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Deep transcranial magnetic stimulation for smoking cessation
For more on deep transcranial magnetic stimulation for smoking cessation see Biol Psychiatry 2014; published online Jun 4. http://dx.doi. org/10.1016/j.biopsych. 2014.05.020 For more on psychiatric disorders after fetal death see BMJ Open 2014; published online Jun 6. http://dx.doi. org/10.1136/ bmjopen-2014-005187 For more on weight gain with antidepressant use see JAMA Psychiatry 2014; published online Jun 4. http:// dx.doi.org/10.1001/ jamapsychiatry.2014.414 For more on pharmacotherapy for alcohol-use disorders see JAMA 2014; published online May 14. http://dx.doi. org/10.1001/jama.2014.3628 For more on miR-1202 in major depression see Nat Med 2014; published online Jun 8. http://dx.doi.org/10.1038/ nm.3582 For more on weapon carrying in adolescents see JAMA Pediatr 2014; published online Jun 9. http://dx.doi. org/10.1001/ jamapediatrics.2014.213
Some insight into the mechanism of smoking cessation is provided in a study by Dinur-Klein and colleagues. In their double-blind trial, 115 adults (smoking at least 20 cigarettes per day) were randomised to either sessions of high-frequency or low-frequency deep repetitive transcranial magnetic stimulation of the prefronal cortex and insula bilaterally, or sham stimulation. Participants had 13 treatment sessions, including ten over a 2-week period. Treatment was delivered either after or without presentation of smoking cues. High frequency stimulation led to a greater reduction in cigarette consumption compared with sham treatment (p=0·0003). High frequency stimulation with or without visual cues led to greater abstinence rates compared with sham with or without cues (44% and 25% vs 13% and 0%, respectively at the end of treatment; p=0·039).
Psychiatric disorders after fetal death According to investigators, women who experience fetal loss may have a temporarily increased risk of having a ﬁrst-time episode of a psychiatric disorder. The risk of psychiatric treatment in women 12 months before and 12 months after fetal loss (spontaneous abortion or stillbirth) was assessed in a Danish registrybased cohort study. Between January 1996, and December 2010, 87 687 cases of fetal death occurred. During follow-up, 1379 women had at least one psychiatric episode. Women were more likely to receive psychiatric treatment in the month after fetal loss compared with 11–12 months after loss (incidence rate ratio 1·51, 95% CI 1·15–1·99); the risk was particularly high for women aged 27–34 years (2·15, 1·37–3·38).
Weight gain with antidepressant use
miR-1202 in major depression
Researchers have investigated the association between individual antidepressant drugs and weight gain. Using electronic health records from Boston (MA, USA) for 22 610 adults, weight gain over 12 months was ascertained for people receiving antidepressant prescriptions (n=19 244). Adults receiving a prescription for citalopram were used as the reference population. Amytriptyline, nortriptyline, and bupropion were associated with significantly less weight gain compared with citalopram. People receiving an SSRI prescription did not have a signiﬁcant diﬀerence in weight gain compared with citalopram users. The investigators concluded that, “while the absolute magnitude of such diﬀerences is relatively modest, these diﬀerences may lead clinicians to prefer certain treatments according to patient preference or in individuals for whom weight gain is a particular concern”.
New ﬁndings identify a possible treatment target for depression, note the investigators of a multifaceted study. Lopez and colleagues compared microRNA expression in post-mortem human brain (ventrolateral prefrontal cortex) samples from individuals with depression (n=14) and psychiatrically healthy controls (n=11). Compared with controls, miR-1202 expression was low in the brain samples from depressed people (p<0·01). miR-1202 was negatively associated with GRM4 expression (which has been linked to anxiety-related behavior). In treatment-naive patients with depression (n=32), baseline blood levels of miR-1202 were lower than that of controls (n=18; p<0·05). Those who responded to citalopram treatment after 8 weeks (n=16), showed an increase in miR-1202 levels from baseline (p<0·05); this change was not evident for non-responders and controls. The study results implicate the microRNA miR-1202 in the pathophysiology of depression.
Pharmacotherapy for alcoholuse disorders
Weapon carrying in adolescents
A new report provides some evidence on the eﬃcacy of various treatments to manage alcohol-use disorders. Jonas and colleagues did a systematic review and meta-analysis of pharmacotherapy for alcohol-use disorders. 95 studies were included in the meta-analysis. Alcohol consumption outcomes were improved with acamprosate (NNT to prevent one person from returning to any drinking=12) and oral naltrexone (NNT=20). Oral naltrexone was also associated with an improvement in return to heavy drinking (NNT=12). Trials directly comparing these two treatments did not show any signiﬁcant differences for alcohol consumption outcomes. Meta-analysis did not show a beneficial effect of disulfiram on return to any drinking. There was not enough trial data to assess the eﬀect of treatments on health outcomes.
Results from a meta-analysis suggest that being a victim of bullying, being simultaneously a bully and a victim (bully-victim), and bullying are associated with increased likelihood of carrying weapons. In their metaanalysis of 25 studies, van Geel and colleagues assessed weapon carrying in these different groups of young people aged 11–21 years. Bullies were more likely to carry weapons than their peers who were not involved in bullying (OR 3·25, 95% CI 2·71–3·89), as were the victims of bullies (1·97, 1·62–2·39). Bully-victims had the highest likelihood for weapon carrying (4·95, 3·77–6·50); notably, bully-victims in the USA were more likely to carry weapons than were bully-victims from other countries.
Seema Kang www.thelancet.com/psychiatry Vol 1 July 2014