"It doesn't do any harm, but patients feel better": a qualitative exploratory study on gastroenterologists' perspectives on the role of antidepressants in inflammatory bowel disease

Background: Interest in psychological factors in patients with inflammatory bowel disease (IBD) has increased in recent years. It has even been proposed that treating psychological co-morbidities with antidepressants may control disease activity and improve quality of life. Despite this, there is no data on gastroenterologists' attitudes to, and experiences with, antidepressant therapy in patients with IBD. Methods: We conducted semi-structured interviews with 18 gastroenterologists associated with metropolitan teaching hospitals. Qualitative content analysis was used to examine their responses. Results: Seventy-eight percent of gastroenterologists had treated IBD patients with antidepressants for pain, depression and/or anxiety, and insomnia. Antidepressants were reported to be useful in improving psychosocial well-being, quality of life, and self-management of the disease by patients. However, in this group of gastroenterologists, there appears to be skepticism towards psychological disorders themselves or antidepressant therapy having a central role in either the causation of IBD or its clinical course. Nevertheless, these gastroenterologists were receptive to the idea of conducting a trial of the role of antidepressants in IBD. Conclusion: While the majority of specialists have treated IBD patients with antidepressants, there is considerable skepticism with regard to efficacy of antidepressive therapy or the role of psychological factors in the outcome of IBD patients.Antonina A Mikocka-Walus, Deborah A Turnbull, Nicole T Moulding, Ian G Wilson, Jane M Andrews and Gerald J Holtman

Nitrous oxide in the Southwest Indian Ocean

The southwestern basin of the Indian Ocean (SWIO) remains a rather under-sampled region with regards to nitrogen cycle processes. Here we present the results of extensive surface and water column nitrous oxide (N2O) measurements as well as the first reported open ocean measurements of hydroxylamine (NH2OH). Wind-driven upwelling in the zonal band between 5°S and 10°S led to an enhanced efflux of N2O to the atmosphere with saturation values up to 122% and a maximum sea-to-air flux of 2.3 nmol m-2 s-1. N2O depth profiles showed supersaturation conditions throughout the water column with a distinct maximum (~ 30 nmol L-1) at about 1000 m. Excess N2O (ΔN2O) was positively correlated with apparent oxygen utilization (AOU) and nitrate concentrations although different slopes of the ΔN2O/AOU relationships could be identified above and below the concentration maxima. Although the vertical distribution of NH2OH was highly variable, combined analysis with N2O and nutrient data suggests nitrification as the major formation pathway of N2O in the SWIO. Our observations suggest that the SWIO is a rather weak, yet, perennial source of atmospheric N2O which should be considered in future efforts aiming to long-term monitoring of greenhouse gases in the Indian Ocean

Nitrous oxide and hydroxylamine measurements in the Southwest Indian Ocean

Highlights: • Enhanced surface N2O saturations were found between 5°S and 10°S in the SWIO. • The SWIO was a rather weak source of N2O to the atmosphere. • A distinct N2O maximum was found at about 1000 m. • The distributions of NH2OH in the water column were highly variable. • Nitrification was the major formation pathway of N2O in the SWIO. The southwestern basin of the Indian Ocean (SWIO) remains a rather under-sampled region with regard to nitrogen-cycle processes. Here we present the results of extensive nitrous oxide (N2O) measurements as well as the first reported open ocean measurements of hydroxylamine (NH2OH). Enhanced N2O sea-to-air fluxes were found in the zonal band between 5°S and 10°S as a result of wind-driven upwelling, and N2O depth profiles showed supersaturation throughout the water column with a distinct maximum at about 1000 m. Excess N2O (ΔN2O) was found to be positively correlated with apparent oxygen utilization (AOU) and nitrate. Although the water column distribution of NH2OH was highly variable, combined analysis with N2O and nutrient data allows us to argue for nitrification as the major formation pathway of N2O in the SWIO