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Patients with MDD responded well to long-term treatment with either escitalopram or citalopram. This study demonstrated the importance of extending treatment of depression beyond 8 weeks.

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cyproterone acetate (CPA) â€"¿ whereas a LHRH ana logue treatment (reducing the plasma testosterone level to castration values) failed to maintain the antiaggressive effect of CPA. Beforestarting the CPA treatment, the plasmatestoster one levelwaswithinthe normalrange(5.2ng/ml)as were the other plasma hormone levels (LH, prolactin, FSH, A4 androstene-dione).In a firststep,theCPAtreatmentwasaddedto the former treatment at a daily dosage of 50mg and slowlyincreased up to 200mg daily. His aggressivebehaviour gradually decreased over a period of one month, making it possible to reduce the neuroleptic treatment down to 150 mg/day and to withdraw the carbamazepine and diazepine prescrip tions. The levelof aggressionbecame0 on the OAS. No significantchangewasobservedin the plasma testosterone level.This improvement was maintained for a period of four months.Then wedecidedto test ifa reductionin the testos terone gonadal secretion (without affecting the androgen receptor level) would produce the same clinical effect. A monthly injection of a long-lasting LHRH analogue treat ment was started and the CPA treatment was withdrawn after the second injection (gosereline acetate 3.6mg monthly).Whereas the testosterone level dropped to castration values (the 0.25 ng/ml remaining originated from the adrenal), the aggressionscore returned to its initial value fifteen days after the interruption of CPA treatment. CPA had to be reintroduced in order to control the patient's aggression.The beneficialeffect of CPA treatment on aggress ive behaviour could be explained either by its well known antiandrogenic effects or by its progestational properties leading to antioestrogenic effects. LHRH analogue treatment is devoid of progestational effects. With regard to the lack of clinical efficacy of LHRH analogue treatment, the antioestrogenic hypothesis seems more plausible.Some preciical studies suggest that, in fact, oes trogens could be more involved than androgens in 255â€"259)happily reported the two distinct, stable, consistent and reliable factors on factor analysis of the Hospital Anxiety and Depression Scale (HAD) which corresponded to the questionnaire's anxiety and depression subscales. Clinical experience of using the HAD, does not however, support this bi dimensional solution. In our trial with HAD in patients suffering from clinical anxiety and de pression we found that the mean anxiety subscale scores were much higher in the depressed patients â€"¿ higher than the anxiety score of the anxiety disorder patients and also higher than the depression subscale score of the depressive disorder patients! Thus the two subscales hardly discriminate between clinical anxiety and depression, irrespective of the statistical derivations. In fact, the authors themselves noted substantially more anxiety than depression but they have not reported the anxiety and depression sub scale scores separately in their depressed and anxiety patients. It seems that the total HAD scores are more meaningful clinically than the subscale scores. At the momen...

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