SURMONTL trim ipramine
Dosage - Oral route: ambulatory patients: 50 to 150 mg daily in 2 or 3 doses. Treatment to be initiated at lowest dosage, increased in a few days, then adjusted to lowest level required when response has been obtained. When insomnia is present, a larger portion of the dosage may be given at night. Hospitalized patients: 100 to 300 mg daily in 2 or 3 doses: occasionally up to 400 mg. Contraindications: glaucoma, prostatic hypertrophy, drug-induced ONS depression. Should not be associated with MAO inhibitors: a two-week delay is recommended before using the drug in patients having received an MAO inhibitor. Warnings: warn against engaging in activities requiring alertness until response is established. May potentiate alcohol and CNS depressants. Safety in pregnancy has not yet been established. Precautions: in elderly patients, in patients with cardiovascular problems or in those with a history of convulsive disorders: start treatment by the oral route with low doses, progressively increased - in ambulatory psychotic patients, if the drug aggravates psychotic manifestations or induces manic episodes: reduce dosage or discontinue therapy-in seriously depressed patients, because of the possibility of suicide at the beginning of treatment, close supervision should be exercised. Adverse reactions: the following have been reported: excitement, confusion, drowsiness (during initial therapy), insomnia, tremor, dystonia, epileptic seizures, dry mouth, blurred vision, urinary retention, constipation, nausea and vomiting, palpitations, orthostatic hypotension, quinidine-like reactions, changes in libido, weight gain, skin rash, obstructive jaundice. Supply: tablets: 12.5, 25, 50 and 100 mg, bottles of 50 and 500.
erroneous psychiatric labelling of the patient. Owing to opposition from those with vested interests in the status quo, the repeal of this bad Canadian law will not be easy but it will result in more economic, confidential, convenient and safer management of Canadian women. C. A. DOUGLAS RINGROSE, FRCS[C] 10830 Jasper Ave. Edmonton, Alta.
To the editor: In his letter commenting on CMA policy on abortion (Can Med Assoc J 111: 900, 1974) Dr. Wendell W. Watters uses the term "compulsory pregnancy". This term suggests that those who are opposed to abortion are motivated by a desire to punish the pregnant woman. The slogan is effective but I believe it is uncharitable and untrue. In the abortion debate the "pro-life" group are not as callous as Dr. Watters makes them out to be. Their stand is based on a real concern to preserve the unborn life, which, just as the mother, has a vital interest in the pregnancy. Even if one does not agree with their point of view one should credit them with having honourable intentions, and they in turn should credit those with views like Dr. Watters as being motivated by concern for the pregnant woman and not by a desire to destroy helpless babies to satisfy the whims of the mothers. I do not consider sound his analogy that physicians objecting to abortion can be compared to surgeons refusing to remove lung cancers as a strategy in the war against smoking. A cancer and a growing fetus are not comparable. The "pro-life" group is not composed of sadists. Although Dr. Watters presents his position as the rational one, I believe his objectivity is in doubt and that he has forfeited the right to this epithet. J. J. KRAYENHOFF, MD
References: 1. KRISTOF, F. E., et al.: Systematic studies with trimiprami ne - a new antidepressive drug. can. Psychiat. Assoc. J. 12:517-520, (Oct.) 1967. 2. DUNLEAvY, D. L. F., et al.: changes during weeks in effects of tricyclic drugs on the human sleeping brain. Brit. J. Psychiat. 120:663672, 1972. 3. MARSHALL, B.: The treatment of depression in general practice by a single-dose schedule. Practitioner, 206, 806-810, June 1971. 4. HUSSAIN, M. Z. and cHAUDHRY, Z. A.: Single versus divided daily dose of trimipramine in the treatment of depressive illness. Amer. J. Psychiat., 130, (10), 1142-44, Oct. 1973.
Full information upon request.
POuienc ,p
MEMBER
1120 Yates St. Victoria, B.C.
To the editor: As Mr. Geekie suggested in his reply to the comments of Dr. Watters on the CMA policy on abortion (Can Med Assoc J 111: 902, 1974), I have re-read his report and I cannot understand why he cannot see in his own report the specific frailties criticized by Dr. Watters. I suspect that the content of Mr. Geekie's report is a faithful description of the facts of the CMA policy, just as the spirit of the report reflects accurately the reluctance of the CMA to push vigorously for a more rational federal legislation on therapeutic abortion. This reluctance is not hard to understand since the CMA is composed of phys-
icians who hold strongly opposing opinions on the morality of therapeutic abortion. Consequently, it will be impossible to find a compromise that will satisfy all members of the association. But the matter simply cannot remain unresolved; if it does, we shall continue to dehumanize thousands of Canadian women each year, women whose only fault is that they are imperfect about as imperfect as our contraceptive technology. The most abused among these women are those who have the coincidental misfortune to live in communities with hospitals that have refused to establish abortion committees. If these women are desperate enough they may "seek the squalid and dangerous help of the back-street abortionist", particularly if they do not have the resources to seek their abortion outside Canada's boundaries. I believe that since therapeutic abortion is legal the CMA has a heavy responsibility to encourage even more strongly the establishment of at least one therapeutic abortion facility in all regions of Canada, Justice Minister Otto Lang's influence notwithstanding. But in the present circumstances this is not enough. The less unfortunate among these women are those who live near a hospital in which a therapeutic abortion committee is established and working. But even in these cases we continue to place these women on trial. A woman whose case is to be heard by the committee is in the humiliating and guilt-provoking position of having to tell her doctor what she thinks he and the committee need to hear in order to approve her request. In this distorted clinical situation we effectively deprive her of the opportunity to explore further with honesty and dignity why she could not have avoided the unwanted pregnancy in the first place. Instead, these women wish to have their abortion and run away from the doctors and hospitals where they have been tried. I suspect that many, if not most, hospitals do not have the humane and smoothly organized clinic described by Dr. Paul Mackenzie (Can Med Assoc 1 111: 667, 1974), and yet he could not follow up more than half of the patients in his series. What is wrong? What I believe is wrong is that an important, at times essential, and in some cases lifesaving, medical decision is contaminated by the stigma of the Criminal Code of Canada. Until a therapeutic abortion can be done with wisdom and good medical judgement by a competent physician, in an accredited hospital, under the supervision of the provincial governing 'body, without the stigma of the Criminal Code in the consulting room, we shall have little success
CMA JOURNAL/JANUARY 11, 1975/VOL. 112
25
Dosage - Oral route: ambulatory patients: 50 to 150 mg daily in 2 or 3 doses. Treatment to be initiated at lowest dosage, increased in a few days, then adjusted to lowest level required when response has been obtained. When insomnia is present, a larger portion of the dosage may be given at night. Hospitalized patients: 100 to 300 mg daily in 2 or 3 doses: occasionally up to 400 mg. Contraindications: glaucoma, prostatic hypertrophy, drug-induced ONS depression. Should not be associated with MAO inhibitors: a two-week delay is recommended before using the drug in patients having received an MAO inhibitor. Warnings: warn against engaging in activities requiring alertness until response is established. May potentiate alcohol and CNS depressants. Safety in pregnancy has not yet been established. Precautions: in elderly patients, in patients with cardiovascular problems or in those with a history of convulsive disorders: start treatment by the oral route with low doses, progressively increased - in ambulatory psychotic patients, if the drug aggravates psychotic manifestations or induces manic episodes: reduce dosage or discontinue therapy-in seriously depressed patients, because of the possibility of suicide at the beginning of treatment, close supervision should be exercised. Adverse reactions: the following have been reported: excitement, confusion, drowsiness (during initial therapy), insomnia, tremor, dystonia, epileptic seizures, dry mouth, blurred vision, urinary retention, constipation, nausea and vomiting, palpitations, orthostatic hypotension, quinidine-like reactions, changes in libido, weight gain, skin rash, obstructive jaundice. Supply: tablets: 12.5, 25, 50 and 100 mg, bottles of 50 and 500.
erroneous psychiatric labelling of the patient. Owing to opposition from those with vested interests in the status quo, the repeal of this bad Canadian law will not be easy but it will result in more economic, confidential, convenient and safer management of Canadian women. C. A. DOUGLAS RINGROSE, FRCS[C] 10830 Jasper Ave. Edmonton, Alta.
To the editor: In his letter commenting on CMA policy on abortion (Can Med Assoc J 111: 900, 1974) Dr. Wendell W. Watters uses the term "compulsory pregnancy". This term suggests that those who are opposed to abortion are motivated by a desire to punish the pregnant woman. The slogan is effective but I believe it is uncharitable and untrue. In the abortion debate the "pro-life" group are not as callous as Dr. Watters makes them out to be. Their stand is based on a real concern to preserve the unborn life, which, just as the mother, has a vital interest in the pregnancy. Even if one does not agree with their point of view one should credit them with having honourable intentions, and they in turn should credit those with views like Dr. Watters as being motivated by concern for the pregnant woman and not by a desire to destroy helpless babies to satisfy the whims of the mothers. I do not consider sound his analogy that physicians objecting to abortion can be compared to surgeons refusing to remove lung cancers as a strategy in the war against smoking. A cancer and a growing fetus are not comparable. The "pro-life" group is not composed of sadists. Although Dr. Watters presents his position as the rational one, I believe his objectivity is in doubt and that he has forfeited the right to this epithet. J. J. KRAYENHOFF, MD
References: 1. KRISTOF, F. E., et al.: Systematic studies with trimiprami ne - a new antidepressive drug. can. Psychiat. Assoc. J. 12:517-520, (Oct.) 1967. 2. DUNLEAvY, D. L. F., et al.: changes during weeks in effects of tricyclic drugs on the human sleeping brain. Brit. J. Psychiat. 120:663672, 1972. 3. MARSHALL, B.: The treatment of depression in general practice by a single-dose schedule. Practitioner, 206, 806-810, June 1971. 4. HUSSAIN, M. Z. and cHAUDHRY, Z. A.: Single versus divided daily dose of trimipramine in the treatment of depressive illness. Amer. J. Psychiat., 130, (10), 1142-44, Oct. 1973.
Full information upon request.
POuienc ,p
MEMBER
1120 Yates St. Victoria, B.C.
To the editor: As Mr. Geekie suggested in his reply to the comments of Dr. Watters on the CMA policy on abortion (Can Med Assoc J 111: 902, 1974), I have re-read his report and I cannot understand why he cannot see in his own report the specific frailties criticized by Dr. Watters. I suspect that the content of Mr. Geekie's report is a faithful description of the facts of the CMA policy, just as the spirit of the report reflects accurately the reluctance of the CMA to push vigorously for a more rational federal legislation on therapeutic abortion. This reluctance is not hard to understand since the CMA is composed of phys-
icians who hold strongly opposing opinions on the morality of therapeutic abortion. Consequently, it will be impossible to find a compromise that will satisfy all members of the association. But the matter simply cannot remain unresolved; if it does, we shall continue to dehumanize thousands of Canadian women each year, women whose only fault is that they are imperfect about as imperfect as our contraceptive technology. The most abused among these women are those who have the coincidental misfortune to live in communities with hospitals that have refused to establish abortion committees. If these women are desperate enough they may "seek the squalid and dangerous help of the back-street abortionist", particularly if they do not have the resources to seek their abortion outside Canada's boundaries. I believe that since therapeutic abortion is legal the CMA has a heavy responsibility to encourage even more strongly the establishment of at least one therapeutic abortion facility in all regions of Canada, Justice Minister Otto Lang's influence notwithstanding. But in the present circumstances this is not enough. The less unfortunate among these women are those who live near a hospital in which a therapeutic abortion committee is established and working. But even in these cases we continue to place these women on trial. A woman whose case is to be heard by the committee is in the humiliating and guilt-provoking position of having to tell her doctor what she thinks he and the committee need to hear in order to approve her request. In this distorted clinical situation we effectively deprive her of the opportunity to explore further with honesty and dignity why she could not have avoided the unwanted pregnancy in the first place. Instead, these women wish to have their abortion and run away from the doctors and hospitals where they have been tried. I suspect that many, if not most, hospitals do not have the humane and smoothly organized clinic described by Dr. Paul Mackenzie (Can Med Assoc 1 111: 667, 1974), and yet he could not follow up more than half of the patients in his series. What is wrong? What I believe is wrong is that an important, at times essential, and in some cases lifesaving, medical decision is contaminated by the stigma of the Criminal Code of Canada. Until a therapeutic abortion can be done with wisdom and good medical judgement by a competent physician, in an accredited hospital, under the supervision of the provincial governing 'body, without the stigma of the Criminal Code in the consulting room, we shall have little success
CMA JOURNAL/JANUARY 11, 1975/VOL. 112
25
