A pilot study of the effect of the 5-HT-uptake inhibitor, zimelidine, on phobic anxiety

A new antidepressant, zimelidine, which is a selective inhibitor of 5-HT-uptake, was tested in an open study of 13 patients, in each of whom the principal clinical diagnosis was phobic neurosis. The dose varied from 200 to 300 mg daily. After 6 weeks of treatment, 6 patients dropped out of the study as they were not appreciably improved, but 7 patients definitely improved and completed a treatment course of at least 12 weeks. In these cases it was possible to observe subjective relief of symptoms, improved social function, increased working capacity and a reduced need for anxiolytics. The effect appeared similar to the previously described effects of clomipramine treatment. The incidence of side effects was low and those that occurred were mild. Tolerance was assessed as very good by the great majority of patients. The study suggests that zimelidine has a favourable effect on mild, moderate, and even in some severe phobic conditions. Some comparisons with MAO-inhibitors were made. The results are sufficiently encouraging to suggest a controlled study.

[Vigilance and beta blockade. The influence of the beta blocker atenolol and other substances on the reaction time of the visual system]

Visual reaction times as a measure of vigilance and of the psycho-physiological condition of subjects was determined after combined physical and mental stress to examine beta-blocker influence. Using the technique of electrooculography 40 subjects aged 25,7 +/- 6 with a mean blood pressure to 126/79 mmHg were measured in a double-blind cross-over design after application of placebo or 50 mg of atenolol (Tenormin) for 3 days. Visual reaction time was defined as the time between display of a peripheral light signal and the start of the eye movement that shifts the direction of gaze from the reference point to the stimulus. The results of the study show, that under these experimental conditions there is a positive effect of beta-blocker medication on vigilance. Findings of other authors are discussed. To prove the sensitivity of the test method in a preliminary study, the effects of the well-described drugs fenetyllinhydrochloride, diazepam, oxazepam and alcohol on visual reaction time were investigated.

Oxazepam in the treatment of anxiety associated with depression: results of treatment in 1600 cases (Studies in depression, VI)

A total of 1600 patients suffering from depression and anxiety was treated in one consultant practice over an 8-year period. In most cases, the depressive component was treated by monoamine oxidase inhibitors, but oxazepam was used as the anxiolytic in all cases in the series. Patients were encouraged to regulate their own dosage of oxazepam, and no difficulties occurred with this technique. The results showed the overall effectiveness of oxazepam as an anxiolytic to be better than 87% in those cases where depression co-existed.

Triazolam compared with nitrazepam and with oxazepam in insomnia: two double-blind, crossover studies analyzed sequentially

1 In two double-blind, crossover studies, general practitioners compared the hypnotic activity of triazolam 0.50 mg with that of nitrazepam 5 mg or oxazepam 50 mg in outpatient insomnias. 2 The patient's preferences served as the main criterion, and were processed by sequential analysis. 3 More patients (P less than 0.05) preferred triazolam to nitrazepam (triazolam 28; nitrazepam 11; no preference 9). 4 The numbers of patients who preferred triazolam or oxazepam did not differ significantly. 5 Triazolam and oxazepam affected sleep parameters similarly except for onset of sleep and feeling in the morning, for which triazolam seemed to be superior to oxazepam.

Efficacy and side effects of lorazepam, oxazepam, and temazepam as sleeping aids in psychogeriatric inpatients

The efficacy and side effects of 2 mg of lorazepam, 30 mg of oxazepam, and 20 mg of temazepam as sleeping aids were investigated in 20 psychogeriatric inpatients. The drugs were administered in a random order, double-blind, for 7 night each. All of these short half-life benzodiazepines proved efficacious in maintaining sleep. None of them reduced initial sleep latency. Oxazepam and to a lesser degree temazepam induced withdrawal insomnia during the first night after the treatments. The withdrawal of lorazepam induced a delayed but prolonged insomnia in 3 patients. Both lorazepam and oxazepam had muscle relaxant side effects after awakening.

Simplified determination of lorazepam and oxazepam in biological fluids by gas chromatography-mass spectrometry

Lorazepam and oxazepam in plasma and urine were measured by gas chromatography-mass spectrometry. Oxazepam was used as an internal standard in the assay of lorazepam and vice versa. After removal of interfering substances with n-hexane, the drugs were extracted with benzene and converted to N1,O3-bistrimethylsilyl derivatives. Glucuronide forms of the drugs were extracted after hydrolysis with beta-glucuronidase. A common fragment ion at m/e 429 was used to monitor the two drugs. The sensitivity was 2 ng/ml for both drugs, which was sufficient to determine plasma and urine concentrations after therapeutic doses to humans.

Dementia: differential diagnosis and treatment

With careful differential diagnosis and judicious treatment, you may be able to reverse certain aspects of dementia in the elderly. Drug toxicity, depression, metabolic and endocrine disorders, and other systemic problems are all potentially treatable causes of mental deterioration. Even when the cause cannot be identified, you can still treat the patient's symptoms. Antidepressants, antipsychotics, and antianxiety agents, plus supportive measures, often effect marked improvement.

Benzodiazepines in the treatment of aggressive patients

A double-blind, controlled clinical trial of chlordiazepoxide, oxazepam and placebo was conducted in 65 outpatients with past histories of temper outbursts, assaultive behaviour and impulsiveness associated with anxiety, irritability and hostility. Of those tests showing statistically significant results, there was a tendency for oxazepam to be somewhat more effective in the reduction of anxiety than chlordiazepoxide. Oxazepam was also superior to the latter on 1 subscale of tests used to measure hostility. No paradoxical rage responses were noted.

The abuse potential of benzodiazepines with special reference to oxazepam

Extensive use of oxazepam, particularly in the abuse-prone population of alcoholic patients, has shown that the dependence-producing potential of this drug is remarkably low, only four cases of dependence having been encountered over many years. Even abrupt withdrawal of oxazepam does not normally precipitate an abstinence syndrome. A computerized literature search retrieved 68 papers on benzodiazepine abuse and/or dependence, only 4 (6%) being concerned with oxazepam. Three reasons are proposed to account for the exceptionally low abuse-potential of oxazepam, the first being considered to be the most important: its onset of central nervous system activity is gradual, so there is no sudden 'intoxication' effect; it tends to cause dizziness at high dosages, discouraging the patient to increase the dose; and because it has a short half-life and no major active metabolites, intermittent therapy (which many patients now practise with all benzodiazepines), periodically allows the complete elimination of the drug from the body.

The clinical activity of oxazepam

Over the years, oxazepam has distinguished itself clinically from other benzodiazepines by virtue of its excellent tolerance. Recent research suggests that this is due to metabolic and pharmacokinetic differences rather than an intrinsically more favourable toxic-to-therapeutic dosage ratio. Because of its excellent tolerance, dosage is very flexible, and it is, therefore, possible to utilize oxazepam in a wide spectrum of anxiety-related disorders including the psychoses. The use of oxazepam in anxiety neurosis, depressive neurosis, psychotic disorders, alcoholism, and insomnia is discussed.

Oxazepam in the treatment of anxiety in children and the elderly

The nature of anxiety, particularly in the young and the elderly, is described. The difficulty of treating anxiety occurring at the extremes of age is emphasized. Oxazepam is exceptionally well tolerated by these patients and is considered to be the benzodiazepine of choice for paediatric and geriatric anxiety. Metabolic and pharmacokinetic factors may account for this distinction.

The clinical pharmacology of oxazepam

The benzodiazepines have been available now for about 15 years but new aspects of their actions are being elucidated all the time. Oxazepam has a short half-life and inactive metabolites and therefore differs from most other benzodiazepines. Some aspects of its clinical pharmacology are reviewed in outline. Firstly, the effects of the drug on psychological functioning is discussed. Next, the controversy regarding benzodiazepines and aggression is examined. Oxazepam appears exceptional here in that it is not associated with paradoxical release of aggression in patients. Finally, the ethical implications of the widespread use of these drugs is commented on, and the problem of dependence, physical and psychological, discussed. It appears that oxazepam is less likely than other benzodiazepines to induce dependence.

Effects of antianxiety agents on relaxation training: a preliminary investigation

The purpose of this preliminary study was to investigate the effects of certain antianxiety agents, that is, minor tranquilizers, sedatives, and hypnotics, on relaxation training. Twelve inpatients and two outpatients were referred to group relaxation training because of tension-anxiety complaints and underwent three training sessions. Results for those patients who were not having any psychotropic medication (Relaxation Only group) were compared with results for those who were receiving anxiolytic drugs (Medication-Relaxation group). Patients in the second group were on antianxiety medication prior to and during relaxation training. Self-report measures indicate that the Relaxation Only group benefited more from relaxation training and showed more treatment generalization effects. The results are interpreted as lending some support to the view that antianxiety drugs may have an interfering effect on relaxation training. Implications and limitations of the study are discussed.

The episodic nature of anxiety and its treatment with oxazepam

The presentation of anxiety in clinical practice is examined, and it is concluded that many patients, perhaps a majority, experience fluctuating levels of anxiety. It is therefore suggested that therapy should be intermittent, according to this waxing and waning of symptoms. Most benzodiazepines are long-acting, and are therefore unsuitable for this type of therapy, but oxazepam, which is short-acting and has no active metabolites, is ideal for this purpose. It is proposed that such a regimen would minimize the problems of over-sedation, psychological habituation, and a reluctance, due to a permanently tranquillized state, to deal with the root causes of the anxiety.

High-dose benzodiazepines in the treatment of severe neurotic anxiety

There has been a paucity of research in the use of high-dose benzodiazepines in the treatment of severe neurotic anxiety. The author presents five cases, three with excellent and two with poor outcomes. The English and Fench language literature is reviewed and reveals evidence that high-dose benzodiazepines may be useful in the treatment of certain neurotic patients. However, the lack of controlled studies is noted. The author poses several questions important to the future of research on benzodiazepines.

Selection among benzodiazepines for alcohol withdrawal

Four pharmacologic differences among the benzodiazepines, which are the drugs of choice to conduct alcohol withdrawal, guide selection of the appropriate one: chlordiazepoxide, diazepam, oxazepam, or chlorazepate. Bases for selection include: (1) availability of other than oral dosage forms; (2) differences in additive effect with alcohol in producing central nervous system depression; (3) differences in anticonvulsant effect; and (4) differences in duration of effect in the body (ie, half-life). Decreasing dosage schedules are preferred to a steady dosage. Illustrative dosage schedules for using chlordiazepoxide and diazepam to conduct alcohol withdrawal are given.