Treatment of depression in general practice: a controlled trial of flupenthixol (‘Fluanxol’)

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Abstract
On the basis of an arbitrary definition of depression, 85 general practitioners treated 231 patients during a 2-week period with flupenthixol (‘Fluanxof)d˚ and placebo in a controlled, randomized, double-blind trial. The male. female ratio was 1:5, and the mean age was 42 years. The severity of the symptoms was assessed by a rating scale, and satisfactory improvement was defined as a reduction of 50% or over of the initial individual scores. Improvement was obtained in 65 % of patients treated with flupenthixol and in 50% of those in the placebo group. The difference is statistically significant, X2 = 5.0, d.f.l.,p = 0.025. The two groups were comparable with respect to sex, age, associated diseases, other medication and failure to take the trial drugs, but relevant personal relationships could not be assessed. Patients showed marked improvement during the first week of treatment and few untoward effects were noted. It is concluded that in patients selected according to the criteria of the trial a better effect may be expected from flupenthixol than from placebo, namely 19 ± 12.8%, greater at the end of 1 week and 15 ± 12.8%, at the end of 2 weeks, but that if improvement has not occurred within the first week, little is to be gained from continued treatment. It is pointed out that a great deal of drug effect must be assumed to be connected with general confidence in medicines, the tendency towards spontaneous improvement, and changes in the patient's background situation and the doctor - patient relationship. It is recommended that a larger number of diseases be defined in general practice, so that G.P.s may realize clearly what they are doing, why they are doing it, and what results they are getting. Only thereby is it possible to gain increased knowledge about the value of diagnostic and therapeutic possibilities.

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