The syndrome concept of alcohol and drug dependence: results of the secondary analysis project.
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Biomedical subjects
Publications and source records attributed to H Rankin.
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One hundred and fifteen patients from 5 general practices participated in a 12-week, double-blind study comparing L-tryptophan, amitriptyline, L-tryptophan-amitriptyline combination and placebo in the treatment of depression. Analysis of total score on the Hamilton Depression Scale and a global rating of depression showed that all 3 active treatments were more effective than placebo. Significantly more patients were withdrawn as treatment failures in the placebo group compared with the active treatment groups. Side-effects necessitated withdrawal of more patients from the amitriptyline group than from the other active treatment groups, but this difference was not significant. Plasma amitriptyline and nortriptyline levels were similar in the amitriptyline and combined treatment groups. Standard haematological and biochemical profiles did not alter significantly in any group, but mean heart rate was significantly increased in patients receiving amitriptyline. There was no change in free or total plasma tryptophan concentration with treatment or on remission of symptoms.
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Twenty-six male compulsive gamblers were seen in one hospital over the last 8 years. Five were single, and only 5 had stable marriages. In most cases the compulsive gambling preceded their marriage. The majority had criminal records arising out of their gambling debts. All were offered treatment based on behavioural principles, but only 5 gained and maintained control over their gambling, 7 lapsed intermittently, and the remaining 14 were gambling when last seen. The problems in treatment are discussed, and modifications suggested.
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