Relationship of dose to antidepressant prophylactic efficacy

Firearms and suicide in US cities

On an average day in the USA more than 100 Americans die by suicide-half use firearms. Suicide rates overall and by firearms are higher, on average, in states where household firearm ownership is more common. In general this means in states where a greater proportion of the population lives in rural areas. The current ecological study focuses on the relation between measures of household firearm prevalence and suicide mortality in urban areas (metropolitan statistical areas and divisions) using survey-based measures of firearm ownership. Suicide rates (1999-2010) for metropolitan statistical areas that are comprised of large US cities come from death certificate records; rates of household firearm ownership come from the 2002 and 2004 Behavioural Risk Factor Surveillance System. Higher rates of firearm ownership are strongly associated with higher rates of overall suicide and firearm suicide, but not with non-firearm suicide. Stratification by gender, age and race did not materially affect the association between firearms and suicide. This study provides evidence consistent with previous case-control work and extends evidence from previous state- and region-level ecological studies that firearms in the home impose suicide risk above and beyond baseline.

Depressive Störungen

Das Spektrum depressiver Erkrankungen macht den Hauptteil affektiver Störungen aus und gehört mit einer Inzidenz von ca. 8–20% zu den häufigsten psychischen Erkrankungen. Depressionen werden nach wie vor zu selten einer adäquaten Therapie (Antidepressiva, störungsspezifische Psychotherapie wie z. B. kognitive Verhaltenstherapie) zugeführt.

Prophylactic effect of mianserin on recurrent depression

The prophylactic effect of mianserin on recurrent depression was studied in a double-blind comparison with an inactive placebo by analyzing the recurrence rate and the number of depressive episodes in 9 mianserin-treated (daily dose 20-60 mg) and 13 placebo-treated patients. The selected patients were those who had a higher incidence of recurrence (more than 2 depressive episodes during the 2 years preceding the study). During the 18-month study period, 4 of 9 mianserin-treated patients and all 13 placebo-treated patients had recurrences. The ratio between patients with recurrence and total patients (recurrence ratio) was lower in the mianserin-treated group throughout the study, and the intergroup difference from the 3rd to the 18th month was significant. In the mianserin-treated group, the frequency of episode recurrence during the study period was significantly lower and the total duration of episodes was significantly shorter than those in the placebo-treated group. The treatments did not differ significantly in safety. These results clearly indicate that mianserin is effective in the prophylaxis of recurrent depressive episodes.

Comparison of full-dose versus half-dose pharmacotherapy in the maintenance treatment of recurrent depression

Recent evidence points to the prophylactic efficacy of maintaining recurrent unipolar patients on the same dose of antidepressant medication that was used to treat the acute episode (Frank et al., 1990; Kupfer et al., 1992). Therefore, the question of whether such patients should be tapered to a lower maintenance dose after successful resolution of an acute episode is clearly important. In this report we describe a small randomized clinical trial in which patients were assigned to either full-dose or half-dose maintenance treatment for a period of 3 years. Survival analysis suggests that superior prophylaxis can be achieved with a full-dose as compared to a half-dose maintenance treatment strategy (p < 0.07). Mean survival time for the full-dose subjects was 135.17 (SE 19.75) weeks as compared to 74.94 (SE 19.78) weeks (median of 43.1 weeks) for the half-dose subjects. We conclude that for patients who have suffered several recurrences, full-dose maintenance treatment is the more effective prophylactic strategy.