Digest

Depression and anxiety Depression‐related insomnia Long‐term use of hypnotics is frowned on but US investigators have found that a modified‐release formulation of zolpidem has sustained benefits in patients with depression‐related insomnia ( J Clin Psychiatry 2011;doi:10.4088/ JCP.09m05571gry). Compared with placebo over eight weeks in individuals taking concomitant escitalopram, zolpidem 12.5mg nightly improved total sleep time, sleep quality and measures of functioning the next day, and reduced sleep onset latency and number of awakenings. It had no effect on scores of depression or quality of life. Some individuals continued treatment for a further 16 weeks, with similar results. Home‐based care Service models can also influence the outcome of treatment: in an Austrian study, 60 elderly people with major depression were randomised to receive conventional outpatient management or home‐based care ( Br J Psychiatry 2010;197:463‐7). After three and 12 months, home‐based care was associated with fewer symptoms of depression, better global functioning and higher quality of life scores. Those receiving home‐based care had fewer admissions and less time in inpatient care, resulting in lower total costs. SSRIs and stroke SSRIs increase the risk of gastrointestinal bleeding but, surprisingly, there is little evidence about the risk of stroke during treatment. A case‐control study, using the UK General Practice Research Database, identified 365 195 patients who had been prescribed an SSRI or a tricyclic antidepressant (TCA) between 1992 and 2006 ( Br J Clin Pharmacol 2011;71:116‐20). Within this cohort, there were 357 cases of stroke, who were matched with 1631 controls. Neither SSRIs nor TCAs were significantly associated with an increased risk of stroke and there was no evidence that a history of cerebrovascular events altered this risk. Depression and HIV People with HIV infection who have depression are less likely to take antiretroviral therapy. Treatment with an antidepressant should therefore improve out‐comes but, US investigators say, estimates of this potential benefit have proved unreliable ( Arch Gen Psychiatry 2010;67:1282‐90). Monitoring 158 people who were homeless or living in shelters over the five years to 2007, they estimated that antidepressant therapy increased the odds of taking anti‐retroviral therapy nearly four‐fold, increased adherence by 25 per cent and doubled the odds of self‐reported complete adherence. These changes were associated with doubling the odds of achieving viral suppression. Discontinuing benzodiazepines What is the long‐term success rate of discontinuing benzodiazepines? Researchers from The Netherlands report that 59 per cent of patients who received a stepped‐care intervention programme remained abstinent 10 years later ( Family Practice 2010; doi:10.1093/ fampra/cmq113). Abstinence at 21 months predicted long‐term success. Those who relapsed tended to use lower doses of benzodiazepines than before the intervention. Psilocybin for anxiety The search for novel anxiolytics has been a long one. Psilocybin, the serotonergic hallucinogen in magic mushrooms, is the latest candidate ( Arch Gen Psychiatry 2011;68:71‐8). In 12 adults with advanced cancer and anxiety, psilocybin 0.2mg per kg significantly reduced anxiety scores at one and three months; there was also a trend for improved mood though this was not consistently significant. No adverse effects were reported. Copyright © 2011 Wiley Interface Ltd