OCD associated with increased risk of substance use disorder

24 Jun 2022Registered users

Patients with obsessive-compulsive disorder (OCD) are nearly four times more likely to develop substance use disorder than those without OCD, a Swedish cohort study has found. This association may be partially attributed to genetic factors, but environmental factors may also be involved.

Discontinuing antidepressants too early raises risk of relapse

27 Oct 2021Registered users

Patients who had been taking antidepressants for at least 9 months and felt well enough to stop were more likely to relapse by 52 weeks if their treatment was discontinued compared with those who carried on with their current therapy, a UK primary care study has found.

Does BPH raise the risk of dementia?

26 Jul 2021Registered users

Men with benign prostatic hyperplasia (BPH) may be at increased risk of developing Alzheimer’s disease and other dementias, the findings of a Danish population-based cohort study suggest.

Pattern of heavy drinking with bingeing linked to depression

25 May 2021Registered users

Patterns of alcohol consumption in particular frequent use plus frequent bingeing have positive associations with symptoms of depression such as depressed mood, poor appetite or overeating, feelings of worthlessness or guilt and psychomotor agitation or retardation, a German study has found.

Evaluating therapies for depression in children and adolescents

24 Jul 2020Registered users

Fluoxetine, either alone or in combination with cognitive behaviour therapy, appears to be the most effective treatment for children and adolescents with moderate to severe depression, a systematic review and network meta-analysis has concluded. NICE recommends that antidepressants should not be initiated in primary care.

Substance use disorder raises risk of treatment resistant depression

23 Apr 2020Paid-up subscribers

Recent or current substance use disorder is associated with treatment resistance in patients who receive prescription treatment for depression, a nested case control study has found.

Gabapentinoids may increase risk of suicidal behaviour in young patients

07 Aug 2019Paid-up subscribers

A large Swedish study has suggested that gabapentinoid medications are associated with an increased risk of suicidal behaviour and unintentional overdose in adolescents and young adults.

Regular cannabis use raises risk of psychosis

24 Apr 2019Paid-up subscribers

Daily cannabis use is associated with a three-fold increased risk of psychotic disorder, a multicentre, international case-control study has shown.

Does intensive BP lowering reduce risk of dementia?

25 Mar 2019Registered users

Intensive blood pressure (BP) control reduces the risk of developing mild cognitive impairment, but not dementia, a US randomised trial has found.

Consumption of nitrate-cured meat products increases odds of mania

20 Dec 2018Registered users

There is a strong and independent association between manic episodes and a history of eating nitrate-cured meat products, a US study has found.

Apathy associated with incident dementia in the elderly

24 Sep 2018Registered users

Apathy symptoms may identify older patients who are at increased risk of developing dementia, a Dutch prospective cohort study has found.

Postnatal depression may have adverse effects on offspring

22 Mar 2018Registered users

The children of women with severe persistent postnatal depression (PND) are at substantially increased risk of preschool behaviour problems, poor academic attainment and adolescent depression, a UK longitudinal cohort study has found.

Assessing suicide and self-harm risk in adolescents

22 Feb 2018Registered users

The incidence of suicide in adolescent boys is more than twice that among adolescent girls, whereas non-fatal self-harm is much more common in girls than boys, an English retrospective database study has found.

Exercise can prevent depression

23 Nov 2017Paid-up subscribers

If healthy adults exercise for a minimum of an hour each week, their risk of incident depression can be reduced by 12%, a Norwegian prospective cohort study has found. 

Depression in midlife does not raise risk of dementia

23 Oct 2017Registered users

Depression may be a prodromal feature of, rather than a risk factor for, dementia, a UK prospective cohort study has found. A total of 10,308 participants (6,895 men) in the Whitehall ll study, aged 35-55 at recruitment, were followed up between 1985 and 2015. 

Moderate alcohol consumption may affect cognitive function

22 Sep 2017Registered users

Even moderate alcohol consumption, compared with abstinence, may raise the risk of hippocampal atrophy and faster decline in lexical fluency, an analysis of data from the Whitehall ll study has found.

Should lithium treatment be continued during pregnancy?

28 Jul 2017Registered users

Women who take lithium during early pregnancy have a slightly increased risk of giving birth to a child with a cardiac malformation, a large retrospective cohort study from the USA has found.

Risk of suicide in university students double that of graduates

22 Jun 2017Registered users

Compared with those who have completed university education, university students are more than twice as likely to commit suicide, a Swedish study has found.

Gene variants associated with increased risk of congenital heart defects with SSRI use

24 Apr 2017Paid-up subscribers

Common variants in genes related to folic acid, homocysteine and glutathione/transsulfuration metabolic pathways are associated with an increased risk of congenital heart disease in the offspring of women who take SSRIs in the periconceptual period, a US case control study has found.

Depression common in patients with mild cognitive impairment

22 Feb 2017Paid-up subscribers

A third of patients with mild cognitive impairment also suffer from depression, a meta-analysis has found.

Women on hormonal contraception at raised risk of depression

23 Jan 2017Registered users

Women who use hormonal contraception are more likely to become depressed, a large Danish prospective cohort study has found. The cohort comprised all adolescents and women aged between 15 and 34 who were resident in Denmark and without a previous history of depression, antidepressant use, other major psychiatric diagnosis, cancer, venous thrombosis or infertility treatment. Data were obtained from national registers of dispensed prescriptions and secondary care psychiatric diagnoses.

Whole body hyperthermia for depression

15 Dec 2016Paid-up subscribers

Whole body hyperthermia (WBH) shows promise as an effective treatment for depression, a randomised double-blind,sham-controlled trial, published in JAMA Psychiatry, has concluded.

A diagnosis of cancer can affect mental health

24 Oct 2016Registered users

Cancer patients have an increased risk of developing common mental health disorders from 10 months prior to their cancer diagnosis, with a peak incidence during the first week after diagnosis,a Swedish study has found.

How should we detect autism in adults?

23 Sep 2016Registered users

The Autism-Spectrum Quotient (AQ) questionnaire has low specificity and should not be used as a rule-out test for autism spectrum disorder (ASD), the findings of a UK study suggest. AQ10 scores failed to predict ASD better than chance.

GP interventions help patients discontinue benzodiazepine therapy

01 Aug 2016Registered users

Primary care intervention programmes were more effective than standard care in helping patients achieve long-term abstinence from benzodiazepines, a study from Spain has shown. Patients aged 18-80 years from primary care centres, were enrolled in a three-arm, randomised controlled trial. All 532 patients had used prescribed benzodiazepines daily for at least six months, mostly for anxiety and insomnia. The median age of patients was 64 years and 72% were female. Overall the intervention programmes were 1.5 times more effective than standard care in helping patients achieve abstinence.

Proactive care improves functioning in chronic depression

01 Aug 2016Registered users

Practice nurse-led structured care of adult patients with chronic or recurrent depression achieved a modest improvement in functional impairment but did not significantly improve depression scores or quality of life, a randomised controlled trial has found. The ProCEED (proactive care and its evaluation for enduring depression) trial recruited participants from 42 general practices throughout the UK. Overall, 276 patients were allocated to the control group (GP treatment as usual) and 282 to the proactive care intervention.

Bipolar disorder is not always recognised in younger people

25 Apr 2016Paid-up subscribers

As many as one in ten patients aged 16-40 prescribed antidepressants for depression or anxiety have unrecognised bipolar disorder, a UK study has found. A total of 21 general practices in West Yorkshire participated in the study. Patients aged 16-40 who had been prescribed antidepressant drugs were identified by a search of the primary care database. Of the 2,341 eligible patients who were invited to participate 236 agreed to do so.

Light therapy effective for nonseasonal depression

22 Feb 2016Paid-up subscribers

Light therapy, both as sole therapy and in combination with fluoxetine, is an effective treatment for nonseasonal depression, an American secondary care study has found.

Antidepressants and CBT are equally effective in major depression

05 Jan 2016Registered users

Second generation antidepressants (i.e. antidepressants other than tricyclics and MAOIs), cognitive behaviour therapy (CBT) and combination therapy are equally effective as initial treatments for adult patients with major depression, a systematic review and meta-analysis has found.

Antidepressant NSAID combination raises risk of brain haemorrhage

21 Oct 2015Registered users

The combination of antidepressants and NSAIDs is associated with an increased risk of intracranial haemorrhage, a retrospective cohort study has found. Data were obtained from the claims database of the Korean National Health Insurance system which covers almost the entire South Korean population of 50.2 million.

Predicting which older patients will fail to respond to antidepressants

24 Sep 2015Registered users

Older people with higher levels of depression severity are unlikely to respond to first-line antidepressant treatment, particularly if they have chronic depression, guilt or marked functional impairment, a US open label study has found. A total of 453 participants were recruited in a secondary care setting and completed the study. Eligible patients were aged 60 or above with current non-psychotic unipolar major depression.

Should SSRIs be discontinued in pregnancy?

22 Jun 2015Registered users

Exposure to selective serotonin reuptake inhibitors (SSRIs) or venlafaxine in early pregnancy is associated with a small increase in the risk of birth defects but this does not appear to be due to a teratogenic effect of the drugs, a large multinational cohort study has found. The cohort consisted of 2.3 million liveborn singleton children from five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). Antidepressant exposure was defined as a redeemed prescription from 30 days before the last menstrual period until the end of the first trimester.

Overtreatment of hypertension may accelerate cognitive decline in the elderly

21 May 2015Registered users

Overtreatment of hypertension in older patients with dementia or mild cognitive impairment may speed up the rate of cognitive decline, an Italian cohort study has found.

Antidepressants may increase suicide risk

23 Apr 2015Paid-up subscribers

Patients prescribed mirtazapine or venlafaxine are more likely to attempt or complete suicide, a UK study has found. Data were obtained from more than 600 contributing practices that use the EMIS medical records system. There were 238,963 participants who were aged between 20 and 64 years and had a first recorded diagnosis of depression between 1 January 2000 and 31 July 2011. The follow-up period ended on 1 August 2012.

Long-term anticholinergic use associated with raised risk of dementia

23 Mar 2015Paid-up subscribers

Elderly patients who take anticholinergic drugs for prolonged periods have an increased risk of developing dementia, an American study has found.

Depression associated with increased mortality risk after stroke

22 Jan 2015Registered users

Stroke survivors with depression are more likely to die within five years, particularly younger patients. Those prescribed selective serotonin reuptake inhibitors (SSRIs) after their stroke appear to have a significantly increased risk of mortality, a UK cohort study has found. Data were obtained from the South London Stroke Register. A total of 3,722 patients, registered between 1998 and 2012 and followed up till the end of June 2013, were recruited to the study. Three months after their stroke, 1,354 survivors were screened for depression using the Hospital Anxiety and Depression Scale (HADS). The outcome measure was all cause mortality within five years of the stroke.

Why do we like to put things off?

15 Dec 2014Registered users

It will soon be time for the annual ritual of New Year’s resolutions, which we invariably fail to follow and put off again until next year. It would appear that the blame lies with our prehistoric ancestors. A twin study from the United States has found that procrastination (pro: in favour of, crastinus: tomorrow) is an inherited trait which is strongly linked to impulsivity. Data were gathered from the Colorado Longitudinal Twin Study. There were 663 participants, from both identical and same-sex fraternal twin pairs.

Psychotherapy effective for subthreshold depression

24 Nov 2014Registered users

Psychological interventions may be effective in the treatment of subclinical depression and prevent progression to major depression, but more high quality evidence is needed, a meta-analysis has concluded. Eighteen randomised controlled trials met the inclusion criteria for the meta-analysis. The 1,913 participants were adults with ‘clinically relevant depressive symptoms’ identified either by using a self-rating depression questionnaire e.g. CES-D score 8-15 or a diagnostic interview. There were 947 patients in the treatment group and 966 in the control group.

Combination treatment only of benefit in severe depression

23 Sep 2014Registered users

The addition of cognitive therapy to antidepressant treatment increases the likelihood of recovery from major depression, but only in those with severe non-chronic depression, an American secondary care study has found. A total of 452 patients with either chronic (duration ≥ 2 years) or recurrent DSM-IV major depression were recruited from outpatient clinics. Of these 225 were randomised to receive antidepressant treatment alone and 227 to combination therapy.

Suicide risk increased in Asperger’s syndrome

24 Jul 2014Registered users

Compared with the general UK population, adults with Asperger’s syndrome are much more likely to experience suicidal thoughts and plan or attempt suicide, a clinical cohort study has found. Asperger’s syndrome was diagnosed by an expert clinician, using the Adult Asperger Assessment and clinical judgement. Over a nine-year period, 374 adults (256 men and 118 women) were diagnosed with Asperger’s syndrome, of whom 367 completed the questionnaire.

Long-term prognosis is poor in depression

22 May 2014Paid-up subscribers

Depression has a poor prognosis, recovery is slow and relapse is common, a primary care study from Finland has found. The Vantaa Primary Care Depression Study screened patients for depression using the PRIME-MD questionnaire. Those with a positive result were invited to attend a DSM-IV structured clinical interview. A total of 137 patients with DSM IV depressive disorder were recruited and followed up for five years.

Managing agitation in Alzheimer’s disease

22 Apr 2014Paid-up subscribers

Citalopram significantly reduces agitation in patients with Alzheimer’s disease, an American and Canadian multicentre study has found. Participants were recruited from a number of different settings, including memory clinics, community outreach and nursing homes. They had probable Alzheimer’s disease, as defined by national criteria, they did not meet DSM IV criteria for major depression and had clinically significant agitation (defined by frequency and severity). A total of 186 participants were randomised to receive a psychosocial intervention plus either citalopram or placebo for nine weeks.

High prevalence of treatment resistant depression in primary care

22 Jan 2014Paid-up subscribers

Fewer than one in four depressed patients are in remission after a minimum of six weeks’ treatment with antidepressants, a UK primary care cross-sectional study has found. The data were collected during the initial stage of the CoBalT study, a randomised controlled trial of CBT augmentation for treatment-resistant depression.1 A total of 2,129 participants were recruited from 73 general practices. Eligible patients were those aged 18-75 who had been prescribed an adequate dose of antidepressant medication for at least six weeks.

Laughter the best medicine for agitation in the elderly

05 Dec 2013Paid-up subscribers

Humour therapy significantly reduces agitation in nursing home residents, an Australian cluster randomised trial has shown. Seventeen homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. The residents had a mean age of 84. Around three quarters (77%) were female and 78% had a diagnosis of dementia. Residents with a fear of clowns were excluded from the study. One member of staff from each of the intervention homes was chosen to be the LaughterBoss: the modern-day equivalent of a court jester. LaughterBosses attended a one day training course, dressed distinctively and were given ‘permission to be silly.’ A professional performer the ElderClown visited the home on 9 to 12 occasions during the three-month intervention period. ElderClowns interact with residents on a personal level, telling jokes, singing songs and asking for advice.

Collaborative care is effective for depression

23 Oct 2013Paid-up subscribers

Collaborative care improves depression outcomes in both the short and medium term, a UK primary care study has found. Fifty one practices were randomised to either collaborative care or usual care. Potential participants were identified by screening GP records for recent depression Read codes. They were enrolled if they met the ICD-10 criteria for depression when interviewed by a research worker. In total, 276 patients were recruited from the collaborative care practices and 305 from the usual care practices. Overall 86% of participants had moderate or severe depression. The intervention was delivered by care managers in liaison with GPs under the supervision of mental health specialists.

Lithium reduces suicide risk in mood disorders

23 Sep 2013Paid-up subscribers

Lithium lowers the risk of suicide in both bipolar disorder and unipolar depression, a systematic review and meta-analysis has found. Overall, 48 randomised controlled trials, involving 6,674 participants, were included. Patients had a diagnosis of bipolar disorder (19 trials), unipolar depression (12 trials) or a mix of bipolar, unipolar or schizoaffective disorder (17 trials). They were randomised to receive either lithium, an active comparator or placebo over a period of at least three months.

CBT prevents relapses in depression

25 Jul 2013Paid-up subscribers

CBT is as effective as continued antidepressant treatment in preventing subsequent relapse, a meta-analysis has found. Nine studies with a total of 506 participants met the inclusion criteria; seven were from the USA, one from the UK and one from Romania. The average Hamilton Depression Rating Scale scores at recruitment ranged from 18.4 to 26.9, indicating moderate to severe depression. Patients were randomised to receive either CBT (18-24 sessions) or antidepressants during the acute phase (12-16 weeks). CBT was not continued during the follow-up period, although a maximum of five booster sessions were allowed. Antidepressant treatment was either continued during the follow-up period, or withdrawn.

Antidepressants in pregnancy raise autism risk

24 Jun 2013Paid-up subscribers

Women who take antidepressants during the first trimester are almost twice as likely to give birth to children with autistic spectrum disorders, a nested case-control study has found. The Stockholm youth cohort comprises all children aged up to 17 years resident within Stockholm County between 2001 and 2007. After exclusion of those with incomplete data, there were 4,429 cases of autistic spectrum disorder. For each case there were ten age- and sex-matched controls (n = 43,227).

Should we abandon the PHQ-9?

23 May 2013Paid-up subscribers

It is uncertain whether the use of structured assessment tools (PHQ-9, HADS-D or BDI-III) improves outcomes for depressed patients and the QOF depression severity indicators should be abandoned, a systematic review has concluded. Eight studies met the inclusion criteria. There was only one (quasi) randomised controlled trial; the rest were observational studies.

Being bullied in childhood has long-term effects on mental health

26 Apr 2013Registered users

Children who are the victims of bullying are more likely to experience psychiatric problems as young adults, an American prospective population-based cohort study has found. A total of 1,420 children were recruited from 11 counties in Western Carolina. Participants were assessed annually between the ages of 9 and 16. Both the child and his/her parent were interviewed to identify bullying or bullying others, childhood psychiatric disorders and family hardships. Subsequent follow-up with a structured diagnostic interview took place at the ages of 19, 21 and 24-26.

Bipolar disorder associated with adverse outcomes in pregnancy

21 Feb 2013Paid-up subscribers

Babies of women with bipolar disorder are more likely to be born preterm, irrespective of whether the mother had received mood stabilising drugs, a Swedish cohort study has found. Infants whose mothers had untreated bipolar disorder had an increased risk of microcephaly and neonatal hypoglycaemia.

When does hoarding become a disorder?

28 Jan 2013Paid-up subscribers

Hoarding disorder is a distinct disorder rather than a subtype of obsessive compulsive disorder (OCD), a functional MRI study has suggested.

Benzodiazepine use may raise risk of dementia in the elderly

13 Dec 2012Paid-up subscribers

Older patients who start taking benzodiazepines have a 50% increased risk of developing dementia, a French prospective cohort study has found.

Anxiety and depression more common in deaf patients

31 Oct 2012Paid-up subscribers

Adults with severe to profound deafness suffer from high levels of psychological distress, and experience difficulties in accessing health care, a review has found. Relevant studies published since 2005 were identified by searching a number of databases.

Antidepressants linked to increased risk of sudden cardiac death

20 Sep 2012Paid-up subscribers

Patients who are prescribed citalopram or nortriptyline are at increased risk of sudden cardiac death, a Danish study has found.

Suicides rise during economic recession

20 Sep 2012Paid-up subscribers

There were more than 1,000 excess suicides in England during the 2008-10 economic downturn, a time trend analysis has found.

GAD increases cardiovascular risk post-MI

25 Jul 2012Registered users

Generalised anxiety disorder (GAD) is associated with a near doubling of the risk of adverse outcomes following myocardial infarction (MI), a Dutch naturalised cohort study has found. A total of 438 patients were recruited following an MI. At three months follow-up, ICD-10 GAD and ICD-10 depressive episode were identified using a standardised diagnostic interview (Composite International Diagnostic Interview). Participants were then followed up over an average of 5.7 years. An adverse outcome was defined as death from any cause or readmission with a cardiovascular event. After adjustment for age and gender, the hazard ratio for adverse events was 1.94 for those with GAD (95% CI: 1.14-3.30). Additional adjustment for depression and severity of cardiac disease did not affect the results.

Exercise therapy of little benefit as an adjunct to antidepressants

25 Jul 2012Registered users

Depression in adults is not improved by the addition of individual exercise therapy to standard care, a pragmatic randomised controlled trial from the UK has found.

Be vigilant for neuropsychiatric side effects in patients on steroid therapy

20 Jun 2012Registered users

An epidemiological study from UK primary care has found that adult patients prescribed oral glucocorticoids are seven times more likely to attempt suicide than untreated patients with the same medical condition. However, the absolute risk is small. They are also significantly more likely to develop depression, mania, delirium and panic disorder.

Depression is more difficult to recognise in older patients

22 May 2012Registered users

A meta-analysis of studies comparing the symptom profiles of younger and older patients with major depression has found that older people are more likely to present with agitation, somatic symptoms and hypochondriasis, whereas younger people are more likely to present with guilt and loss of libido.

Use of SSRIs in pregnancy increases risk of persistent pulmonary hypertension in the newborn

21 Mar 2012Paid-up subscribers

A population-based cohort study from the Nordic countries has found that women who take SSRIs during the second half of pregnancy are more than twice as likely to give birth to children with persistent pulmonary hypertension of the newborn (PPHN). However, the absolute risk remains very low. Data were obtained from national registers of births, deaths and dispensed prescriptions. Exclusion criteria were multiple births and a gestational age of less than 33 weeks. More than 1.6 million infants, born between 1996 and 2007, were included in the study.

Burnout is common in GPs

25 Feb 2012Registered users

A cross-sectional, postal survey of GPs has found high levels of burnout. The study revealed high scores for emotional exhaustion and depersonalisation in more than four out of ten respondents, and low scores for perceived personal achievement in a third. Dr Phillip Bland, GP with an interest in mental health reflects upon the findings, 'It is suprising that, in the current study, depersonalisation did not appear to be associated with impaired performance.'

Music therapy beneficial as an adjunct for depression

16 Dec 2011Registered users

Individual music therapy improves outcomes in depression when combined with standard therapy, a randomised controlled trial from Finland has found. A total of 79 participants (62 women), aged 18 to 50, with an ICD-10 diagnosis of depression were recruited from psychiatric health centres and polyclinics. Thirty three were allocated to the intervention group and 46 received standard care only. The intervention consisted of 20 twice-weekly sessions, each session lasting for one hour. Both the therapist and patient were provided with a keyboard, percussion instrument and acoustic drum. A therapeutic musical relationship was developed by improvising music together.

Life review therapy can help older patients with depression

22 Nov 2011Registered users

Life review therapy is an effective intervention for adults aged 55 and older with depressive symptoms, a Dutch pragmatic randomised controlled trial has found. Dr Philip Bland comments ont he study: 'NICE recommends a low-intensity psychosocial intervention for patients with persistent subthreshold symptoms (>2-3 months). Life review therapy would seem to be an attractive option for older patients, but the positive findings of the present study should be treated with caution. First, the participants in this study were recruited by advertisement and may therefore have been more highly motivated and more likely to respond to therapy than patients presenting in a primary care setting. Second, comparison with usual care does not control for non-specific benefits of group participation, so we do not know what proportion, if any, of the response to treatment was due to the specific intervention. Finally, there is a problem of publication bias among trials of psychotherapy for adult depression. GPs are primarily diagnosticians, not therapists. The diagnosis of depression is complex and should incorporate an assessment of cognition as well as the number and severity of symptoms and the degree of functional impairment. Depressed patients have negative, unhelpful thoughts about themselves, their current experiences and the future: Beck’s cognitive triad. I suggest that for older patients we should add a fourth category i.e. negative evaluation of their past life. I find that the use of genograms is an effective way of placing the presenting problem within a historical and family context, and encouraging patients to tell stories about their lives. '

Which type of antidepressants are best for elderly patients?

20 Oct 2011Paid-up subscribers

A large cohort study from the UK has reached the surprising conclusion that tricyclics are the safest class of antidepressants in elderly people. The cohort comprised 60,746 primary care patients aged 65 and over (mean age 75) with a new diagnosis of depression recorded between January 1 1996 and December 31 2007. The cohort was followed up until December 31 2008. Comments Dr Phillip Bland,'Perhaps the most striking result from this study is that almost 90% of the patients were given antidepressants. For elderly patients with mild to moderate depression, the risks of antidepressant medication are likely to outweigh the benefits, and a psychosocial intervention may well be preferable.If we are to prescribe, I do not think there is sufficient evidence to justify prescribing very low dose tricyclics (

Use of online messaging via electronic records improves management of depression

20 Sep 2011Paid-up subscribers

Online messaging via an electronic medical record is an effective and efficient way of providing enhanced care for depressed patients, a primary care study from the United States has found. Patients were also more likely to be satisfied with their treatment than those who received standard care.

Bipolar disorder often goes unrecognised

20 Sep 2011Paid-up subscribers

 A significant minority of depressed patients have unrecognised bipolar disorder, a primary care study from Wales has found. Dr PhilipBland comments on the study: 'There are a number of reasons why bipolar disorder is often not recognised. Patients may perceive hypomania as normal wellbeing, distinction from personality disorder (particularly borderline personality disorder) can be difficult, and comorbid substance misuse may be misdiagnosed as the primary disorder. At the same time, early recognition is important. There are concerns that antidepressant monotherapy may be harmful in bipolar disorder, with a risk of mood destabilisation, rapid cycling and treatment resistance. Therefore, we should raise our awareness of bipolar disorder, particularly among those with early-onset, severe or treatment-resistant depression. However, I would argue against the routine use of screening questionnaires as this is likely to replace the problem of underdiagnosis with that of overdiagnosis.'

Guided self-help for anxiety and depression of limited benefit in primary care

09 Aug 2011Paid-up subscribers

A systematic review has concluded that patients with mild to moderate anxiety and depression derive only limited short-term benefit from guided self-help interventions in primary care.  Comments Dr Phillip Bland, 'There are good reasons for not prescribing antidepressants to patients with mild-moderate depression of

CBT reduces risk of recurrent events in CHD patients

22 Jun 2011Paid-up subscribers

Following a coronary heart disease (CHD) event, group CBT reduces the risk of recurrent cardiovascular events by 41%, a randomised controlled trial from Sweden has found. Philip Bland, The Practitioner's reviewer in mental health, writes: 'This study provides some justification for the NICE recommendation that group CBT should be the treatment of choice for CHD patients with moderate depression.' However, it would appear that long-term therapy (6-12 months) may be necessary in order to improve cardiovascular outcomes, whereas NICE recommends that group CBT should be delivered over a period of six to eight weeks. Screening for depression among patients with CHD is of doubtful value in view of the high number needed to screen, the reluctance of patients to accept treatment, and the lack of evidence to suggest that treatment of depression can reduce cardiovascular mortality. A more fruitful approach may be to facilitate successful adjustment in all patients through the addition of group CBT to cardiac rehabilitation programmes.'

Selecting the best treatment for generalised anxiety disorder

20 Apr 2011Paid-up subscribers

A multiple treatments meta-analysis has found that sertraline is the best tolerated therapy for generalised anxiety disorder (GAD). There were 27 randomised controlled trials which were suitable for inclusion in the analysis. Response was defined as a reduction of 50% or more from the baseline Hamilton anxiety scale (HAM-A) score, remission as a final HAM-A score ≤7 and tolerability as the withdrawal rate due to adverse events. For each outcome measure, drugs were ranked according to the probability of their being the most effective/well tolerated treatment.Nine drugs (duloxetine, escitalopram, fluoxetine, lorazepam, paroxetine, pregabalin, sertraline, tiagabine, and venlafaxine) were compared with one another. Fluoxetine was ranked first for response (probability 62.9%) and remission (60.6%) whereas sertraline was ranked first for tolerability (49.3%). Of those drugs which are licensed in the UK for the treatment of GAD, duloxetine was ranked first for response (probability 2.7%), escitalopram was ranked first for remission (26.7%) and pregabalin was ranked first for tolerability (7.7%). 'These findings need to be treated with caution. All studies were sponsored by drug companies, unpublished studies were not specifically looked for, and publication bias is therefore likely. The absence of tricyclics from the list of drugs included in the analysis does not mean that SSRIs are superior to tricyclics in the treatment of GAD. It simply reflects the fact that most clinical trials of tricylics were carried out before GAD became a recognised diagnosis.'

Antidepressants are effective for depression in chronic conditions

23 Mar 2011Paid-up subscribers

Antidepressants are a safe and effective treatment for depression in patients with a chronic physical illness, a NICE systematic review and meta-analysis has concluded. There are several reasons for not prescribing antidepressants to patients with chronic conditions who present with mild to moderate depression of recent onset:antidepressants are little better than placebo;the physical illness may increase susceptibility to side effects; there is an increased risk of drug interactions;patients may be reluctant to take them. NICE recommends that they should only be prescribed if low-intensity psychosocial interventions are ineffective, or if there is a previous history of moderate or severe depression, or if the depression complicates the care of the chronic condition. If an antidepressant is to be prescribed, SSRIs are the drug group of first choice as they may be better tolerated and have been shown to improve quality of life. NICE recommends sertraline and citalopram as they are less likely than other SSRIs to interact with other medication and appear to be safe in heart disease.

Antidepressants not effective in minor depression

21 Feb 2011Paid-up subscribers

Antidepressants are no more effective than placebo as a treatment for patients with subthreshold depression, a meta-analysis has found. Six double-blind randomised controlled trials met the inclusion criteria. There was a total of 468 participants (234 treated with antidepressants and 234 with placebo). Three studies compared paroxetine with placebo, and fluoxetine, amitriptyline and isocarboxacid were each compared with placebo in individual studies. 'Both NICE and the British Association for Psychopharmacology do not recommend the use of antidepressants for short-duration (

Suicide risk raised following bariatric surgery

24 Jan 2011Paid-up subscribers

Patients who have undergone bariatric surgery are at substantially increased risk of suicide, a study from the United States has found. Although the absolute suicide rate (1 in 538) was low, this was much higher than that of the general population. All Pennsylvania residents who underwent bariatric surgery between January 1st 1995 and December 31st 2004 were identified from the comprehensive state records. This data was then matched to mortality data for the period September 1st 1996 to December 28th 2006. Of the 16,683 patients who underwent bariatric surgery, 31 committed suicide during the study period. The suicide rates for men and women were 13.7 and 5.2 per 10,000 person-years respectively. The corresponding age-matched rates for the US population were 2.4 (men) and 0.7 (women) per 10,000 person-years.The true number of suicides is likely to have been significantly higher as a result of the misclassification of suicides as unintentional poisoning. While the official US suicide rate declined by 12% between 1987 and 2006, there was a more than four-fold increase in the number of deaths attributed to unintentional poisoning. 'I would draw two lessons from this study. First, before referring patients for bariatric surgery, we must have a detailed discussion with them regarding both the potential benefits and associated risks of surgery, including the risk that they will ultimately be disappointed with the result. Second, we should ensure that bariatric surgery patients receive adequate support and follow-up, particularly during the second and third postoperative years.'


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