24 Apr, 12 | by BMJ Group
Articles of interest in other scholarly journals
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Sverre Bergh, Geir Selbæk, Knut Engedal
The effect of stopping SSRIs in patients with dementia, and neuropsychiatric symptoms (but no depression) in Norwegian nursing homes was assessed in a double blind, parallel group RCT. In patients taking SSRIs for three months or more, SSRIs were discontinued in 63 patients, and continued in 68 patients. The patients who stopped SSRIs had higher scores on the Cornell scale for depression in dementia after 25 weeks. 54% of patients had at least a 30% worsening on the Cornell scale in the discontinuation group compared to 29% in the continuation group. Although this study showed that discontinuation of antidepressant treatment in patients with dementia and neuropsychiatric symptoms leads to an increase in depressive symptoms, a limitation is that 37% patients withdrew from the study early.
Vorobeychik Y, Gordin V, Mao J, Chen L.
This review of combination therapy for the treatment of neuropathic pain found only small numbers of clinical studies on this topic. There was clinical evidence that gabapentin and pregabalin combined with an opioid, cyclo-oxygenase-2 inhibitor or antidepressants improved responses compared with monotherapy for painful diabetic neuropathy and postherpetic neuropathy. Topical 8% capsaicin and 5% lidocaine patches were shown to be effective add-on therapies for several causes of painful neuropathy. There were only small clinical studies in cancer-related neuropathic pain, which showed that combination therapy enabled better pain control with reduced side effects. The authors recommend the development of further clinical evaluation tools and future clinical studies to compare single-drug and combination therapies and the combination of non-drug modalities such as physical, psychological and biofeedback therapies.
This questionnaire based cross-sectional pilot study investigated insomnia, sleep quality, and daytime sleepiness in 75 relatives of dying patients cared for at home in Sweden. The mean sleep duration was 6.5 hours with the need of sleep being 8 hours. 23% reported moderate or severe clinical insomnia with 15% reporting excessive daytime sleepiness. 4% had very poor sleep quality, whereas 39% reported very good sleep quality. Younger relatives had more insomnia and daytime sleepiness compared with older relatives and the sleep quality reported by women was less than that of men. Although 73% reported getting less sleep than they wanted only a minority had clinical insomnia or excessive daytime sleepiness.
Pirl WF, Greer JA, Traeger L, Jackson V, Lennes IT, Gallagher ER, Perez-Cruz P, Heist RS, Temel JS.
To evaluate the effect of early palliative care (EPC) on depression and prognosis, 151 patients with newly diagnosed metastatic non-small-cell lung cancer (NSCLC) were randomised to standard oncology care with or without EPC. Depression was assessed at baseline and at 12 weeks with the Patient Health Questionnaire-9 (PHQ-9) and was scored using Diagnostic and Statistical Manual of Mental Disorders IV. Depression response was considered ≥ 50% reduction in PHQ-9 scores at 12 weeks. At baseline, 14% patients were diagnosed with depression which predicted worse survival. Patients assigned to EPC had greater improvements in depression at 12 weeks. However, improvement in depression was not associated with improved survival. EPC was associated with improved survival after adjusting for improvement in depression. Although EPC in patients with metastatic NSCLC has been shown to improve survival and EPC is associated with greater improvement in depression, this study does not indicate that it is the treatment of depression which mediates the survival benefit from EPC.