Antidepressants: general practitioners' opinions and clinical practice.

OBJECTIVE: To describe and compare general practitioners' (GPs) opinions on antidepressant drugs and their prescriptions to depressed patients. METHOD: Between November 2000 and July 2001 a representative sample of French GPs was asked their opinion of the 15 most prescribed antidepressants, and then to describe the treatments of the current depressive episode of four depressive patients each, their changes and the reasons thereof. RESULTS: One hundred and eighty-one GPs and 778 patients participated. The best-ranked antidepressants by the GPs were paroxetine, fluoxetine, sertraline and clomipramine for efficacy, and paroxetine, tianeptine, sertraline and fluoxetine for tolerability. In patients, the drugs most often prescribed were fluoxetine, paroxetine, and sertraline. Those least often stopped for intolerance were moclobemide (0%), dosulepine (0%), venlafaxine (4.5%) and citalopram (5.0%), and maprotiline (0%), citalopram (1.7%) and venlafaxine (2.3%) for lack of efficacy. The best predictor for prescription of antidepressants was the GPs' overall ranking, itself depending on opinions of the tolerability and efficacy of the drug. However, opinions of tolerability and efficacy were not related to the rates of treatment discontinuation for intolerability or inefficacy. CONCLUSION: Prescriber opinion does not seem related to actual product performance.

Antidepressants: psychiatrists' opinions and clinical practice.

OBJECTIVE: To describe and compare psychiatrists' opinion on antidepressant drugs and their prescriptions to depressed patients. METHOD: Between January and September 1999 a representative sample of French psychiatrists was asked their opinion of the 15 most prescribed antidepressants, and then to describe the treatments of the current depressive episode of four depressive patients each, their changes and the reason thereof. RESULTS: A total of 232 psychiatrists and 935 patients participated. The best ranked antidepressants were clomipramine, paroxetine and amitriptyline for efficacy, tianeptine, paroxetine and citalopram for tolerability. In patients, the most often prescribed were paroxetine, fluoxetine and venlafaxine. Those least often stopped for intolerance were tianeptine (2.9%), citalopram (5.2%), venlafaxine (3.3%) and amitriptyline (5.7%) for lack of efficacy. There was no difference in stopping rates for inefficacy of tricyclics and serotonin-selective agents. CONCLUSION: The best predictors for the prescribed antidepressants were the psychiatrists' overall rankings and opinions of the tolerability of the drug.

[Human neurotoxicity of ethylene-bis-dithiocarbamates (EBDC)]. / La neurotoxicité des éthylène-bis-dithiocarbamates (EBDC) chez l'homme.

Ethylene-bis-dithiocarbamates (EBDC) (maneb, mancozeb,...) are fungicides which rarely cause acute toxicity reactions, but may have a severe long-term toxic effect. Twelve cases reported to the Bordeaux Anti-Poison Center over a 10-year period generally exhibited short-term neurological symptoms of variable severity. Cases of acute intoxication reported in the literature have involved various neurological signs including headache, dizziness and confusion, and a few cases of seizures, all of which were rapidly reversible. Long-term exposure has been associated with parkinsonism and epidemiological studies have found an increased risk of neurocognitive impairment associated with long-term exposure to pesticides in general and to EBDC specifically. Experimentally, EBDC increases the neurotoxicity of MPTP and paraquat. Their metabolite, ethylene thiourea (ETU), is neurotoxic in utero. There are indications that EBDC and/or ETU may increase sensitivity to genetic and environmental risk factors for cell death and apoptosis. Occupational or accidental exposure to EBDC and its possible long-term consequences require adequate studies concerning their mechanism, surveillance and prevention.