Cipriani and colleagues published a major multiple-treatments meta-analysis of new generation antidepressants last week - see abstract below.  As Parikh wrote in his linked editorial (see below) "Andrea Cipriani and colleagues provide the field with a major answer.  Free of any potential funding bias (and including an analysis of studies based on pharmaceutical-company sponsorship), these researchers used a newer methodology, multiple treatments meta-analysis, to examine 117 head-to-head randomised trials in almost 26 000 patients ... Of 12 newer antidepressants, four emerged as superior in efficacy: escitalopram, mirtazapine, sertraline, and venlafaxine ... In terms of acceptability, four agents were better tolerated: bupropion, citalopram, escitalopram, and sertraline.  Balancing efficacy and acceptability and lower drug costs, the researchers concluded that sertraline might be particularly appropriate as a first-choice treatment ... "  This is superbly useful information.  Parikh's editorial goes on to raise helpful queries about next step questions, however Cipriani et al have done antidepressant prescribers and users a major service with this very important paper.

Here are five papers on difficulties experienced by adolescents.  A couple of the papers are follow-up studies.  Colman et al looked at the multiple negative personal & relationship outcomes in a UK national cohort of adolescents with conduct problems followed over 40 years.  Wentz et al studied the somewhat more encouraging 18 year outcomes of a group of adolescents suffering from anorexia. 

A couple of the papers are about depression.  Kennard and colleagues report again on the well-known Treatment for Adolescents with Depression Study (TADS) comparing antidepressants, cognitive-behavioural therapy and combined treatment.  By about six months there was little difference between the three forms of treatment.  At nine months the remission rate for intent-to-treat cases was 60% overall.  Primack et al investigated the association between electronic media use in adolescence and subsequent depression in young adulthood.  They reported "Controlling for all covariates including baseline Center for Epidemiologic Studies-Depression Scale score, those reporting more television use had significantly greater odds of developing depression."

Here are a few handouts that I've put together over the years to provide background information about depression.  The development & maintenance diagram is probably the handout here that I use most - both to explain issues about depression and also for many other psychological disorders as well. 

Development & maintenance of distressed states - I use this Powerpoint diagram a lot when discussing with people why they are in a distressed state.  The diagram applies to depression but it also applies to nearly all other distressed psychological states as well.  It can be helpful in highlighting the importance of maintaining, precipitating and vulnerability factors.  I also point out that therapeutic gains can be made working with all three of these general sets of factors - for example, emotional processing work for past experience (both precipitating and vulnerability factors) and more standard cognitive-behavioural approaches for maintaining factors. 

The excellent UK Food Standards Agency  has recently launched a campaign (see the TV ad) to encourage people to cut down their intake of saturated fats.  As the FSA points out on their webpage about saturated fats most people in the UK eat about 20% more than the maximum recommended amount.  They list examples of foods that are high in saturated fats, including:

• fatty cuts of meat and meat products such as sausages and pies
• butter, ghee and lard
• cream, soured cream, crème fraîche and ice cream
• cheese, particularly hard cheese
• pastries
• cakes and biscuits
• some savoury snacks
• some sweet snacks and chocolate
• coconut oil, coconut cream and palm oil

The FSA recommend checking food labels for saturated fat content.  More than 5gm of saturated fat per 100gm of the food is a high level, while less than 1.5gm per 100gm is low.  Their ten tips to help reduce your saturated fat intake are:

Here are five papers on lifestyle and the benefits of making healthy choices.  The first by Cohen et al on sleep habits and susceptibility to the common cold, showed increased risk of developing a cold after infection for those with shorter sleep duration.  Interestingly the increased risk was even greater for those with poor sleep efficiency.  Sleep efficiency is calculated by dividing the time spent asleep by the time spent in bed trying to sleep.  The Good Knowledge section of this website contains useful information on assessing and treating sleep difficulties.

I'm a big fan of self-determination theory (SDT).  I've posted before on SDT.  See, for example, the September post from last year with its links to a lecture I've given and to a number of handouts.  See too Wellbeing, time management & self-determination in the website's Good Knowledge handouts section.

I have now added a series of three questionnaires - with relevant background information - to the Good Knowledge handouts.  The questionnaires are downloaded, and reformatted, from the excellent Self-Determination website at www.psych.rochester.edu/SDT .  They are:

Basic need satisfaction scale - this 21-item scale assesses how well the three basic psychological needs for autonomy, competence & relatedness are being met. 

Here are a couple of very interesting, helpful websites that I've been reminded of recently.  They illustrate in a fun way the diversity and possibilities of the internet.

Here are half a dozen papers with anxiety relevance.  The first couple are about the interaction between genetic vulnerability (or resilience) and childhood experience.  The Stevens et al paper is an update on the large body of research looking at psychological genetic vulnerability/resilience in macaque monkeys and how this interacts with parenting quality to lead, or not lead, to emotional and neurophysiological disturbances in adulthood.  The Battaglia paper particularises this gene/environment investigation by looking at the connections between early human childhood separation anxiety, loss of a parent, and panic disorder in adulthood.  

Over nearly 35 years of practice as a doctor and psychotherapist I've assembled a collection of 300 to 400 handouts and questionnaires that I use in my work.  I'm gradually uploading most of these handouts to this website so people can use any that they'd like to.  The collection is searchable in the Good Knowledge section of the site at Handouts, questionnaires and other leaflets.  Of the twenty two subsections on this part of the website, one of the more frequently visited areas is the Increasing access to psychological therapies (IAPT) outcomes toolkit.  This is a pretty full hand of cards for the recommended IAPT assessment measures.  I've recently updated the list of downloadable questionnaires available by including:

Last month's article in the British Medical Journal on the dangers posed by radon gas in buildings jogged my awareness of this important hazard (Gray, Read et al. 2009).  Quoting Wikipedia on radon "Radon is the invisible, radioactive mono-atomic gas that results from radioactive decay of some forms of uranium that may be found in rock formations beneath buildings or in certain building materials themselves. There are relatively simple tests for radon gas, but these tests are not commonly done, even in areas of known systematic hazards." and "According to the United States Environmental Protection Agency, radon is reportedly the second most frequent cause of lung cancer, after cigarette smoking; and radon-induced lung cancer the 6th leading cause of cancer death overall." and "Some ... areas, including Cornwall and Aberdeenshire in the United Kingdom have high enough natural radiation levels that nuclear licensed sites cannot be built there - the sites would already exceed legal radiation limits before they opened, and the natural topsoil and rock would all have to be disposed of as low-level nuclear waste."