considerable individual differences in sensitivity to AMP and suggest a relationship between the DS effects of AMP and specific mood states.
