Brain 5-hydroxytryptamine (5HT) system has been implicated in the processes associated with the response to punishment and the suppression of behavior, as in conflict situations (29). The selective neurotoxin lesions of the 5HT forebrain pathways reverse the suppressive effects of punishment, as do anxiolytic drugs, supporting the view that 5HT may play a role in conflict behavior and in the biology of anxiety disorders. It has been reported that release of behavioral suppression following intraraphe chlordiazepoxide was abolished by prior 5,7-dihydroxytryptamine infusion in this nucleus (27). On the other hand, evidence against the involvement of se­rotonergic neurons in the antipunishment activity of diazepam in the rat has been also demonstrated (28). However, it is known that different classes of anxiolytics, including benzodi­azepines, cause marked inhibition of dorsal raphe neuronal firing (7). Consistent with this finding is the fact that benzodiazepines significantly reduce 5HT turn­over in the central neurons system (32). The role of 5HT neurons in the effects of anxiolytic drugs has recently become of interest in studying a novel nonben-zodiazepine agent, buspirone (8) (Table 1). Unlike diazepam, buspirone has no effect on the benzodiazepine-GABA receptor complex. It is inactive at benzo
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The University Department of Psychiatry, The Royal Liverpool Hospital, Liverpool, L69 3BX, England

The prevalence of depression in the original random sample of 1,070 com­munity subjects was 11.3% overall (8.3% for depressive neurosis, 3.0% for de­pressive psychosis). Of the total sample, 2.7% reached case levels (diagnostic confidence level 3 and above) on both depression and anxiety clusters, or 24.0% of the depressive cases as a whole, or 70.7% of the anxious cases as a whole. Table 1 shows the percentage prevalence for subjects having coexistent levels of depression and anxiety after other diagnoses, e.g., organic states, schizophrenia,
hypochondriasis, obsessional and phobic states, had been excluded. Of the whole sample, 3.8% reached case level for anxiety and 32.2% reached subcase level; 11.7% of the total sample reached a subcase level of depression and of the 8.3% with depressive neurosis, 4.9% and 1.8% reached subcase and case levels of anx­iety, whereas, of the 3.0% with depressive psychosis, 1.9% and 0.9%, respectively, reached subcase and case levels of anxiety. Thus, although the association of depressive levels with anxiety levels was common, 83.5% of cases of depression were associated with some levels of anxiety; those with coexistent case levels of both depression and anxiety seem to represent only a small proportion of elderly subjects. The outcome of the subjects in the study at this stage in the analysis is expressed crudely as dead, well (no confidence level on any diagnostic cluster), and psy-chiatrically ill (reached case level 3 and above on a diagnostic cluster). The first 80 subjects followed up after 3 years are reported. Ten of these 80 subjects with depressive case levels refused interview. The death rate of the subjects as a whole over the three years was 18%, or 6% per year, but was higher for the depressive sample at 27.1% or 9% per year. In order to compare outcome on these three indices the sample was split in a number of ways. The sample was separated into those depressive cases that had no anxiety confidence levels (14) and those depressive cases that had some anxiety levels (56) (Table 2). Although there is a tendency for a higher proportion of those subjects with depressive case levels and anxiety levels to be well at the end of three years, the differences do not reach statistical significance. The subjects were divided into those depressive cases with no AGECAT anxiety levels taken together with those scoring level 1 (19), against those scoring AGECAT anxiety levels 2 to 5 (51). Those depressive (more…)