dothiepin-hydrochloride and Anxiety-Disorders

Repeated assessments of psychopathology, together with personality status, were made over two years on 181 psychiatric out-patients with generalised anxiety disorder (59), panic disorder (66), or dysthymic disorder (56) diagnosed using an interview schedule for DSM-III. Patients were randomly allocated to drug treatment, cognitive and behaviour therapy, or a self-help treatment programme. Although there were no overall differences in compliance rate and efficacy between the three modes of treatment, the psychological treatment methods, particularly self-help, were more effective in patients without personality disorder, and those with personality disorder responded better to drug treatment, primarily antidepressants. The findings suggest that assessment of personality status could be a valuable aid to selection of treatment in neurotic disorders and that self-help approaches are particularly valuable once personality disorder has been excluded.

Topics: Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Depressive Disorder; Diazepam; Dothiepin; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurotic Disorders; Panic Disorder; Personality Assessment; Self-Help Groups

The validity of the general neurotic syndrome, a combination of anxiety, depression and dependent personality disorder, was examined in a 2-year study of outpatients with dysthymic, panic and generalized anxiety disorder diagnosed using a structured interview schedule. The general neurotic syndrome, found in a third of the patients, was associated with greater mental disorder and a significantly worse outcome than patients without the syndrome. It did not, however, predict response to treatment. Further analysis revealed that the general neurotic syndrome was a better predictor of short- and long-term outcome than any other variable apart from initial psychopathology score. It is argued that the syndrome may represent a personality diathesis that makes the individual more vulnerable to both anxiety and depressive symptoms.

Topics: Adjustment Disorders; Anxiety Disorders; Cognitive Behavioral Therapy; Depressive Disorder; Diazepam; Dothiepin; England; Follow-Up Studies; Humans; Life Change Events; Neurotic Disorders; Panic Disorder; Personality Disorders; Psychiatric Status Rating Scales; Self Care

Two hundred and ten psychiatric patients with one of three DSM-III diagnoses, generalized anxiety disorder (N = 71), panic disorder (N = 74) or dysthymic disorder (N = 65), were included in a clinical trial in which diazepam, dothiepin or placebo tablets, cognitive and behaviour therapy, or a self-help package were given over ten weeks. Personality status was assessed independently using a structured interview, the Personality Assessment Schedule. One hundred and ninety-eight patients had personality assessments, 89% with a close informant. Thirty-six per cent had a personality disorder and these patients had more severe psychopathology than those with no personality disorder. Personality disorder was more common in patients with dysthymic disorder and this group responded less well to treatment. The category of personality disorder had no apparent influence on symptoms.

Topics: Anxiety Disorders; Behavior Therapy; Clinical Trials as Topic; Cognitive Behavioral Therapy; Depressive Disorder; Diazepam; Dothiepin; Double-Blind Method; Fear; Follow-Up Studies; Humans; Panic; Personality Assessment; Personality Tests

210 psychiatric outpatients with generalised anxiety disorder (71), or panic disorder (74), or dysthymic disorder (65) diagnosed by an interview schedule for DSM-III were allocated by constrained randomisation to one of five treatments: diazepam (28), dothiepin (28), placebo (28), cognitive and behaviour therapy (84), and a self-help treatment programme (42). All treatments were given for 6 weeks and then withdrawn by 10 weeks. Ratings of psychopathology were made by psychiatric assessors blind to both treatment and diagnosis before treatment and at 2, 4, 6, and 10 weeks after randomisation. 18 patients had insufficient data for analysis because of early drop-out. There were no important differences in treatment response between the diagnostic groups, but diazepam was less effective than dothiepin, cognitive and behaviour therapy, or self-help, these three treatments being of similar efficacy. Significantly more patients in the placebo group took additional psychotropic drugs in the 10 week period, and those allocated to dothiepin and cognitive and behaviour therapy took the least.

Topics: Adult; Aged; Analysis of Variance; Anxiety Disorders; Behavior Therapy; Clinical Trials as Topic; Cognition; Counseling; Depressive Disorder; Diazepam; Dibenzothiepins; Dothiepin; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Panic; Psychotherapy; Random Allocation; Relaxation Therapy; Time Factors

Dothiepin, a thio analogue of amitriptyline, has been used extensively in Europe during the past 15 years. It is a safe and effective agent for the treatment of major depressive disorder. Although the onset of action is comparable to that of other tricyclic antidepressants, dothiepin may cause fewer intolerable side effects and have less cardiotoxicity than these other compounds. In addition, dothiepin reduces the anxiety associated with some major depressive episodes. These features suggest that dothiepin may be particularly helpful for treating anxious depressed patients and patients who have underlying cardiac disease or who are elderly.

Topics: Adult; Anxiety Disorders; Clinical Trials as Topic; Constipation; Depressive Disorder; Dibenzothiepins; Dothiepin; Female; Humans; Male; Middle Aged; Nausea; Psychiatric Status Rating Scales; Sleep; Xerostomia

Topics: Adjustment Disorders; Adolescent; Adult; Aged; Amitriptyline; Anxiety Disorders; Clinical Trials as Topic; Depression; Depressive Disorder, Major; Dibenzothiepins; Dothiepin; Drug Tolerance; Female; Humans; Male; Middle Aged; Motor Activity; Sleep Wake Disorders; Thymus Gland

Topics: Adolescent; Adult; Anti-Anxiety Agents; Anxiety Disorders; Benzodiazepines; Dibenzothiepins; Dothiepin; Humans; Methotrimeprazine; Middle Aged

Topics: Anxiety Disorders; Dibenzothiepins; Dothiepin; Female; Humans; Neurotic Disorders; Personality; Personality Inventory

Topics: Antidepressive Agents, Tricyclic; Anxiety Disorders; Climacteric; Depressive Disorder; Dibenzothiepins; Dothiepin; Female; Humans; Middle Aged

Topics: Adult; Anxiety Disorders; Dibenzothiepins; Dothiepin; Female; Humans; Middle Aged; Personality Inventory; Psychiatric Status Rating Scales

The European clinical experience with dothiepin since 1962 indicates that it is efficacious in the treatment of depression (neurotic, psychotic, and with concomitant anxiety) in dose of 75-200 mg/day. The side effects profile is similar to the tricyclic antidepressant drugs with significantly less anticholinergic side effects and cardiotoxicity then amitriptyline. The result of the current ongoing clinical trails in the United States with several hundred patients will more precisely define the efficacy, dosage and side effect profile of dothiepin.

Topics: Adolescent; Adult; Affective Disorders, Psychotic; Aged; Anxiety Disorders; Depressive Disorder; Dibenzothiepins; Dothiepin; Double-Blind Method; Drug Administration Schedule; Europe; Female; Humans; Male; Middle Aged