Effects of carbamazepine on serum antidepressant concentrations in psychiatric patients.

The combination of carbamazepine and an antidepressant (doxepin, amitriptyline, mianserin) was given to 22 psychiatric inpatients with 29 measurements of their serum antidepressant concentrations. For comparison, sex-, age-, and dose-matched inpatients, treated with the antidepressant but not with carbamazepine, were selected as controls (N = 29). All the patients were treated with their routine daily dose for at least 7 days before the gas-chromatographic measurement of serum predose concentrations of the antidepressants. In patients with carbamazepine, serum doxepin and doxepin + nordoxepin concentrations (N = 17) were decreased significantly (p less than 0.05), on average to 46% and 45%, respectively, as compared to that in subjects without carbamazepine. Also in carbamazepine + amitriptyline patients, serum nortriptyline and amitriptyline + nortriptyline concentrations (N = 8) were significantly lower than in those not receiving carbamazepine (p less than 0.05). The mean serum antidepressant levels were decreased to 42% and 40%, respectively. The serum mianserin concentration of carbamazepine patients (N = 4) was reduced to 30% of that in patients not treated with carbamazepine (p less than 0.01). The percentage fractions of demethylated metabolites (nordoxepin, nortriptyline) from the total antidepressant levels were not influenced by carbamazepine. In patients treated with carbamazepine, serum total antidepressant concentrations remained more often below the suggested therapeutic ranges than in those patients without carbamazepine. The results suggest that serum antidepressant concentrations are reduced by concurrent carbamazepine therapy, and that the concentrations should be carefully monitored when carbamazepine is added to the antidepressant regimen.

Mortality among male farmers in Finland during 1979-1983.

In this study the cause-specific mortality of male farmers in Finland was compared with the mortality of all economically active men. Mortality was also examined by size of farm, by type of farm production, and by geographic area. It was shown that, compared to the mortality of all economically active men, that of the farmers was generally low. The only exception was mortality due to respiratory diseases, for which the mortality rate of the farmers was about 40-50% higher than that of all economically active men. The rate ratio, which was higher for those men with small farms, was almost independent of the cause of death. The rate ratio was highest for farmers in eastern and northern Finland. Assessed by type of farm production, the differences in mortality were small. It was supposed that the high rate ratio of respiratory deaths among farmers was, at least partly, work-related. The high mortality of the men with a small farm was shown to be associated with the higher proportion of smokers among this group of farmers.

Incidence of clinically confirmed farmer's lung in Finland and its relation to meteorological factors.

In Finland, data about the incidence of clinically confirmed (according to predefined criteria) farmer's lung have been collected in successive years since 1980. All special hospitals for pulmonary diseases and departments of pulmonary diseases in other hospitals (23 clinical units throughout Finland) took part in the study. This report deals with the results collected from 1980 to 1982 (inclusive), during which 512 new cases of farmer's lung were recorded, 186 in 1980, 153 in 1981, and 173 in 1982. The mean age of the patients was 47 years (range 14-75), 45 years for men and 48 years for women. About two-thirds of the patients were women. The mean annual incidence of farmer's lung among the entire farming population (standardized for age and sex to the total population in Finland in 1975) was 44 per 100,000 persons in farming. Both the standardized mean annual incidence (range 8-60 per 100,000 persons in farming) and the female/male ratio of the standardized incidence showed distinct regional differences. Most cases of farmer's lung occurred during the indoor feeding season for cattle. The highest frequency of new cases was observed in April and the lowest in October. The incidence of farmer's lung was positively correlated with measures of daily rainfall and negatively correlated with days without rainfall and with sunshine during the haymaking period preceding the diagnosis. A rainy haymaking period calls for artificial drying of hay in order to reduce the incidence of farmer's lung.