Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: A meta-analysis

PURPOSE Depression is common in primary care. There are no systematic reviews of depression treatment comparing antidepressants with placebo; hence, we do not know whether these medications are effective in primary care.METHODS We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Group register of controlled trials, MEDLINE, International Pharmaceutical abstracts, PsycINFO, and EMBASE. Abstracts of potential studies were reviewed independently by 2 authors. Studies needed to include randomized controlled trials of either a tricyclic antidepressant (TCA) or selective serotonin reuptake inhibitor (SSRI), or both, and placebo in a primary care setting. The data and quality of the studies were extracted and assessed by 2 authors blind to the other’s choice. Disagreements were resolved by discussion. The main outcome measures were the standardized mean difference and weighted mean difference of the final mean depression scores, the relative risk of improvement, and the number withdrawing because of side effects. Pooling of results was done using Review Manager 4.2.2.RESULTS There were 10 studies in which TCAs were compared with placebo, 3 in which SSRIs were compared with placebo, and 2 with both compared with placebo. One half of the studies were of low methodological quality, and nearly all studies were of short duration, typically 6 to 8 weeks. Pooled estimates of efficacy data showed a relative risk of 1.26 (95% CI, 1.12–1.42) for improvement with TCAs compared with placebo; For SSRIs, relative risk was 1.37 (95% CI, 1.21–1.55). Most patients, 56% to 60%, responded well to active treatment compared with 42% to 47% for placebo. The number needed to treat for TCAs was about 4, and for SSRIs it was 6. The numbers needed to harm (for withdrawal caused by side effects) ranged from 5 to 11 for TCAs and 21 to 94 for SSRIs. Low-dose (100 mg or 75 mg) as well as high-dose TCAs were effective.CONCLUSION This systematic review is the first comparing antidepressants with placebo for treatment of depression in primary care. Both TCAs and SSRIs are effective. This review is also the first to show that low-dose TCAs are effective in primary care. Prescribing antidepressants in primary care is a more effective clinical activity than prescribing placebo

The ROSAT All-Sky Survey: a Catalog of Clusters of Galaxies in a Region of 1 Ster around the South Galactic Pole

A field of 1.013 ster in the ROSAT all-sky survey (RASS), centered on the south galactic pole (SGP), has been searched in a systematic, objective manner for clusters of galaxies. The procedure relied on a correlation of the X-ray positions and properties of ROSAT sources with the distribution of galaxies in the COSMOS digitised data base, which was obtained by scanning the plates of the UK Schmidt IIIa-J optical southern sky survey. The study used the second ROSAT survey data base (RASS-2) and included several optical observing campaigns to measure redshifts. The search, a precursor to the larger REFLEX survey of the whole southern sky, reached the detection limits of the RASS and the COSMOS data, and yielded a catalog of 186 clusters in which the lowest flux is 1.5e-12 erg/cm2/s in the 0.1-2.4 keV band. Of these 157 have measured redshifts. Using a limit of 3.0e-12 erg/cm2/s a complete subset of 112 clusters was obtained, of which 110 have measured redshifts. The spatial distribution of the X-ray clusters out to z = 0.15 shows an extension of the Local Supercluster to the Pisces-Cetus supercluster (z<~0.07), and a more distant orthogonal structure at 0.07<z<0.15.Comment: To be published in ApJ Supplements in February 2002: 53 pages: 18 figure

Water safety plans and climate change mitigation

[Excerpt] Definition Quality water at affordable prices for all is a key condition for the promotion of public health, environmental sustainability, and quality and safety of life. In a context of growing external uncertainties arising from changes in the climate and the environment, ensuring these conditions is an upward concern and is of utmost relevance to increase scientific research on the impacts of climate change on water quality modification and in minimization/mitigation strategies

Patient factors associated with SSRI dose for depression treatment in general practice: A primary care cross sectional study

BackgroundAntidepressant prescribing continues to rise. Increased long-term prescribing and higher doses are contributing to current growth; however, patient factors associated with the use of higher doses remain unknown. This study’s aim was to investigate patient factors associated with selective serotonin re-uptake inhibitor (SSRI) prescribed daily dose for depression treatment in general practice.MethodsA stratified sample of low to high prescribing practices were selected. Routine individual patient-level data were extracted one practice at a time: September 2009 to January 2011. Patients included were ≥18 years, and prescribed an SSRI for depression. Logistic regression analysis was undertaken to assess individual predictor variables on SSRI daily dose by standard therapeutic dose versus higher dose, as SSRIs demonstrate flat dose response curves for depression treatment. Predictor variables included: age, gender, deprivation, co-morbidity, smoking status, being prescribed the same SSRI for ≥2 years, and patients’ general practice. For a subgroup of patients a second sub-group analysis included long-term benzodiazepine and/or z-hypnotic (B&Z) as a predictor variable.ResultsInter-practice SSRI prescribing varied significantly; practice point prevalence ranged from 2.5% (94/3697) to 11.9% (359/3007) of the practice population ≥18 years old; median 7.3% (250/3421) (χ2 = 2277.2, df = 10, p

UCP1 expression in human brown adipose tissue is inversely associated with cardiometabolic risk factors.

ObjectiveBrown adipose tissue (BAT) is a therapeutic target for obesity. 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG-PET) is commonly used to quantify human BAT mass and activity. Detectable 18F-FDG uptake by BAT is associated with reduced prevalence of cardiometabolic disease. However, 18F-FDG uptake may not always be a reliable marker of BAT thermogenesis, for example insulin resistance may reduce glucose uptake. Uncoupling protein 1 (UCP1) is the key thermogenic protein in BAT. Therefore, we hypothesized that UCP1 expression may be altered in individuals with cardiometabolic risk factors. MethodsWe quantified UCP1 expression as an alternative marker of thermogenic capacity in BAT and white adipose tissue (WAT) samples (n=53) and in differentiated brown and white pre-adipocytes (n=85). ResultsUCP1 expression in BAT, but not in WAT or brown/white differentiated pre-adipocytes, was reduced with increasing age, obesity and adverse cardiometabolic risk factors such as fasting glucose, insulin and blood pressure. However, UCP1 expression in BAT was preserved in obese subjects of &lt;40 years of age. To determine if BAT activity was also preserved in vivo, we undertook a case-control study, performing 18F-FDG scanning during mild cold exposure in young (mean age ~22y) normal weight and obese volunteers. 18F-FDG uptake by BAT and BAT volume were similar between groups, despite increased insulin resistance. Conclusion18F-FDG uptake by BAT and UCP1 expression are preserved in young obese adults. Older subjects retain precursor cells with the capacity to form new thermogenic adipocytes. These data highlight the therapeutic potential of BAT mass expansion and activation in obesity. <br/