The impact of continuing terror and stress on the use of psychoactive drugs in Israel

ENGLISH :
An unprecedented wave of terrorism has plagued the Israeli population over the last two years. Between September 29, 2000 and October 1, 2002, Magen David Adom recorded a total of 4,535 casualties. Of these, 539 people were killed, 406 severely injured and 554 moderately injured. Among the additional 3,036 people lightly injured were 11 MDA staff members. Fears of random shootings and of human bombs exploding in schools, restaurants, and buses have caused extreme stress in the general population. Because the country is so small, everyone knows a terror victim personally - or knows someone else who does. At the same time, the economic situation, with its rising unemployment, reflects both the reality of war and the international recession. Stress and uncertainty are widespread. This ongoing study explores the assumption that terror, stress and uncertainty influences the prescribing practices of community physicians. Initially, we were interested only in psychoactive drugs, namely anxiolytics, hypnotics and antidepressants. However, as this pilot study was planned to become part of a larger study done by the Mental Health Services, we then decided to include analgesics, asthma medications and H1 antagonists for hyperacidity and anti-hypertensives We believed that by measuring changes in prescribing patterns and actually measuring the dispensing of these medications, we would also receive a certain picture regarding the coping mechanisms of Israeli society. This is retrospective study, utilizing prescribing and dispensing data from some of the major HMOs' computerized data bank. The data were to be evaluated in terms of DDD/1000 population for given categories of medication. Our study, like the situation in Israel, is ongoing. Even as this article is being written (in late December 2002), the Israeli medical establishment, along with the rest of the country, is preparing for the possibility of Iraqi chemical and biological warfare. As can be imagined, the fluidity of our security situation has affected the planned study many times over, and forced us to reconsider our goals, scope, and methodology. Indeed, our initial study has since been incorporated into a larger, national study under the auspices of the Mental Health Services of the Israeli Ministry of Health. At this date, only initial dispensing data have been analysed, but if what we see holds true, our findings are of enormous significance. Initially we assumed that there would be an increased use of anxiolytics and hypnotics, either benzodiazepine derivatives or benzodiazepine-related drugs. Instead, we found no statistically significant increases in either. The use of antidepressants proved most interesting: we noted a significant increase in SSRI dispensing, and to our surprise, it was not at the expense of traditional antidepressants. (Author' s abstract)