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The author reviews a number of neurotic disorders, including generalized anxiety disorders, panic disorders, obsessive-compulsive disorders, the phobic anxiety-depersonalization syndrome, depressive neurosis, and psychophysiologic disorders, with regard to the effectiveness of various classes of psychopharmacologic agents and the current understanding of the pharmacologic basis for their therapeutic effects.

In a matched controlled study 102 patients with neurotic depression were compared with other neurotics. There was significantly more parental loss before 17 years of age in the depressive patients.

In this study the traditional and transitional nosology and etiology of the spirit disorder vimbuza was investigated by interviewing patients (n = 116) who were suffering from that condition. The illness concept was compared with western psychiatric classifications. As a result, 23 symptom descriptions were identified, 13 can be referred to as conversion or dissociation disorder and 7 to depressive neurosis. The remaining 3 symptom descriptions refer to an acute delusional or confusional state. Comparing the traditional and transitional symptom descriptions on the head and heart, a shift from the heart to the head becomes evident in the transitional or urban Malawian. The transitional etiology is the same as the traditional etiology, only that the transitional person more often refers to ‘Too much thinking’ and ‘natural’ than to ‘bad ancestral spirits’ and ‘witchcraft’.

Sixty-five depressed outpatients were treated in an open label cross-over study of chlordiazepoxide and amitriptyline. The treatment was changed only in those patients in whom the response to the first medication was inadequate. Global rating and self-rating scales were compounded into a rating of treatment preference. For the group as a whole chlordiazepoxide appeared to be more effective than amitriptyline. The patients who responded to treatment with chlordiazepoxide tended to show reactivity, symptoms of anxiety or tension and were not retarded. Chlordiazepoxide appeared to be more effective in patients who were initially diagnosed as suffering from exogenous depressions, whereas amitriptyline appeared to be more effective in those with endogenous depressions. The findings suggest that in a large proportion of depressed patients it is possible to predict from their clinical features which class of psychotropic drugs is likely to be more effective.

In a matched controlled study, there was no more sexual dysfunction amongst female psychiatric patients with hysterical neurosis than amongst those with depressive neurosis.

Maprotiline (Ludiomil) is a dibenzo bicyclooctadiene pharmacologically related to the tricyclic antidepressants and stereochemically having a tetracyclic structure. A controlled, double-blind comparison of maprotiline and imipramine in a group of 71 female outpatients with primary depression is presented. Maprotiline was found to be at least as effective as imipramine and significantly better in depressive neurosis. It also showed a bipolar action, being effective in both agitation and retardation.

As one of the investigators who has reported on epidemiologic rates of major depression, I welcome Dr Mattes' letter regarding the high prevalence of DSM-III MDEs reported in recently published articles in theArchives. The chief criticism by Dr Mattes is that the DSM-III diagnostic criteria for major depression do not include sufficient severity requirements. Therefore, a large num ber of mild depressives, who otherwise might never be considered for treatment, could meet these criteria. He suggests that the diagnosis of depressive neurosis in the DSM-II might better describe the condition of these patients. Several points require clarification. To my knowledge, the published epidemiologic studies, including my own, 1 have not used the DSM-III criteria because these criteria have not been available until recently. These studies have used the RDC criteria for major depression. The RDC require persistence of symptoms for two weeks and severity to the point of causing