The economic burden of depression is often underestimated, especially when both the direct and indirect costs of treating the disease are considered. The costs associated with antidepressant drug therapy are often the focus of efforts to reduce overall treatment costs, but in actuality they represent only 10% of the overall economic costs of depression. Thus, in analyses of the costs of depression, other factors-including hospitalization, physician costs, monitoring, and indirect costs associated with lost productivity and comorbidity-are important. Economic assessments comparing different antidepressant classes have often found that newer antidepressants are more cost-effective than older, less expensive drugs because of improved tolerability or efficacy. Venlafaxine represents the newest class of antidepressants and offers potential pharmacologic benefits, including early onset of action, dose flexibility, broad range of activity, and improved tolerance. In one analysis that used the results from a study of 67 hospitalized depressed patients, venlafaxine was estimated to result in a cost savings of 11.3% versus fluoxetine. These findings support the concept that the overall costs of depression are more important than the drug costs in determining the cost-effectiveness of therapy.

Antidepressive Agents, Second-Generation↗

PubMedDate not supplied

[The British and French systems of classification and psychiatric disorders].

We compare the french diagnostic system with that used in Great-Britain. The criteria are very similar except in the case of the non-affective functional psychoses. The French divide these into acute and chronic. Bouffée délirante, the prototype of the acute functional psychoses, is not diagnosed in Great-Britain. The British divide these psychoses into schizophrenic and non-schizophrenic disorders, particularly using Schneiderian criteria for the diagnosis of schizophrenia. Curiously, it is precisely these criteria, referred to as "automatisme mental" (Clérambault) which are used in France in order to diagnose the "chronic hallucinatory psychoses". This is a diagnosis which is unknown in Great-Britain, and which is in France classed firmly among the non-schizophrenic psychoses, truly a paradoxical situation.

Cross-Cultural Comparison↗

PubMedDate not supplied

How sleep and mental disorders are related to complaints of daytime sleepiness.

BACKGROUND: Daytime sleepiness is widespread and has negative impacts on the public sector. OBJECTIVE: To ascertain the incidence and prevalence of daytime sleepiness and associated risk factors in the general population. METHOD: In 1994, a representative sample of the non-institutionalized British population aged 15 years or older was interviewed via telephone using an expert computer-assisted program designed to facilitate surveys of this type (Sleep-Eval, M. M. Ohayon, Montreal, Quebec). Subjects were classified into 3 groups based on the severity of their daytime sleepiness. We completed 4972 interviews (acceptance rate, 79.6%). RESULTS: Severe daytime sleepiness was reported in 5.5% (95% confidence interval, 4.9%-6.1%) of the sample, and moderate daytime sleepiness in another 15.2% (95% confidence interval, 14.2%-16.2%). Associated factors with severe daytime sleepiness included female sex, middle age, napping, insomnia symptoms, high daily caffeine consumption, breathing pauses or leg pain in sleep, depressive disorder (based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria), falling asleep while reading or watching television, and motor vehicle crashes or accidents involving use of machinery. Moderate daytime sleepiness was associated with female sex, napping, insomnia symptoms, arthritis or heart disease, and gross motor movements during sleep. CONCLUSIONS: It is likely that daytime sleepiness deleteriously affects work activities, social and/or marital life, and exhibits a negative socioeconomic impact. In addition, the risk of a motor vehicle crash appears to be higher in this specific population: twice as many subjects operating a motor vehicle or using machine tools reported having a crash or accident, respectively, in the previous year in the groups with severe daytime sleepiness or moderate daytime sleepiness than did the general population with no daytime sleepiness. The high prevalence rates of daytime sleepiness and multiplicity of related factors mandate further scrutiny by public health officials.

Adolescent↗