In recent years the development of effective anti-depressant drugs has led to much controversy and uncertainty regarding the treatment of depressive states. Indications for the primary use of E.C.T. remain obscure, whilst choice of drug seems to be determined by current personal preference rather than by any specific rationale. If reliable prognostic formulations—and so, rational lines of treatment—are to be developed, there is an urgent need for the accumulation of data from controlled trials rather than a continuing spate of “1”.Amitriptyline, a new anti-depressant chemically resembling both imipramine and chlorpromazine has, in a blind controlled study carried out by the authors, been shown to be significantly superior to imipramine in the treatment of female patients between 30 and 70 years of age, hospitalized with primary depressive states (Burt, Gordon, Holt and Hordern, 1962). The findings in the first 74 patients were unexpectedly so much in favour of amitriptyline that to confirm them the trial was extended to include a further 65 patients conforming to the same criteria; but as two died, the total sample consisted of 137 female patients. The size of this sample facilitated (1) an investigation of the phenomenology of depressive states in women and (2) a study of the significance of a number of prognostic variables in relation to the outcome of treatment with amitriptyline and imipramine.
“What's the use of their having names” the Gnat said, “if they won't answer to them?” “No use to them“, said Alice, “but it's useful to the people that name them, I suppose. If not, why do things have names at all?”
Since its introduction in 1938, electroconvulsive therapy (E.C.T.) has shown itself to be a dramatically effective, unusually safe treatment for severe depressive states (“melancholias”, “endogenous” or “psychotic” depressions). Nevertheless, it is repugnant to many patients and psychiatrists, produces a troublesome, if transient, amnesia—especially in older individuals—and is occasionally complicated by fractures and dislocations as well as by anaesthetic and relaxant misadventures. Worst of all, as early studies showed, of the 80–90 per cent. of severe depressives who respond to E.C.T., some 30 per cent. relapse (Huston and Locher, 1948 a, b). Recent work suggests that the rate of relapse may often be higher still—thus of 94 per cent. of a group of patients who had responded to E.C.T., Kiloh and Ball (1961) reported that 46 per cent. had relapsed during the six months following the cessation of treatment. For these reasons, the trend to chemotherapy initiated by the advent of effective antidepressant compounds in 1957 continues to develop, and signs are becoming manifest that within a few years E.C.T. may be replaced by pharmacotherapy.
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