Special Interest: Mental health

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.

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.

Autism, like most psychiatric disorders, covers a spectrum of severity from severely disabling classic autism to milder forms of Asperger’s syndrome which border on normality. The term autism spectrum disorder (ASD) includes autism, atypical autism and Asperger’s syndrome. Some parents consult their GP worried that their child might have autism. Others may attend with a range of concerns that might point to the condition such as problems with hearing, vision, hypersensitivity to sensory stimuli, behaviour management, language impairment or repetitive behaviour. Autism conditions often co-exist with neurological disorders (particularly those including epilepsy), and more than 300 syndromes which include autism have been described.The new NICE guidelines, launched in September 2011, cover children, from birth up to 19 years, on the autism spectrum and build on the guidance published by SIGN in 2007.ASD was once believed to be relatively rare but is now thought to occur in about 1% of children. There is certainly increasing demand for diagnostic services for children and young people. Whether the apparent increasing prevalence signifies an epidemic or an epidemic of discovery is debatable. [With external links to the evidence base]

Generalised anxiety disorder (GAD) is a common condition, with a point prevalence of 4.4% among the adult population in England. It is characterised by a persistent, unfocused sense of threat, associated with symptoms of tension, autonomic hyperactivity and vigilance. Patients repeatedly overestimate the danger of physical or social harm, and at the same time underestimate their ability to cope. As a result, they worry excessively about a wide range of activities and life events, such as work, family issues, financial difficulties and health problems. GAD is a chronic relapsing condition, with a remission rate of only 38% after five years. It is associated with even greater impairment of occupational and social functioning than that associated with major depression, and has a significant impact on quality of life. However, around two-thirds of patients are not recognised in primary care and only a third of those identified by the 2007 household survey in England were receiving any form of treatment. Both in research and in clinical practice, there has been an excessive focus on depression to the detriment of the anxiety disorders. This is unfortunate in view of the high prevalence of GAD, its substantial impact on functioning and its association with chronic physical health problems. It is to be welcomed that this imbalance is now being addressed.

For patients with  a chronic condition and depression the prognosis is thought to be  worse. Comorbid depression is associated with increased pain, greater functional impairment and reduced quality of life. Depressed patients may lack the confidence to self-manage their condition, increasing the risk of long-term complications.

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.

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.

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.