RDC Criteria Research Articles

Prevalence of TMD in patients visiting private dental institution - A retrospective study

Temporomandibular disorder is a collective term for a group of musculoskeletal and neuromuscular conditions. Patients will complain of pain in the TMJ region and the fatigue of the Cranio cervico facial muscles. The aim of the study was to assess the prevalence of TMD in patients visiting a private dental college. This was a retrospective study. Samples were collected from June 2019 to March 2020. The sample size was 55 patients. Data of Temporomandibular disorders were collected. Excel tabulation was done. Chi-Square test was performed and results were obtained using SPSS software. Out of 55 patients, the prevalence of group I of RDC criteria was 34.5%, prevalence of group II of RDC criteria was 62% and the prevalence of group III of RDC criteria was 3.5%. From the present study, it can be concluded that the prevalence of TMD in patients visiting a private dental College was very less. Group II of our RDC criteria was found to be high, with a percentage of 62%.

Cognitive Impairment In Treatment-Na\xefve Bipolar II and Unipolar Depression

Cognition dysfunction may reflect trait characteristics of bipolarity but cognitive effects of medications have confounded previous comparisons of cognitive function between bipolar II and unipolar depression, which are distinct clinical disorders with some overlaps. Therefore, we examined the executive function (WCST), attention, cognitive speed (TMT-A) and memory (CAVLT, WMS-Visual reproduction) of 20 treatment-naïve bipolar II patients (BPII), 35 treatment-naïve unipolar depressed (UD) patients, and 35 age/sex/education matched healthy controls. The subjects were young (aged 18–35), and had no history of psychosis or substance use, currently depressed and meeting either RDC criteria for Bipolar II Disorder or DSM-IV-TR criteria for Major Depressive Disorder. The patients were moderately depressed (MADRS) and anxious(HAM-A), on average within 3.44 years of illness onset. Sociodemographic data and IQ were similar between the groups. UD patients had significantly slower cognitive speed and cognitive flexibility (WCST perseverative error). BPII depressed patients showed relatively intact cognitive function. Verbal memory (CAVLT List A total) correlated with illness chronicity only in BPII depression, but not UD. In conclusion, young and treatment-naïve BPII depressed patients differed from unipolar depression by a relatively intact cognitive profile and a chronicity-cognitive correlation that suggested a stronger resemblance to Bipolar I Disorder than Unipolar Depression.

Phenomenology of depression in older compared with younger adults: Meta-analysis

Late-life depression may differ from early-life depression in its phenomenology. To investigate the effect of age on the phenomenology of major depression. A systematic search was conducted in PubMed, Embase and PsycINFO for all studies examining the relation between age and phenomenology of major depression according to RDC, DSM and ICD criteria. Studies were included only if the age groups were compared at the single-item level using the 17-, 21- or 24-item versions of the Hamilton Rating Scale for Depression; a meta-analysis was done for each item of the 17-item scale. Eleven papers met the inclusion criteria. Older depressed adults, compared with younger depressed adults, demonstrated more agitation, hypochondriasis and general as well as gastrointestinal somatic symptoms, but less guilt and loss of sexual interest. The phenomenology of late-life depression differs only in part from that of early-life depression. Major depression in older people may have a more somatic presentation, whereas feelings of guilt and loss of sexual function may be more prevalent in younger people.

Introduction: The extended psychosis phenotype--relationship with schizophrenia and with ultrahigh risk status for psychosis.

In clinical practice, psychotic disorders naturally come as diagnosable ‘‘things,’’ categories, the carriers of which form a diagnostic boundary below which reside the healthy noncarriers who do not display the mental phenomena observed in patients. In research, however, the focus is on scientific exploration of the distribution of experiences at all levels of severity in populations and its genetic and nongenetic causes. Population research has shown high rates of psychotic experiences in people who are not readily diagnosable according to ICD/DSM/ RDC criteria—suggesting an ‘‘extended psychosis phenotype,’’ which shares demographic, etiological, familial, and psychopathological factors with clinical psychotic disorder. In fact, affective dysregulation, psychotic experiences, motivational impairments, and cognitive alterationsappeartobedistributed andcoexpressedtoadegree in nonill individuals and have been shown to index risk for later onset of disorder, particularly if they tend to persist over time. 1 (also, R. J. L & J. v. O., unpublished data,

P-1213 - The continuum hypothesis: multidimensional eye movement phenotypes in nosology and taxonomy

Clinical diagnosis currently requires fitting symptoms to DSM, ICD or RDC criteria and assumes face validity of the presentation and medical history. Clinical signs and symptoms can overlap illness categories, and the recent genetic evidence of biological overlap between major illnesses such as schizophrenia and bipolar disorder lends significant support to the case for refinement of classification systems. We recruited 222 individuals who had DSM-IV schizophrenia or mood disorders (bipolar, unipolar/MDD, schizo-affective) confirmed with OpCrit, and 208 diagnosis-free volunteers as controls. Eye movement function was assessed using pursuit, fixation and static picture viewing tests; extensive demographic, neuropsychological and state measures were also obtained for each person. The natural boundaries between illness types were probed using supervised and unsupervised machine learning using eye movement information alone. Respectively, a probabilistic network delineated case groups and controls according to current nosological practice with exceptional accuracy while a Bayesian approach described a taxonomic geometry consistent with a trait continuum. Taxonomies derived from eye movement measures reveal a multidimensional space spanning naturally occurring clusters of ‘normal’, subclinical and abnormal clinical traits. Dimensionality reduction to simplify interpretation of cluster shape, orientation and fuzziness provides an index of phenotype heterogeneity. These results let us understand various psychiatric eye movement phenotypes hierarchically and at multiple scales and support the idea of a psychometric continuum along non-linear dimensions populated by many subtypes of people. We now need to study how clinical symptoms map onto this space.

First-episode psychosis is characterized by failure of deactivation but not by hypo- or hyperfrontality

It is not known whether first-episode psychosis is characterized by the same prefrontal cortex functional imaging abnormalities as chronic schizophrenia. Thirty patients with a first episode of non-affective functional psychosis and 28 healthy controls underwent functional magnetic resonance imaging (fMRI) during performance of the n-back working memory task. Voxel-based analyses of brain activations and deactivations were carried out and compared between groups. The connectivity of regions of significant difference between the patients and controls was also examined. The first-episode patients did not show significant prefrontal hypo- or hyperactivation compared to controls. However, they showed failure of deactivation in the medial frontal cortex. This area showed high levels of connectivity with the posterior cingulate gyrus/precuneus and parts of the parietal cortex bilaterally. Failure of deactivation was significantly greater in first-episode patients who had or went on to acquire a DSM-IV diagnosis of schizophrenia than in those who did not, and in those who met RDC criteria for schizophrenia compared to those who did not. First-episode psychosis is not characterized by hypo- or hyperfrontality but instead by a failure of deactivation in the medial frontal cortex. The location and connectivity of this area suggest that it is part of the default mode network. The failure of deactivation seems to be particularly marked in first-episode patients who have, or progress to, schizophrenia.

P02-502 - Postpartal psychosis: Serbian experience

IntroductionChildbirth and the postpartal period present a form of specific maturational crisis and an extremely vulnerable period for every woman, especially for those who have potential for some psychological disturbances.AimWe explored sociodemographic and clinical manifestations of women in the postpartal period who were hospitalized at the Institute of Psychiatry, Clinical Center of Serbia.MethodThis retrospective study included 60 patients with psychiatric disorders developed within six months after childbirth. Inclusion criteria were: negative psychiatric hystory, negative history of puerperal episode, and postpartal disorder as a first manifestation of psychiatric disturbances. Patients were diagnosed according to RDC criteria (research diagnostic criteria).ResultsPatients with psychotic features were predominant, average age 23.6; married; mothers of male offspring and with positive family history of psychiatric disorders in 30%. Subacute development of clinical manifestations was noticed, 3.5 weeks after childbirth on average. No psychopathology was observed before third postpartal day. Obstetric manifestations did not influence psychopathology.ConclusionChildbirth is a significant risk factor for the expression of mental dysfunction in the puerperal period. The most vulnerable group is women with clinical expression of dysfunction, specific sociodemographic characteristics, and positive family history of psychiatric disorders.

Psychometric Evaluation of the Insomnia Symptom Questionnaire: a Self-report Measure to Identify Chronic Insomnia

The objective was to psychometrically evaluate the Insomnia Symptom Questionnaire (ISQ), a self-report instrument designed to establish a clinically relevant case definition of insomnia consistent with widely used insomnia classification criteria, using methods from classical test theory and item response theory (IRT). The ISQ was evaluated using IRT algorithms in a cohort of 362 pre-, peri- and post-menopausal women recruited for the SWAN (Study of Women's Health Across the Nation) Sleep Study. This yielded a dichotomous outcome consistent with the presence/absence of insomnia. The internal consistency and criterion validity of the dichotomized ISQ were compared to traditional measures of sleep from sleep diaries, polysomnography, and the Pittsburgh Sleep Quality Index using kappa statistics, and indices of sensitivity, specificity, positive and negative predictive value (PPV), and likelihood ratio tests (LRs). The ISQ identified 9.8% of the sample as meeting insomnia, consistent with established diagnostic criteria. Reliability was established with Cronbach alpha (alpha = 0.89). The ISQ had high specificity (> 90%), but sensitivity, PPV, NPV, and LRs varied according to which sleep measure was used. Concurrent validity was not confirmed with any of the traditional sleep summary measures (kappas < 0.30). The ISQ captures the multidimensionality of insomnia better than traditional sleep measures as it ascertains symptoms of insomnia that are based on DSM-IV and RDC criteria. The high specificities suggest that the ISQ has a high probability of correctly identifying those without insomnia and would be a cost-effective tool in large observational studies in which the prevalence of insomnia is likely to be about 10%. Further evaluation of the ISQ, including validation against clinical interviews, is warranted.

Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions

Objectives: To analyse the time course and some risk factors for a diagnostic change from major depression to bipolar disorders (BP) over an average of 20 years from the onset of the disorders. Methods: Patients (406) with major mood disorders hospitalised at some time between 1959 and 1963 were followed-up until 1985. The analysis also included the course prior to hospitalisation. Survival analyses and Cox regression models were applied. Results: A diagnostic change from depression to bipolar I occurred in about 1% of the patients per year and to bipolar II disorders in about 0.5% per year. Risk factors for a change from depression to BP-I disorder were male sex and an early onset of the disorder; risk factors for a change from depression to BP-II disorder were female sex, a later onset of the disorder and a positive family history of mania. Conclusions: Across the entire lifetime, every new episode of depression brings a new risk for mania; more than half of our severe mood disorder cases became bipolars. The risk of depression developing into bipolar disorder remains constant lifelong. Limitations: The diagnostic classification of ICD-9 met RDC criteria for bipolar disorder in only 90% of cases. Part of the data collected in retrospect may be less reliable; the prospective data were only collected every 5 years from 1965 to 1985 using multiple sources; mild manifestations between the follow-ups may have been partially missed. The sample of subsequent hospital admissions for major depression and mania represents a severe group of patients and generalisations to ambulatory cases may not be possible. Not all risk factors for diagnostic conversion described in the literature could be assessed in this study.

Personality Disorder Symptoms Predict Declines in Global Functioning and Quality of Life in Elderly Depressed Patients

The authors evaluated personality disorder symptoms as predictors of change in global functioning and quality of life among elderly depressed patients. Treated elderly patients (N=40) who no longer met RDC criteria for major depression were assessed for personality disorders, depression, global functioning, and quality of life after treatment of the acute episode and at 1-year follow-up. In interaction with persisting or recurrent depression, Cluster B personality disorder symptoms contributed to declines in global functioning and quality of life over a 1-year period. Personality disorder symptoms in elderly patients appear to operate as co-factors that amplify or exacerbate the impact of residual depression on long-term functioning and quality of life.

Personality Disorder Symptoms Predict Declines in Global Functioning and Quality of Life in Elderly Depressed Patients

The authors evaluated personality disorder symptoms as predictors of change in global functioning and quality of life among elderly depressed patients. Treated elderly patients (N=40) who no longer met RDC criteria for major depression were assessed for personality disorders, depression, global functioning, and quality of life after treatment of the acute episode and at 1-year follow-up. In interaction with persisting or recurrent depression, Cluster B personality disorder symptoms contributed to declines in global functioning and quality of life over a 1-year period. Personality disorder symptoms in elderly patients appear to operate as co-factors that amplify or exacerbate the impact of residual depression on long-term functioning and quality of life. The authors evaluated personality disorder symptoms as predictors of change in global functioning and quality of life among elderly depressed patients. Treated elderly patients (N=40) who no longer met RDC criteria for major depression were assessed for personality disorders, depression, global functioning, and quality of life after treatment of the acute episode and at 1-year follow-up. In interaction with persisting or recurrent depression, Cluster B personality disorder symptoms contributed to declines in global functioning and quality of life over a 1-year period. Personality disorder symptoms in elderly patients appear to operate as co-factors that amplify or exacerbate the impact of residual depression on long-term functioning and quality of life.

Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors.

The electrical dosage of the ECT stimulus impacts on efficacy and cognitive side effects, yet seizure threshold (ST) may vary as much as 50-fold across patients. It would be desirable to predict ST on the basis of patient and treatment characteristics. In particular, concerns have been raised that benzodiazepine use and higher dosage of barbiturate anesthetics elevate ST. In a three-site study, ST was quantified at the first ECT session using an identical empirical titration procedure in 294 patients who met RDC and DSM-IIIR criteria for a major depressive episode. ST varied over a 35-fold range across patients treated with right unilateral (RUL) (n = 267) and bilateral (BL) (n = 27) ECT. Higher ST was associated with BL electrode placement (p = 0.001). Among patients treated with RUL ECT, univariate analyses indicated that higher ST was associated with advanced age (p < 0.001), male gender (p < 0.001), greater burden of medical illness (p < 0.001), weight (p < 0.01), duration of mood disorder (p < 0.01), and history of previous ECT (p < 0.05). Average lorazepam dose in the 48 hours prior to ECT was not associated with ST, but was associated with decreased seizure duration (p < 0.01). Absolute, but not weight-adjusted, methohexital dose was associated with ST (p < 0.01). Multivariate analyses in patients treated with unilateral ECT showed that only 27.6% of the variance in ST (p < 0.0001) could be predicted. In the multivariate analyses, only age (p = 0.0001), gender (p = 0.01), and methohexital dose (p = 0.0001) were independently related to ST. Low dosage of lorazepam and methohexital dosage below 1 mg/kg are unlikely to impact on ST. Given the limited capacity to predict ST, empirical titration remains the only accurate method to determine electrical dosage in RUL ECT.

The validity of diagnosis of melancholic depression according to different diagnostic systems

Background: Melancholic versus nonmelancholic depression dichotomy is perhaps the most widely accepted distinction in categorization of depression. This research aims to compare RDC, DSM-III, DSM-III-R, DSM-IV and ICD-10 melancholic/endogenous/somatic and nomelancholic/nonendogenous/nonsomatic depressive patients with regards to biological variables thyroid stimulating hormone (TSH), basal and post dexamethasone cortisol levels, age, age of onset of depression, psychosocial stressors, and severity of depression. Methods: Sixty-five patients who had been diagnosed as having major depression according to DSM III-R, using SCID were included in this study. Patients were divided into melancholic and nonmelancholic subtypes using RDC, DSM-III, DSM III-R, DSM-IV and ICD-10 criteria and groups were compared on the basis of biological variables, as well as age, psychosocial stressors and the severity of depression. Results: RDC endogenous depressives were older, more severely depressed and had higher cortisol levels then RDC nonendogenous depressives. DSM III-R melancholics were older, more severely depressed, reported fewer numbers of psychosocial stressors and had lower levels of TSH than nonmelancholics. DSM-IV melancholics were more severely depressed, had higher basal and post dexamethasone cortisol levels and lower TSH levels. The ICD 10 somatic depression group contained more severe, older depressives with lower TSH levels. Conclusion: The results of this research show that different criteria may identify different groups of patients as having melancholic depression. They also partly support the hypothesis that endogenous or melancholic depression have a biological basis. Limitations of study: The study involved a relatively small sample size from a single centre and the results are based on this relatively small sample.

Puerperal psychosis: associated clinical features in a psychiatric hospital mother-baby unit.

Current psychiatric diagnostic systems do not regard puerperal psychosis as a separate entity. However, there is continuing debate about the validity and clinical utility of this concept. This paper aims to investigate the prognostic importance of a number of clinical features in a sample of patients with puerperal psychosis. A retrospective case note study was conducted on 42 consecutive admissions to a mother-baby unit in a psychiatric hospital. Data were collected on a range of variables, and diagnoses made according to DSM-III-R and RDC criteria for puerperal psychosis. Maternal hostility toward the baby was the only studied variable to increase the likelihood of the baby being cared for by someone other than the mother, indicating the mother's inability to safely care for the baby. These findings tentatively suggest that it is maternal hostility toward the baby, not puerperal psychosis per se that is associated with foster care.

Negative symptoms, depression and parkinsonian symptoms in chronic, hospitalised schizophrenic patients

Background: Negative symptoms of schizophrenia are often confounded by overlapping depressive and parkinsonian symptoms. The role of medication as an aetiological factor in the development of these symptoms is an important issue for prevention and treatment. Methods: A total of 45 inpatients in chronic wards who met RDC criteria for schizophrenia were assessed with the Hamilton depression rating scale (HDRS) and negative symptom rating scale (NSRS) and the targeting abnormal kinetic effect scale (TAKE). Results: No significant correlation was found between the total scores on the vegetative superfactor of the HDRS and the NSRS. Duration of neuroleptic treatment was positively correlated with depressive symptoms ( r=0.299, P<0.05) and negative symptoms ( r=0.443, P<0.001). Dose of antipsychotic was also correlated positively with negative symptoms ( r=0.260, P<0.05). Age was negatively correlated with depressive symptoms as assessed by the HDRS ( r=0.306, P<0.05). Conclusion: The data suggest that depressive and negative symptoms can be separated in chronic schizophrenia, while pointing to a possible role of antipsychotic medication in the aetiology. Limitations: The study was conducted in a small chronically hospitalised population treated with relatively high doses of antipsychotics. It is not clear that the results obtained here would be applicable to an acute patient population.

Problems in validating endogenous depression in the Arab culture by contemporary diagnostic criteria

This study highlights the difficulties that may be encountered in attempting to apply the clinical construct of endogenous depression derived from western studies to depressed Arab patients. The agreement between 4 operational systems on the diagnosis of endogenous (melancholic) depression is explored in 100 patients with primary depressive disorder in Al-Ain, United Arab Emirates. The symptom characteristics of the 61 patients in whom all diagnostic systems agreed are then described quantitatively and qualitatively. Subjects were evaluated by the Newcastle scale, Hamilton's 21 item depression scale, global assessment of functioning scale, and the operational criteria of the diagnostic systems used. Diagnosis of endogenicity was derived by computer according to the respective criteria. The agreement between DSM-IV, ICD-10, and RDC criteria is moderately high (0.72). When the Newcastle Index is included, it is only moderate (0.58). Disagreements are related to differences in diagnostic criteria. Small differences affect concordance appreciably. DSM-IV agreed with a majority of external validators, differentiating a more homogeneous groups of patients. In the present study, endogenous depression identified by western criteria, was less likely to manifest by guilt feelings, a distinct quality of mood, and loss of libido. The descriptions of patients reveal that the mood component of depression is expressed differently, somatic metaphors are used frequently to express distress, religious elements influence the expression of symptoms, and depression may manifest in behaviours not directly indicative of the disorder. Endogenous depression may be identified in the Arab culture, but considerable variation in its component symptom frequencies and mode of expression needs to be taken in consideration for defining it in terms appropriate to the culture.

Diagnostic accuracy and confusability analyses: an application to the Diagnostic Interview for Genetic Studies.

The dominant, contemporary paradigm for developing and refining diagnoses relies heavily on assessing reliability with kappa coefficients and virtually ignores a core component of psychometric practice: the theory of latent structures. This article describes a psychometric approach to psychiatric nosology that emphasizes the diagnostic accuracy and confusability of diagnostic categories. We apply these methods to the Diagnostic Interview for Genetic Studies (DIGS), a structured psychiatric interview designed by the NIMH Genetics Initiative for genetic studies of schizophrenia and bipolar disorder. Our results show that sensitivity and specificity were excellent for both DSM-III-R and RDC diagnoses of major depression, bipolar disorder, and schizophrenia. In contrast, diagnostic accuracy was substantially lower for subtypes of schizoaffective disorder-especially for the DSM-III-R definitions. Both the bipolar and depressed subtypes of DSM-III-R schizoaffective disorder had excellent specificity but poor sensitivity. The RDC definitions also had excellent specificity but were more sensitive than the DSM-III-R schizoaffective diagnoses. The source of low sensitivity for schizoaffective subtypes differed for the two diagnostic systems. For RDC criteria, the schizoaffective subtypes were frequently confused with one another; they were less frequently confused with other diagnoses. In contrast, the DSM-III-R subtypes were often confused with schizophrenia, but not with each other.

The prevalence, associations and symptoms of depression amongst dementia sufferers

Objective: To examine the prevalence rates of RDC major and RDC minor depression in dementia sufferers, to compare the prevalence rates and symptoms of depression between different dementias and to look at the associations of RDC major depression. Design: Case control. Setting: Referrals to clinical services. Subjects: 124 patients with DSM-III-R dementia. Measures: The patients were assessed using the GMS/HAS package and the Cornell Depression Scale. Depression was diagnosed according to RDC criteria. Results: 25.0% of patients had RDC major depression and 27.4% had RDC minor depression. Major depression occurred significantly more often and was significantly more severe in patients with vascular dementia than patients with Alzheimer's disease. Severe visual impairment was significantly associated with RDC major depression in Alzheimer's disease and physical health problems were significantly associated with depression in vascular dementia. Most symptoms of depression including suicidal thoughts were common. Conclusions: Major depression is more common and more severe in patients with vascular dementia. The associations of depression may be different in these patients.

Relationship of genetically transmitted alpha EEG traits to anxiety disorders and alcoholism

We tested the hypothesis that a heritable EEG trait, the low voltage alpha (LV), is associated with psychiatric disorders. Modest to moderate evidence for genetic linkage of both panic disorder and the low voltage alpha trait to the same region of chromosome 20q has recently been reported, raising the issue of whether there is a phenotypic correlation between these traits. A total of 124 subjects including 50 unrelated index subjects and 74 relatives were studied. Alpha EEG power was measured and EEG phenotypes were impressionistically classified. Subjects were psychiatrically interviewed using the SADS-L and blind-rated by RDC criteria. Alcoholics were four times more likely to be LV (including so-called borderline low voltage alpha) than were nonalcoholic, nonanxious subjects. Alcoholics with anxiety disorder are 10 times more likely to be LV. However, alcoholics without anxiety disorder were similar to nonalcoholics in alpha power. An anxiety disorder (panic disorder, phobia, or generalized anxiety) was found in 14/17 LV subjects as compared to 34/101 of the rest of the sample (P < 0.01). Support for these observations was found in the unrelated index subjects in whom no traits would be shared by familial clustering. Lower alpha power in anxiety disorders was not state-dependent, as indicated by the Spielberger Anxiety Scale. Familial covariance of alpha power was 0.25 (P < 0.01). These findings indicate there may be a shared factor underlying the transmissible low voltage alpha EEG variant and vulnerability to anxiety disorders with associated alcoholism. This factor is apparently not rare, because LV was found in approximately 10% of unrelated index subjects and 5% of subjects free of alcoholism and anxiety disorders.

Org 3770 versus amitriptyline: A 6‐week randomized double‐blind multicentre trial in hospitalized depressed patients

AbstractFollowing a placebo washout period of 3–7 days, 251 hospitalized patients with a major depressive episode (DSM III and RDC criteria) were treated with either Org 3770 (20–60 mg/day) or amitriptyline (75–225 mg/day) for six consecutive weeks in this randomized, double‐blind, multicentre study. Forty‐one patients (19 Org 3770, 22 amitriptyline) withdrew before completion of the 6‐week active treatment period. In both groups, the main reason for withdrawal was lack of efficacy. However, fewer patients in the Org 3770 group than in the amitriptyline group withdrew as a result of adverse events (one and three patients, respectively). The severity of depressive symptoms and general psychopathology, as assessed by HPRSD (total and factors) and BPRS scales, improved to the same extent after 6 weeks' treatment with Org 3770 and amitriptyline. Similar improvement in global functioning, as assessed by GAS scale, was observed in both treatment groups. There were no statistically significant differences between the two treatments on all scales used. Dry mouth and sweating were reported significantly more often in the amitriptyline group. Other adverse events, such as constipation, dizziness, tremor and muscle weakness, occurred more frequently in the amitriptyline‐treated patients as well. The results of this study indicate that Org 3770 has similar antidepressant efficacy to amitriptyline and a more favourable tolerability profile in patients with major depression.