• A survey of the prescribing of selective serotonin reuptake inhibitors by psychiatrists

      Lawton, John D.; Naik, Prakash (1995)
      Questionnaires were sent to 92 doctors asking them aspects of their antidepressant prescribing; 72 returned them. Sixty had prescribed selective serotonin reuptake inhibitors (SSRIs) in the previous year. The ratio of SSRIs to all antidepressants prescribed in the previous year exceeded 40% in only eight doctors. Inability to tolerate and failure to respond to established antidepressants were the most common indications for prescribing SSRIs. Side effects and cost were the most common reasons deterring doctors from prescribing SSRIs. SSRIs being new products and doubtS regarding their efficacy were factors that were significantly more likely to deter 'doctors of other grades' than consultants from prescribing them. Fluoxetine and paroxetine were the most frequently prescribed SSRIs.
    • The Edinburgh cohort of HIV-positive drug users: The effects of depressed mood and drug use upon neuropsychological function

      Egan, Vincent (1996)
      The effect of the human immunodeficiency virus (HIV) on cognitive function drug users is subject to the effects of drug use and depression. The current study tested the effect of these potential confounders in 244 HIV-positive drug users (147 asymptomatic, 97 symptomatic) and 42 confirmed HIV-negative drug users. No difference was found between HIV-positive and HIV-negative groups for measures of drug use, negative mood, or verbal IQ. Symptomatic HIV-positive patients were significantly more impaired on measures of non-verbal performance intelligence and memory than HIV-negative or HIV-positive asymptomatic patients. Structural modelling of the data suggested associations between falling CD4 count and impaired non-verbal performance; low mood, greater benzodiazepine use and poorer memory; and higher opiate use and slight impairment on non-verbal performance. Drug use and low mood did not act upon low CD4 count to affect non-verbal cognitive performance. Our results suggest cognitive impairment in HIV-positive drug users attributable to HIV illness can be detected, and that concurrent drug use and mood are not major confounders, provided such factors are recognized to begin with. © 1996 The British Psychological Society.
    • Recurrent hyponatremia associated with sertraline and lofepramine

      Bouman, Walter P.; Johnson, Hazel (1997)
      Reports a case of recurrent hyponatremia in a 78-yr-old woman with depression. One week after the start of sertraline (50 mg/day) therapy, S was admitted to hospital for complaints of feeling depressed, weak, and lethargic. The setraline treatment was discontinued and fluids were restricted to 1 liter/day. After 1 wk, the hyponatremia had resolved and a regimen of lofepramine (70 mg/day) was started. Two weeks after starting the lofepramine, her serum sodium level fell, and the serum and urine osmolality rose. Lofepramine was discontinued and the 1 liter restriction was reinstated. Everything normalized within a week. Finally, the S was treated with ECT. She made a full recovery and was placed on clozapine. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • SSRI prescribing in the elderly: Caution required

      Pinner, Gill; Bouman, Walter P.; Johnson, Hazel (1997)
    • An investigation of the prevalence of psychological morbidity in burn-injured patients

      Tedstone, Josephine E. (1997)
      Research on the psychological impact of burn injuries has concentrated on major burns, while small burns have been largely neglected. In a prospective study, 45 patients with burn injuries ranging from 1 per cent or less up to 40 per cent total body surface area were assessed using semi-structured interviews within 2 weeks of sustaining the burn, and followed-up at approximately 3 months postburn to investigate the prevalence of mental health problems. The prevalence of clinically significant levels of anxiety, intrusions and avoidance remained similar at 2 weeks and 3 months postburn, however, the prevalence of depression and Post Traumatic Stress Disorder (PTSD) increased 6- and 4-times, respectively, by 3 months. Patients with small burn injuries of 1 per cent or less also experienced clinically significant levels of psychological difficulties postburn. The implications for the identification of patients at risk of future psychological morbidity are discussed.;
    • Selective serotonin reuptake inhibitors (SSRI)-induced hyponatraemia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in the elderly: An overview

      Bouman, Walter P.; Pinner, Gill (1998)
      Hyponatraemia due to SIADH is a common and potentially lethal adverse effect of selective serotonin reuptake inhibitors in elderly patients. The possibility of hyponatraemia due to SIADH needs to be borne in mind if an elderly patient experiences a significant and rapid deterioration in their clinical condition after commencing an SSRI, and appropriate physical investigations and treatment undertaken. Careful management in the prescription of SSRIs to elderly patients includes routine monitoring of electrolytes for early detection and reduction of morbidity.
    • Withdrawal reaction associated with venlafaxine

      Johnson, Hazel; Bouman, Walter P.; Lawton, John D. (1998)
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    • Family history as a predictor of poor long-term outcome in depression

      Duggan, Conor (1998)
      BACKGROUND: We investigated whether family history had prognostic significance in depression in a study which addressed some of the methodological shortcomings of previous studies.
    • An investigation of the factors associated with an increased risk of psychological morbidity in burn injured patients

      Tedstone, Josephine E. (1998)
      Previous research aimed at identifying factors that increase the risk of major burns patients experiencing psychological problems post-burn has generally ignored the potential role of psychological factors. In a prospective study, patients with burn injuries ranging from < 1 per cent up to 40 per cent were interviewed within 2 weeks of sustaining the burn and followed up at ca 3 months post-burn in order to assess the effects of both non-psychological and psychological factors on their subsequent mental health. The factors investigated included burn related information, demographic information, previous psychiatric history, levels of psychological morbidity at 2 weeks post-burn, responsibility for the injury, previous life events, compensation claims and factors from the coping literature including appraisal, coping strategies and coping efficacy. Forward stepwise multiple regression analyses were used to investigate the relationships between these factors and subsequent mental health. Post-burn psychological morbidity was strongly associated with psychological factors including levels of psychological morbidity in the first 2 weeks of sustaining the injury and factors from the coping literature.;
    • How disabling is depression? Evidence from a primary care sample

      Duggan, Conor (1999)
      Background. Major depression is an illness with a high prevalence and is most commonly seen and treated by general practitioners (GPs). Aim. To determine the level of disability in depressed patients seen in a primary care setting, and to investigate whether the level of disability was associated with the severity of the depression. Method: Prospective data collection, using the 36-item Shortened Form (SF-36), from the Medical Outcomes Study, as a measure of disability, and from the Beck Depression Inventory (BDI) in a sample of depressed patients recruited from a Counselling versus Antidepressant in Primary Care (CAPC) study in the Trent Region. All patients met the research diagnostic criteria for major depression. Results. Two hundred and fifty patients were assessed. These patients reported high levels of disability compared both with published norms and with other chronic physical illnesses. Increases in disability were especially noticeable in the domains of the SF-36 that were specific to mental illness. There was a significant correlation between scores on the SF-36 and the BDI. Conclusion. This study confirms that depressed patients in primary care report high levels of disability on the SF-36, and that the instrument is both specific to the domains expected to be affected by mental disorder and is sensitive to the severity of mood disturbance.
    • Assessing effectiveness of treatment of depression in primary care: Partially randomised preference trial

      Duggan, Conor (2000)
      Background: There is a mismatch between the wish of a patient with depression to have counselling and the prescription of antidepressants by the doctor. Aims: To determine whether counselling is as effective as antidepressants for depression in primary care and whether allowing patients to choose their treatment affects their response. Method: A partially randomised preference trial, with patients randomised to either antidepressants or counselling or given their choice of either treatment. The treatment and follow-up were identical in the randomised and patient preference arms. Results: There were 103 randomised and 220 preference patients in the trial. We found: No differences in the baseline characteristics of the randomised and preference groups; that the two treatments were equally effective at 8 weeks, both for the randomised group and when the randomised and patient preference groups for a particular treatment were combined; and that expressing a preference for either treatment conferred no additional benefit on outcome. Conclusions: These data challenge several assumptions about the most appropriate treatment for depression in a primary care setting. Declaration of interest: None. The NHS Executive, Trent, funded the study.
    • Antidepressant drugs and generic counselling for treatment of major depression in primary care: Randomised trial with patient preference arms

      Bedi, Navjot; Duggan, Conor (2001)
      Objectives: To compare the efficacy of antidepressant drugs and generic counselling for treating mild to moderate depression in general practice. To determine whether the outcomes were similar for patients with randomly allocated treatment and those expressing a treatment preference. Design: Randomised controlled trial, with patient preference arms. Follow up at 8 weeks and 12 months and abstraction of GP case notes. Setting: 31 general practices in Trent region. Participants: Patients aged 18-70 who met research diagnostic criteria for major depression; 103 patients were randomised and 220 patients were recruited to the preference arms. Main outcome measures: Difference in mean Beck depression inventory score; time to remission; global outcome assessed by a psychiatrist using all data sources; and research diagnostic criteria. Results: At 12 months there was no difference between the mean Beck scores in the randomised arms. Combining the randomised and patient preference groups, the difference in Beck scores was 0.4 (95% confidence interval -2.7 to 3.5). Patients choosing counselling did better than those randomised to it (mean difference in Beck score 4.6, 0.0 to 9.2). There was no difference in the psychiatrist's overall assessment of outcome between any of the groups. 221/265(83%) of participants with a known outcome had a remission. Median time to remission was shorter in the group randomised to antidepressants than the other three groups (2 months upsilon 3 months). 33/221 (15%) patients had a relapse. Conclusions: Generic counselling seems to be as effective as antidepressant treatment for mild to moderate depressive illness, although patients receiving antidepressants may recover more quickly. General practitioners should allow patients to have their preferred treatment.
    • Using homework in therapy for depression

      Garland, Anne (2002)
      There is a growing body of research evidence that demonstrates that completion of homework assignments is significantly correlated with outcome in cognitive therapy. The cognitive model of depression sees homework as an intrinsic aspect of the therapy process. Homework serves a number of purposes, including generalizing learning from the session into everyday life and fostering the independent practice of skills acquired during treatment. We review a number of commonly occurring problems that arise when seeking to engage the client in homework. The negotiation and implementation of homework assignments is a core clinical skill, and we present a range of strategies the clinician can use to optimize its effectiveness. It is vital that practitioners have an awareness of their own role and expectations in developing homework assignments.;
    • Antidepressants for people with both schizophrenia and depression

      Furtado, Vivek (2002)
      Background: Depressive symptoms, often of substantial severity, are found in 50% of newly diagnosed suffers of schizophrenia and 33% of people with chronic schizophrenia who have relapsed. Depression is associated with dysphoria, disability, reduction of motivation to accomplish tasks and the activities of daily living, an increased duration of illness and more frequent relapses. Objectives: To determine the clinical effects of antidepressant medication for the treatment of depression in people who also suffer with schizophrenia. Search methods: We undertook electronic searches of the Cochrane Schizophrenia Group's Register (October 2000), ClinPsych (1988-2000), The Cochrane Library (Issue 3, 2000), EMBASE (1980-2000) and MEDLINE (1966-2000). This was supplemented by citation searching, personal contact with authors and pharmaceutical companies. We updated this search January 2013 and added 71 new trials to the awaiting assessment section. Selection criteria: All randomised clinical trials that compared antidepressant medication with placebo for people with schizophrenia or schizoaffective disorder who were also suffering from depression. Data collection and analysis: Data were independently selected and extracted. For homogeneous dichotomous data the fixed effects risk difference (RD), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, reviewers calculated weighted mean differences. Statistical tests for heterogeneity were also undertaken. Main results: Eleven studies met the inclusion criteria. All were small, and randomised fewer than 30 people to each group. Most included people after the most acute phase of psychosis and investigated a wide range of antidepressants. The quality of reporting varied a great deal. For the outcome of 'no important clinical response' antidepressants were significantly better than placebo (n=209, 5 RCTs, summary risk difference fixed effects -0.26, 95% CI -0.39 to -0.13, NNT 4 95% CI 3 to 8). The depression score at the end of the trial, as assessed by the Hamilton Rating Scale (HAM-D), seemed to suggest that using antidepressants was beneficial, but this was only statistically significant when a fixed effects model was used (n=261, 6 RCTs, WMD fixed effects -2.2 95% CI -3.8 to -0.6; WMD random effects -2.1 95% CI -5.04 to 0.84). There was no evidence that antidepressant treatment led to a deterioration of psychotic symptoms in the included trials. Heterogeneous data on 'any adverse effect' are equivocal (n=110, 2 RCTs, RD fixed 0.11 CI -0.03 to 0.25, Chi square 7.5, df=1, p=0.0062). In one small study extrapyramidal adverse effects were reported less often by those allocated to antidepressant (n=52, 1 RCT, RD fixed -0.28 CI -0.5 to -0.04). Only about 10% of people left these studies by 12 weeks. There was no apparent difference between those allocated placebo and those given an antidepressant (n=426, 10 RCTs, RD fixed 0.04 CI -0.02 to 0.1). Authors' conclusions: Overall, the literature was of poor quality, and only a small number of trials made useful contributions. Though our results provide some evidence to indicate that antidepressants may be beneficial for people with depression and schizophrenia, the results, at best, are likely to overestimate the treatment effect, and, at worst, could merely reflect selective reporting of statistically significant results and publication bias. At present, there is no convincing evidence to support or refute the use of antidepressants in treating depression in people with schizophrenia. We need further well-designed, conducted and reported research to determine the best approach towards treating depression in people with schizophrenia. Note: the 71 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.<br/>Copyright &#xa9; 2013 The Cochrane Collaboration.
    • Counseling versus antidepressant therapy for the treatment of mild to moderate depression in primary care: Economic Analysis

      Bedi, Navjot (2003)
      Objectives: To compare the cost-effectiveness of generic psychological therapy (counseling) with routinely prescribed antidepressant drugs in a naturalistic general practice setting for a follow-up period of 12 months.Methods: Economic analysis alongside a randomized clinical trial with patient preference arm. Comparison of depression-related health service costs at 12 months. Cost-effectiveness analysis of bootstrapped trial data using net monetary benefits and acceptability curves.Results: No significant difference between the mean observed costs of patients randomized to antidepressants or to counseling (£342 vs £302, p = .56 [t test]). If decision makers are not willing to pay more for additional benefits (value placed on extra patient with good outcome, denoted by K, is zero), then we find little difference between the treatment modalities in terms of cost-effectiveness. If decision makers do place value on additional benefit (K &gt; £0), then the antidepressant group becomes more likely to be cost-effective. This likelihood is in excess of 90% where decision makers are prepared to pay an additional £2,000 or more per additional patient with a good global outcome. The mean values for incremental net monetary benefits (INMB) from antidepressants are substantial for higher values of K (INMB = £406 when K = £2,500).Conclusions: For a small proportion of patients, the counseling intervention (as specified in this trial) is a dominant cost-effective strategy. For a larger proportion of patients, the antidepressant intervention (as specified in this trial) is the dominant cost-effective strategy. For the remaining group of patients, cost-effectiveness depends on the value of K. Since we cannot observe K, acceptability curves are a useful way to inform decision makers.