June 2010

Olanzapine Long-Acting Injection
Extended-release injectable olanzapine (Zyprexa Relprevv) appears to be similar in efficacy to oral olanzapine for relapse prevention in patients with schizophrenia.

Preventing Relapse in Bipolar I Disorder: Lithium, Valproate, or the Combination?
In an open-label trial, the combination of lithium and valproate (Depakote and others) was more effective at preventing breakthrough mood episodes than valproate monotherapy in patients with bipolar I disorder.

Choosing among SSRIs: How Does Fluvoxamine Rate?
Fluvoxamine (Luvox and others) is similar to other selective serotonin reuptake inhibitors (SSRIs) in efficacy and overall tolerability for the acute treatment of major depression. Specific side effects vary among antidepressants.

In Brief
"Traditional" Diet Lowers Risk of Depression and Anxiety; ECT Benefits Patients with Chronic PTSD

Green Tea and the Risk of Depression
In a cross-sectional study, increased consumption of green tea was associated with a decreased risk of depression.

In Brief

June 2010

Dietary choices may play a role in the development of mood and other psychiatric disorders. Jacka and colleagues in Australia assessed diet quality and its relationship to psychiatric symptoms in over 1000 women, aged 20 to 93 years, who were randomly selected from the general population (Am J Psychiatry 2010;167:305-311). The investigators identified three dietary patterns: "traditional" (vegetables, fruit, meat, fish, whole grains), "western" (processed and fried foods, white bread, sugar, beer), and "modern" (fruit, salad, tofu, fish, beans, nuts, red wine). Subjects completed a food questionnaire, the 12-item General Health Questionnaire (GHQ-12) to measure psychological symptoms, and a structured clinical interview to assess current depressive and anxiety disorders. The traditional diet was associated with a lower risk for depression, dysthymia, and anxiety disorders. The western diet was associated with a higher GHQ-12 score, and there was an inverse association between diet quality score and GHQ-12 score. These results parallel those of Akbaraly and associates, who, in a similar study, found that participants with the highest intake of whole foods had lower odds of depression (BTP 2010;33:4). In an editorial accompanying the Jacka report, Dr Marlene Freeman encourages clinicians to include nutritional habits in patient assessments and calls for community and national efforts to educate the population about healthy eating (Am J Psychiatry 2010;167:244-246).

For patients with chronic, severe, treatment-refractory posttraumatic stress disorder (PTSD), electroconvulsive therapy (ECT) might provide relief. Margoob and others treated 10 men and 10 women, aged 21 to 61 years, with a fixed course of bilateral ECT, twice weekly for 3 weeks for their PTSD (Brain Stim 2010;3:28-35). Subjects had previously failed to respond to adequate trials of at least four antidepressant drugs, as well as 12 sessions of CBT. Response to ECT was defined as at least a 30% decrease in ratings on the Clinician-Administered Posttraumatic Stress Disorder Scale (CAPS); remission, as an endpoint CAPS score of 20 or less. By intent-to-treat analysis, there was a statistically and clinically significant improvement in the sample as a whole. The mean decrease in CAPS scores was 34.4%, and depression scores decreased by a mean of 51.1%. Most of the improvement occurred by the third ECT session. In the 17 patients who completed the study, the response rate was 82%, but no patient remitted. The improvement in CAPS score was independent of the improvement in depression ratings and did not differ significantly between patients with less severe versus more severe depression at baseline.

Heather S. Hopkins