Prophylactic effect of citalopram in unipolar, recurrent depression: placebo-controlled study of maintenance therapy.

BACKGROUND: Major depression is highly recurrent. Antidepressant maintenance treatment has proven efficacy against recurrent depression. AIMS: Comparison of prophylactic efficacy of citalopram versus placebo in unipolar, recurrent depression. METHODS: Patients 18-65 years of age with recurrent unipolar major depression (DSM-IV), a Montgomery-Asberg Depression Rating Scale score of > or =22 and two or more previous depressive episodes, one within the past 5 years, were treated openly with citalopram (20-60 mg) for 6-9 weeks and, if responding, continued for 16 weeks before being randomised to double-blind maintenance treatment with citalopram or placebo for 48-77 weeks. RESULTS: A total of 427 patients entered acute treatment and 269 were randomised to double-blind treatment. Time to recurrence was longer in patients taking citalopram than in patients taking placebo (P:<0.001). Prophylactic treatment was well tolerated. CONCLUSIONS: Citalopram (20, 40 and 60 mg) is effective in the prevention of depressive recurrences. Patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase.

[New indications for antidepressive agents. Now also in anxiety disorders and premenstrual syndrome?]. / Neue Indikationen für Antidepressiva. Jetzt auch bei Angststörungen und prämenstruellem Syndrom?

Social anxiety and posttraumatic stress disorders are quite common in the adult general population, and often lead to suffering and impaired function in major areas of daily life. In addition to behavioral therapy, pharmacological strategies may bring about significant improvement. Particularly effective are the SSRIs, nefazodone and venlafaxine. Premenstrual syndrome--a common complaint in women of reproductive age--can also be effectively treated with SSRIs.

[Mainstream medicine versus complementary medicine (homeopathic) intervention: a critical methodology study of care in pregnancy]. / Schulmedizinische versus komplementärmedizinische (homöopathische) Intervention: eine methodenkritische Studie zur Schwangerschaftsbetreuung.

This meticulously evaluated study investigated two fundamental questions. The first dealt with the usefulness and adequacy of the instruments (questionnaires and case report forms) presently available in mainstream clinical research when trying to evaluate two dissimilar therapeutic systems such as main stream medicine and homeopathy. The second question dealt with the comparability of the two populations of patients in terms of individual personality characteristics as well as regarding the progress of the pregnancies and the course of the deliveries under the two systems of care and control. It turned out that a study of that kind is feasible in principle but is very demanding and time consuming. In addition the study showed clearly that the instruments presently available in mainstream medicine do not cover essential aspects of homeopathy and, therefore, impede a comparison of the two therapeutic systems. In the homeopathic group the frequency of situations requiring a Cesarean was remarkably low. However, the number of cases is too small to draw qualifying conclusions.

[Quality of life of pregnant women in homeopathic or mainstream medical type of care and the course of the pregnancy]. / Lebensqualität von schwangeren Frauen in Abhängigkeit von einer homöopathischen oder schulmedizinischen betreuungsform und vom Schwangerschaftsverlauf.

This study investigated 120 pregnant women cared for and treated by physicians specialized in homeopathy and 85 pregnant women cared for and treated by mainstream gynecologists. Quality of life was assessed twice during pregnancy and once shortly after delivery by the instrument SEIQoL (Schedule for the Evaluation of Individualized Quality of Life). In addition, the study registered individual personality characteristics, the psychological situation, the attitude towards the forthcoming delivery, and the functional state before and after delivery. It turned out that women who preferred homeopathic care judged their quality of life lower than women from the other group. However, their criteria for medical decisions and for the assessment of their own personal situation differed as well. There was some correlation between quality of life and age, number of deliveries, partnership and certain personality characteristics. The study showed the importance of paying more attention to the subjective world of the pregnant women. This applies especially in an analysis of two dissimilar therapeutic systems. It could also be concluded that the SEIQoL was a useful instrument for such a study. Finally it turned out that the two populations investigated were different.

The Zurich Study: XXII. Epidemiology of gastrointestinal complaints and comorbidity with anxiety and depression.

A representative cohort of Swiss adults recruited at age 20 years and interviewed at ages 23, 28 and 30 years was studied regarding the symptomatology, prevalence and longitudinal course of functional gastrointestinal symptoms and their association with psychiatric syndromes. A functional gastrointestinal complaint was identified if a proband reported symptoms at least eight times in the past year or for a duration of at least 2 weeks without medical explanation and with a moderate degree of distress. Of the population, 9.4-17.7% was found to suffer from functional stomach complaints and 4.9-16% from functional intestinal complaints. Women reported functional gastrointestinal complaints two to three times more often than men, and increasingly so with age. The overlap of stomach and intestinal complaints was modest with 2.0-6.7%. Cross sectionally, functional stomach complaints were significantly associated with major depression (DSM-III-R), recurrent brief depression (RBD), subthreshold RBD and dysthymia, and with subthreshold panic disorder, agoraphobia, social phobia and recurrent brief anxiety. Functional intestinal complaints showed a consistently significant association with RBD, dysthymia, major depression, subthreshold RBD, panic disorder, subthreshold panic disorder, agoraphobia, simple and social phobia and generalized anxiety disorder. Individuals who at younger ages suffered from functional gastrointestinal complaints did not show an increased risk for a subsequent development of an anxiety or depressive disorder. Functional gastrointestinal complaints reflect an unspecific concomitant vegetative disturbance common to depression and anxiety; they do not reflect a risk factor for the development of a specific anxiety or depressive disorder.

Recurrent brief depression: the Zurich Study.

The initial conception of manic depressive illness by Kraepelin included short and mild depressive and hypomanic states in the nosologic category of affective illnesses. A longitudinal epidemiologic study in Switzerland (the Zurich Study) identified brief, but recurrent, episodes of depression with severity of symptoms, impairment, and distress equivalent to major depression. The concept of recurrent brief depression was further confirmed in recent community and general practice studies. The diagnostic criteria for recurrent brief depression require the presence of at least five of nine depressive symptoms analogous to the symptoms of major depression, yet a duration of less than 2 weeks (in general 1 to 3 days), a recurrence of at least 12 times a year, and the evidence of work impairment. The 1-year prevalence in the general population is about 5% and the lifetime prevalence 16%. Recurrent brief depression may develop into major depression and vice versa in about the same percentage of cases. It is associated with considerable suicidality and treatment-seeking and is comorbid with anxiety disorders. Patients with combined major and recurrent brief depression are more severely affected, have a higher suicide attempt rate, and have an increased frequency of treatment-seeking than patients with only one condition. Further studies are needed to establish appropriate treatment strategies.

[Homeopathy and conventional medicine in the management of pregnancy and childbirth]. / Homöopathie und Schulmedizin in der Schwangerschafts-und Geburtsbetreuung.

Among alternative methods of healing, homeopathy is the most frequent. Few studies on the efficacy of homeopathic interventions exist which withstand scientific scrutiny. Nevertheless, some evidence supports the efficacy of homeopathy in certain indications, including obstetrics. The practice of preventive antepartum care of pregnant women, adopted at the beginning of this century, has reduced perinatal mortality and the rates of low birth weight and preterm births. The attention of conventional prenatal and obstetric care has been focused on early identification and appropriate management of specific pregnancy risks, such as maternal chronic illness, previous pregnancy complications or intercurrent illnesses. An ongoing monitoring system on studies of perinatal care by Chalmers et al. established the effectiveness of screening for maternal risk factors, of interventions to prevent early pregnancy terminations, of instructions and social support for pregnant women and specific monitoring during childbirth. Studies on homeopathic interventions in obstetrics report positive influence of homeopathic remedies on uterine contractility and the evolution of childbirth. The only study comparing homeopathic and conventional therapy in women with increased risk for contraction abnormalities found few differences between the treatments, except fewer hemorrhages and decreased abnormal contractions in patients treated with homeopathic remedies. Methodological difficulties in comparing homeopathic and conventional medical intervention require specific research designs, taking into account the different theoretical and practical approaches of the two disciplines.

[Epidemiology of sleep disorders]. / Epidemiologie von Schlafstörungen.

Epidemiological investigations on subjectively reported sleep disturbance suggest an average prevalence of 26.2%. About 12.8% of the general population suffer from moderate to severe sleep disturbance. With a narrow definition, a prevalence of disorders of initiating and maintaining sleep associated with daytime sleepiness of 1.6% was found. Female gender and increasing age are risk factors for sleep disturbances. Psychological stress and psychiatric symptoms, especially anxiety and depressive disorders, are associated with sleep disturbances.

Silent myocardial ischemia. Is the person or the event silent?

The symptoms of organic disease vary widely among patients with the same tissue abnormality, because the experience of a symptom is shaped by the patient's perceptual and cognitive style. Thus, the relationship between myocardial ischemia and chest pain is variable in that many patients experience pain without ischemia and many others exhibit ischemia without pain-termed "silent" or "asymptomatic ischemia." Although the nature of the ischemic event may be important in determining the degree of associated pain, we suggest more study of the individual who perceives the event. Myocardial ischemia may not generate a spontaneous report of chest pain because the patient is generally hyposensitive to visceral sensation; because he or she is coping with the threat of heart disease by denying the evidence of it--ie, denying the pain to deny the disease; or because the patient misunderstands the cause and significance of a vague or ambiguous cardiac sensation, normalizing the symptom and misattributing it to a nonpathologic cause.

[Cardiovascular risk factors: an intervention program for general practice]. / Kardiovaskuläre Risikofaktoren: ein Interventionsprogramm für die Praxis.

A new multiple risk factor intervention program, combining a comprehensive, stepwise and health education-based approach, was tested in an outpatient setting. In the first 47 patients (aged 17-55, referred by their physicians) total cardiovascular risk (estimated by Framingham index) was reduced within the first 12 months by an average of 32.5%. This improvement derived from significant reductions in all major risk factors. These findings demonstrate the feasibility and potential, yet unexploited, benefit of a more comprehensive risk factor, approach in general medical practice.

[Behavior therapeutic training for weight reduction]. / Ein verhaltenstherapeutisches training zur Gewichtsreduktion.

A behaviour therapeutic program for weight reduction was worked out by a team of psychologists, dieticians and doctors. A 10 week's course for weight reduction was given by 8 dieticians to a group of 5-7 female overweights (N=50). All dieticians based their work on a written handout. 4 of them had an additional training in behaviour and group therapy prior to the course. During the course all participants showed a significant weight loss and a change in their eating behaviour, the patients counselled by an additionally trained dietician (group E1) showing a significantly greater weight loss than the others (group E2). A follow-up after 3 1/2 months revealed similar differences but subsequent controls after 6 and 20 months showed a gradual decrease of the difference between the two groups. However three different patterns of the patient's weight curve could be distinguished. Pattern a): 26.3% of the participants showed a sinking tendency over all 20 months. Pattern b): 21.4% of the participants showed a significant weight loss over the 20 months with a slight upward tendency after the second follow-up (6 months). Pattern c): 52.3% of the participants lost weight only during the course which was regained in the following 3 months period. In pattern a) and c) group E1 and E2 are evenly represented. Pattern b) was only seen with participants of group E1. The results suggest that there are different characteristics of obese persons which influence the success of weight reduction programs. Further studies will have to describe these characteristics and define their therapeutical implications.

[Nutrition and somatic development of infants in the canton of Berne (with special emphasis on the question of obesity)]. / Ernährung und somatische Entwicklung von Säuglingen im Kanton Bern (mit besonderer Betonung der Frage nach Ubergewicht).

160 babies of 3, 6 or 9 month were investigated in weight, length, subscapular and triceps skinfolds and a history of their nutrition since birth was taken. At the age of three month purely breast-fed babies are significantly lighter and show less weight gain since birth than purely bottle-fed ones. Girls fed on demand are significantly lighter and show thinner subscapular skinfolds than girls fed in fixed intervals. Boys show a similar tendency in weight, but the opposite tendency in skinfolds. The results suggest that feeding on demand supports the natural course of somatic growth of babies. The frequency of feeding on demand and the source of information about baby-foods vary greatly with social class.