I like the American Journal of Clinical Nutrition (AJCN).  It comes out monthly and nearly always has an article or two that I find interesting and helpful.  The AJCN May edition produced a bumper crop.  Interesting articles included a report by Chen and colleagues (see below for all abstracts) on the effects of encouraging people to reduce their consumption of sugar-sweetened beverages (SSB).  In the 810 US adults they studied, 19% of total daily energy intake came from drinks.  They found "A reduction in liquid calorie intake had a stronger effect than did a reduction in solid calorie intake on weight loss. Of the individual beverages, only intake of sugar-sweetened beverages (SSBs) was significantly associated with weight change. A reduction in SSB intake of 1 serving/d was associated with a weight loss of 0.49 kg ... at 6 mo and of 0.65 kg ...

Looking back over relevant research papers that caught my attention last month, some stand out for me more than the others.  Here are three on depression that stood out and got me thinking.  The Fergusson et al paper looks at links between alcohol abuse and major depression.  There has been debate for years on whether alcohol dependence leads to depression or depression leads to alcohol dependence.  In this kind of debate, it's usually a good bet that both pathways contain some truth.  What this study adds is that often it is the alcohol dependence that is primary.  As the authors state " ... the associations between AAD (alcohol abuse or dependence) and MD (major depression) were best explained by a causal model in which problems with alcohol led to increased risk of MD as opposed to a self-medication model in which MD led to increased risk of AAD." 

Cipriani and colleagues published a major multiple-treatments meta-analysis of new generation antidepressants last week - see abstract below.  As Parikh wrote in his linked editorial (see below) "Andrea Cipriani and colleagues provide the field with a major answer.  Free of any potential funding bias (and including an analysis of studies based on pharmaceutical-company sponsorship), these researchers used a newer methodology, multiple treatments meta-analysis, to examine 117 head-to-head randomised trials in almost 26 000 patients ... Of 12 newer antidepressants, four emerged as superior in efficacy: escitalopram, mirtazapine, sertraline, and venlafaxine ... In terms of acceptability, four agents were better tolerated: bupropion, citalopram, escitalopram, and sertraline.  Balancing efficacy and acceptability and lower drug costs, the researchers concluded that sertraline might be particularly appropriate as a first-choice treatment ... "  This is superbly useful information.  Parikh's editorial goes on to raise helpful queries about next step questions, however Cipriani et al have done antidepressant prescribers and users a major service with this very important paper.

This is the third in a series of blog posts on last Wednesday's SIGN draft guideline seminar on "Non-pharmacological management of mild to moderate depression."  The first session of the day was on "Lifestyle and Alternative/Complementary Therapies 1".  Yesterday's blog discussed the first presenter, Ian Ross's talk on the value of exercise in depression.  The second presentation was by Cliff Sharp, a psychiatrist from NHS borders.  He reviewed St John's Wort & Dietary Supplements.  He talked about the possible value of folate in treating depression when used to supplement conventional antidepressants.  He concluded that current evidence was insufficient to determine whether folate boosts response for those on antidepressants only if their initial folate levels are low, or whether it boosts response for anyone taking antidepressants.  See an

Teratology is the study of the effects that drugs, medications, chemicals and other exposures may have on the unborn child during pregnancy.  Particulary when a mother is taking a medication that is helping her stay well, it can be a difficult decision whether or not to stop taking the medication because of a possible risk to the fetus ... or because of a possible risk that could be transmitted through breastfeeding.  This decision is made harder because we know that if a pregnant woman becomes unwell, for example with depression, this too risks damaging the fetus, so it's not necessarily the case that stopping medication is going to be in the unborn baby's best interest.

Manber, R., J. D. Edinger, et al. (2008).

A GP friend recently asked me about taking folic acid supplements.