Sir, Clinicians have depended on antidepressants for years in the management of depressive disorders Drug abuse involving antidepressants is not common, most of them involve agents with amphetamine like proper ties, including amineptine and tranylcypromine.1 Amineptine dependence and tianeptine abuse has been well documented.2 No case report related to dothiepin abuse has been documented till date. Herein we report on a case of dothiepin dependence.

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Seroprevalence of HIV, HBV, HCV and syphilis in voluntary blood donors.

The aims of this cross-sectional survey were to assess psychotic sufferers' perception of the effectiveness of their medication, the distress caused by adverse effects and the impact these might have on overall patient satisfaction with treatment. Three hundred and forty-one people diagnosed with psychosis who called a national mental health helpline (SANELINE) in the UK, between July 1998 and February 1999, were asked to take part in the survey. They were given a choice of either a postal questionnaire or a telephone interview in which the same questionnaire was used. One hundred and nineteen were interviewed on the telephone and 83 (out of 222) returned completed questionnaires. In total, information was available from 202 callers. Almost one-half of the respondents were dissatisfied with their medication, and almost all of them reported experiencing at least one adverse effect. Depression (or low mood), sedation and difficulty thinking and concentrating were the most prevalent adverse effects. Weight gain was the most distressing, particularly to women. Those taking atypical antipsychotics were significantly more likely than those on typical antipsychotics to experience insomnia and dry mouth, but were less likely to perceive depression and difficulty thinking/concentrating as quite or extremely distressing. Low satisfaction, as opposed to high satisfaction, was significantly associated with reporting weight gain, difficulty thinking/concentrating, insomnia and sexual dysfunction. It was also significantly associated with reporting weight gain, difficulty thinking/concentrating, muscle/joint stiffness and depression as quite or extremely distressing. Attention should be given to the management of cognitive impairment and weight gain as adverse effects of antipsychotics. Doctors should be more open to discussing the risks and nature of adverse effects with patients who should also be encouraged to do so.

Prevalence and extent of distress of adverse effects of antipsychotics among callers to a United Kingdom National Mental Health Helpline.

BACKGROUND: Rates of prescription drug abuse have reached epidemic proportions. Large-scale epidemiologic surveys of this under-recognized clinical problem have not included antidepressants despite their contribution to morbidity and mortality. The purpose of this review is to look specifically at the misuse of antidepressants and how this behavior may fit into the growing crisis of nonmedical use of prescription drugs. METHODS: We conducted a comprehensive search on PubMed, Medline, and PsycINFO using the search terms "antidepressant", "abuse", "misuse", "nonmedical use", "dependence", and "addiction", as well as individual antidepressant classes (eg, "SSRI") and individual antidepressants (eg, "fluoxetine") in various combinations, to identify articles of antidepressant misuse and abuse. RESULTS: A small but growing literature on the misuse and abuse of antidepressants consists largely of case reports. Most cases of antidepressant abuse have occurred in individuals with comorbid substance use and mood disorders. The most commonly reported motivation for abuse is to achieve a psychostimulant-like effect. Antidepressants are abused at high doses and via a variety of routes of administration (eg, intranasal, intravenous). Negative consequences vary based upon antidepressant class and pharmacology, but these have included seizures, confusion, and psychotic-like symptoms. CONCLUSION: The majority of individuals prescribed antidepressants do not misuse the medication. However, certain classes of antidepressants do carry abuse potential. Vulnerable patient populations include those with a history of substance abuse and those in controlled environments. Warning signs include the presence of aberrant behaviors. Physicians should include antidepressants when screening for risky prescription medication use. When antidepressant misuse is detected, a thoughtful treatment plan, including referral to an addiction specialist, should be developed and implemented. Language: en

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Abuse and misuse of antidepressants.

Trends in the injection of midazolam and other drugs and needle sharing among injection drug users enrolled in the AIDSVAX B/E HIV-1 vaccine trial in Bangkok, Thailand

The aim of the present study was to compare the possible dependence potential of antidepressants (ADs) to benzodiazepines (BZDs). The Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the Benzodiazepine Dependence Self-Report Questionnaire (Bendep-SRQ) and the Symptom Checklist-90 (SCL-90) were administered to 70 psychiatric outpatient BZD users and 54 psychiatric outpatient AD users. Significantly more Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R) as well as International Classification of Diseases, Tenth Edition (ICD-10) past year (PY) and lifetime (LT) dependence diagnoses were made in the BZD group than in the AD group. Bendep-SRQ scale scores for Problematic Use, Preoccupation and Lack of Compliance were significantly higher in the BZD group than in the AD group. The BZD group also had a higher rating on the Withdrawal scale, but this difference was not statistically significant. According to DSM-III-R and ICD-10 criteria ADs do have some dependence liability in psychiatric outpatients, but clearly to a lesser extent than BZDs. Further research is needed to differentiate the dependence potential among the various classes of ADs.

Dependence potential of antidepressants compared to benzodiazepines

A case report of a patient with amineptine and midazolam dependence is presented. A literature search was done for other cases of amineptine abuse and their presentations and medical investigations are compared. This is the first locally reported case of amineptine abuse and highlights the fact that amineptine is a potential drug of abuse.

Amineptine and midazolam dependence.

What you need to know: addiction--cough mixture.

Aim of study: To study the description of callers using a telephone helpline to improve support to patients in between appointments. Method: This includes creating a helpline in the department and getting psychiatrists, medical officers, psychologists and social workers trained to man this line during office hours. Information from callers were recorded and analysed using SPSS for MS Windows version 6.0. Results: The callers were mainly females calling about personal problems, namely psychiatric symptoms and sleep difficulties. Half were given specialist appointments and one-fifth were discharged after telephone counselling. Conclusions: Telephone counselling is useful in clarifying medical instructions and supporting psychiatric patients in between outpatient appointments.

I. Perera

Papers

Amineptine and midazolam dependence.

What you need to know: addiction--cough mixture.

Telephone counselling in psychiatry.