March 2010

Treating Persistent Insomnia: Therapy, Meds, or Both?
While cognitive behavioral therapy is probably best for long-term treatment of chronic insomnia, hypnotics can add benefits acutely.

Diet and Depression
Overall dietary pattern may be more important than individual components (such as omega-3 fatty acids) in lowering the risk of depression.

In Brief
Another Negative Trial of Ginkgo biloba for Cognitive Decline; Physical Activity during Pregnancy Has Mixed Results on Postpartum Depression

Carotidynia Associated with SSRIs
Carotidynia may be a rare side effect of selective serotonin reuptake inhibitors and might be more common in migraine sufferers.

Clozapine Hypersalivation: A Negative Study with Ipratropium
In a small, double-blind trial, ipratropium (Atrovent and others) was not effective in decreasing sialorrhea associated with clozapine (Clozaril and others) treatment.

In Brief

March 2010

Ginkgo biloba has antioxidant properties and is believed to preserve memory, but studies of its effects on dementia have been mixed. Last year (BTP 2009;32:19-20,28), we reported on two negative trials, both of which suggested that not only did ginkgo fail to provide benefit for dementia, it also appeared to increase the risk of stroke. Recently, Snitz et al conducted a randomized, double-blind, placebo-controlled trial to investigate the effect of ginkgo on rates of global or domain-specific cognitive decline in older adults (JAMA 2009;302:2663-2670). Between 2000 and 2008, 3069 community-dwelling subjects, aged 72 to 96 years, with normal cognition or mild cognitive impairment were enrolled at six academic medical centers in the United States. Subjects received ginkgo extract, 120 mg bid, or identical-appearing placebo. After a median follow-up of 6.1 years, annual rates of decline in scores on individual tests of the neuropsychological domains of memory, attention, visual-spatial abilities, language, and executive functions did not differ between the two groups. There also were no differences in rates of change between treatment groups on the Modified Mini-Mental State Examination (3MSE) or the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog).

Postpartum depression is estimated to affect 5% to 15% of childbearing women. In nonpregnant populations, evidence suggests that physical activity, a modifiable behavioral factor, improves depression and general well-being. Strøm and colleagues in Denmark investigated the effects of physical activity during pregnancy on the risk of postpartum depression (J Clin Psychiatry 2009;70:1707-1714). Over 70,000 women identified from the Danish National Birth Cohort were included in the analyses. Each woman was interviewed by telephone regarding duration, frequency, and type of physical activity. Information on hospital admissions due to depression and antidepressant prescriptions, separate outcome measures, was obtained from the Danish Psychiatric Central Register and the Register of Medicinal Product Statistics, respectively. Thirty-seven percent of participants reported engaging in physical activity during pregnancy, with one-third of these women reporting vigorous activity. Overall, there was no association between physical activity during pregnancy and hospital admission for depression in the first year following childbirth. For underweight women, however, physical activity was associated with an increased risk of hospitalization due to depression during this time period. Women who reported vigorous physical activity during pregnancy had a 20% lower risk of being prescribed an antidepressant within 1 year postpartum compared with women who were not physically active.

Heather S. Hopkins