non-adherence to antidepressant medication is a significant problem in older patients. Our study probably overestimated adherence as it was self-report, which usually overestimates adherence and the refusals are more likely to have been people not taking tablets but still found nearly one third of the patients were non-adherent. An intervention comprising education, eliciting and addressing specific concerns about antidepressant medication and using medication, which minimises side effects, may be helpful.

The regular use of ecstasy (3,4-methylenedioxymethamphetamine, MDMA) has been associated with depressed mood, anxiety and hostility, but it is not known whether such effects persist after people stop using the drug. Furthermore, little is known about what factors might influence the decision to quit using MDMA. The aim of the present study was to examine the reasons why ex-users had stopped using this drug and to assess their current levels of depression, anxiety, anger and aggression. Telephone interviews were conducted with people who used to take MDMA on a regular basis but who no longer used the drug. The participants comprised sixty-six ex-users who used to take MDMA regularly (at least once every 2 months over a period of at least 1 year), but who had not taken MDMA for at least 1 year (average 3 years). Participants were asked about why they had quit MDMA. They also completed questionnaires to assess trait mood. Ex-users could be divided into two groups based on their reason for quitting: (i) those who had quit for mental health reasons and (ii) those who had quit for circumstantial reasons. Approximately half of those in the mental health group scored in the range for clinical depression. In that group, current levels of depression and anxiety correlated significantly with the cumulative amount of MDMA that they had taken several years previously. These findings suggest that some users may either be more vulnerable to the adverse effects of MDMA or have pre-existing mental health problems for which they self-medicate by using ecstasy. The present study shows that some ex-users experience an impairment to mental health that persists for years after they stop using this drug.

Aims and MethodThere is a shortage of doctors in the UK, particularly in psychiatry and pathology. Little is known about prospective medical students' career intentions or attitudes. This study aimed to report on the career intentions and attitudes to psychiatry of 819 attenders at a sixth-form conference for prospective medical students.ResultsA much higher proportion of students expressed favourable attitudes to psychiatry as a career than might have been expected. The most popular career was paediatrics and the least popular was genitourinary medicine.IMPLICATIONSMedical schools need to be proactive in providing information, career advice and positive role models. This may counteract negative propaganda and encourage career choice in tune with students' earlier feelings and patients' needs.

This follow-up study of 234 doctors examined whether improvements in attitudes to psychiatry following an undergraduate psychiatry attachment were maintained after graduation, and explored the relationship between attitudes to psychiatry and intention to pursue psychiatry as a career. Improvements in attitudes following undergraduate psychiatric attachment decayed over time but remained higher than pre-attachment levels. Attitudes of doctors who definitely intended to pursue psychiatry, however, increased at each stage. Attitudes of doctors were predicted by post-attachment attitudes, which in turn were predicted by encouragement from consultants and influences of specialist registrars during the attachment at medical school. There were no differences between a problem-based and a traditional psychiatry curriculum in attitude change. The findings suggest that encouragement during medical school from more senior doctors increases the numbers wanting to pursue psychiatry and may increase the number who subsequently pursue psychiatry as a career.