2007-2008 Mental health clinical reviews


Patients with depression have impaired sense of humour

17 Dec 2008Paid-up subscribers

Laughter is an effective antidote to stress, promotes a sense of wellbeing, strengthens relationships and may have beneficial effects on immunity and pain tolerance. Lack of a sense of humour may increase vulnerability to depression, and loss of the ability to appreciate humour may contribute to the downward spiral of mood in patients with depression.

Smoking doubles risk of depression

19 Nov 2008Paid-up subscribers

This study suggests that we should encourage our depressed patients to stop smoking once they have achieved remission. However, we need to be aware that, by emphasising the role of lifestyle factors in depression, we may unwittingly make patients feel responsible for their illness, adding to their sense of guilt.

Two-way link between diabetes and depression

15 Oct 2008Paid-up subscribers

This study suggests that we should not only promote exercise as an effective treatment for patients with mild to moderate depression but also as a way of reducing their risk of developing diabetes.

Effect size of antidepressants overestimated

10 Sep 2008Paid-up subscribers

In my opinion, the key question is whether the placebo effect is mainly caused by spontaneous remission or a genuine therapeutic effect. If the former, we should perhaps adopt a policy of watchful waiting, only offering antidepressant treatment if there is no improvement within a specified period of time. If the latter, unless we have access to an effective alternative (such as CBT), we need to consider whether we can justify withholding such a highly effective treatment from our patients.

Children who have ingested buprenorphine should be referred to A&E

13 Aug 2008Paid-up subscribers

GPs need to be sure that patients in treatment who have, or who have contact with, children are properly counselled about the safe storage of take-home doses of buprenorphine. Given the absence of any fatality in the study, I would welcome debate about the relative safety of inadvertent methadone and buprenorphine overdoses in children.

Antenatal depression can affect child development

13 Aug 2008Registered users

Children of mothers with persistent antenatal depression were 34% more likely to have developmental delay

Regular exercise associated with better mental health

23 Jul 2008Paid-up subscribers

The findings of this study are consistent with the evidence from randomised controlled trials that exercise may be effective in the short term as a treatment for mild to moderate depression. However, this is a cross-sectional study and cannot therefore indicate the direction of causation. The results may simply reflect the fact that depressed patients are less motivated and exercise less.

Suicide risk increased following death of spouse

18 Jun 2008Paid-up subscribers

This study provides strong evidence to support the recommendation that bereavement visits should occur as soon as possible after a patient has died:the surviving spouse is at most risk during the first few days. Risk assessment tools may help to identify those most at risk; this study suggests that age and gender are relevant.

Children with depressed parents at risk of major depression in adulthood

21 May 2008Paid-up subscribers

The use of CBT, either alone or with antidepressant treatment, may not only help patients to change their harmful modes of thought and behaviour, but also help to prevent them teaching them to their children.

Metformin reduces weight gain in patients on atypical antipsychotics

23 Apr 2008Paid-up subscribers

Combination therapy with an atypical antipsychotic and metformin may be an attractively simple solution but more data from larger, long-term, preferably primary care-based trials are required to test this approach. In the meantime, we should be closely monitoring weight gain and cardiovascular risk in patients newly started on atypical antipsychotics, bearing in mind that the Framingham risk score underestimates risk in obese patients with the metabolic syndrome.

Treatment of postnatal depression beneficial

01 Mar 2008Paid-up subscribers

NICE recommends that GPs should ask two questions to screen for depression at the postnatal check. A recent audit in our practice found that an assessment of mental health was documented in the records of only 31% of our postnatal women, and we have therefore decided to send out the two-question screen with our postnatal check invitations. Although postnatal depression tends to remit spontaneously at 4-6 months, it leads to considerable distress and disruption, and treatment doubles the recovery rate. Screening and treatment is therefore entirely justified.

Guidelines for depression improve patient outcomes

01 Feb 2008Paid-up subscribers

After controlling for patient prognosis, a significant inverse relationship was found between quality of care and the probability of persistent depression at 18 and 24 months. This suggests that doctors whose practice is concordant with guidelines achieve better outcomes; as an observational study, however, a causal link cannot be established.

Depression associated with disability in older patients

01 Feb 2008Paid-up subscribers

There are two possible conclusions. Either the DSM-IV fails to identify a large proportion of elderly patients with depression, or depression is much less common in the elderly than generally believed and is overdiagnosed by GMS-AGECAT.

Chocolate may alleviate depression

01 Dec 2007Paid-up subscribers

A prescription of chocolate, hot baths and plenty of sleep is not a panacea for depression. There may, however, be a subgroup of patients whose personality not only makes them vulnerable to depression, but also allows them to alleviate symptoms in this way.

Should SSRIs be used in children with depression?

01 Nov 2007Paid-up subscribers

The authors conclude that there is a favourable risk/benefit profile, justifying the cautious use of antidepressants as a first-line treatment option. It is likely, however, that they have underestimated the risk of suicidal behaviour. Youths at risk were excluded from the trials and data were only collected retrospectively as part of adverse event reporting.

Screening for depression post-MI may not be beneficial

01 Oct 2007Paid-up subscribers

The question as to whether identification and treatment of post-MI depression can improve cardiovascular prognosis remains unanswered: an adequately powered trial that incorporates managed care in the intervention arm is required. This trial does, however, provide further evidence for the view that we should not be screening for depression until we have set in place efficient and effective management programmes.

Internet-based CBT not effective as stand-alone intervention for depression

01 Sep 2007Paid-up subscribers

One of the fundamental principles of cognitive therapy is that it requires a sound therapeutic alliance. It has even been suggested that the quality of the therapeutic relationship is more important than the specific type of psychotherapy used in determining the clinical outcome. Computers may complement the role of physicians and therapists, but they are no substitute.

Severe mental illness associated with increased CHD mortality

01 Sep 2007Paid-up subscribers

The data suggest that patients on high doses of conventional antipsychotics may be at particularly high risk of CHD mortality, although dose may simply be a marker of illness severity.

CBT effective in treatment of hypochondriasis

01 Jul 2007Paid-up subscribers

Antidepressants may have a role in treating associated major depression, panic disorder or functional somatic syndromes, but more evidence is required before they can be advocated as a specific treatment for hypochondriasis.

Intervention in older people with depression may reduce mortality

01 Jun 2007Paid-up subscribers

This study provides support for the view that screening alone cannot improve outcomes for depressed patients and that the focus should be on achieving better organisation and delivery of care.

Consider residual symptoms in depression recovery

01 Jun 2007Paid-up subscribers

The review cites a number of studies that provide evidence that cognitive behaviour therapy (CBT) following successful pharmacotherapy reduces the risk of relapse. Given the paucity of CBT therapists, our patients are unlikely to receive CBT if we do not provide it ourselves.

Predictors of suicide differ according to patient gender

01 May 2007Paid-up subscribers

This study suggests that it is important to take an adequate family history of patients who are at risk of attempting suicide, particularly in men. This may be facilitated by construction of a simple genogram.