Do minor affective disorders need medication?

How wide and deep is wide and deep enough? A critique of surgical practice in excisions of primary cutaheous malignant melanoma. 11 Day CL, Harrist TJ, Gorstein F, et al. Malignant melanoma; prognostic significance of "microscopic satellites" in the reticular dermis and subcutaneous fat. Sober AJ, et al. Prognostic factors for melanoma patients with lesions 0-76 through 1-69 mm in thickness; an appraisal of "thin" level IV lesions. Minor affective disorders usually present with symptoms of anxiety or depressed mood. Difficult life events are often important in causing these,I2 and improvement tends to occur within six to 12 months.34 These disorders may not be associated with a severe disturbance of behaviour or a disruption of normal life, but they do cause considerable distress and are particularly frequent among patients who consult general practitioners.' Over the past 20 years psychotropic drugs, especially minor tranquiflisers, non-barbiturate sedatives, and anti-depressants, have become increasingly popular in the treatment of patients with minor affective disorders. Nevertheless , both the value and the dangers of this form of treatment are still uncertain. Though they appear to be safer than alcohol or self prescribed medication,6 their long term use may be associated with serious disadvantages and may not even be effective.7 Indeed, some studies have suggested that in patients with moderate or low levels of anxiety psychotropic drugs are no better than placebo.8 The potential hazards of psychotropic drugs include a proneness to road traffic accidents,9 excessive dependence with adverse reactions on withdrawal,'0 deliberate self poisoning," aggressive outbursts,'2 and interaction with alcohol.'3 In addition, the cost to the National Health Service is immense,'4 for these are probably the most frequently prescribed drugs in general practice." So which patients really benefit from psychotropic drugs, and what will happen if these drugs are not prescribed? New evidence is provided by Catalan et al, who examined the effects of withholding anxiolytic drugs from patients who would normally have been given them by their general practitioners. 16 Patients who had not consulted their general practitioner for a psychiatric disorder during the preceding three months and who had not received psychotropic drugs during this time were allocated randomly to treatment either with anxiolytic drugs or by brief counselling. The latter included explanation of symptoms, exploration of underlying problems and ways of dealing with them, as well as reasons for not prescribing. The two groups were compared for psychiatric state, social adjustment, and …