[Depression].

Despite the reality that smoking remains the most important preventable cause of death and disability, most clinicians underperform in helping smokers quit. Of the 46 million current smokers in the United States, 70% say they would like to quit, but only a small fraction are able to do so on their own because nicotine is so highly addictive. One third to one half of all smokers die prematurely. Reasons clinicians avoid helping smokers quit include time constraints, lack of expertise, lack of financial incentives, respect for a smoker's privacy, fear that a negative message might lose customers, pessimism because most smokers are unable to quit, stigma, and clinicians being smokers. The gold standard for cessation treatment is the 5 As (ask, advise, assess, assist, and arrange). Yet, only a minority of physicians know about these, and fewer put them to use. Acceptable shortcuts are asking, advising, and referring to a telephone "quit line" or an internal referral system. Successful treatment combines counseling with pharmacotherapy (nicotine replacement therapy with or without psychotropic medication such as bupropion). Nicotine replacement therapy comes in long-acting (patch) or short-acting (gum, lozenge, nasal spray, or inhaler) forms. Ways to counter clinicians' pessimism about cessation include the knowledge that most smokers require multiple quit attempts before they succeed, that rigorous studies show long-term quit rates of 14% to 20%, with 1 report as high as 35%, that cessation rates for users of telephone quit lines and integrated health care systems are comparable with those of individual clinicians, and that no other clinical intervention can offer such a large potential benefit.

Antidepressive Agents↗

PubMed2005

A video method for the evaluation of antidepressant clinical and behavioural actions.

Measuring efficacy and behavioural actions of new antidepressants (ADs) is greatly enhanced by having videotaped records of assessment interviews. This study describes a revised version of the Video Interview Behaviour Evaluation Scales (VIBES), shortened to make it more applicable to clinical trials. The method focuses on physically expressive, motor and social behavioural aspects of the depressive disorder. The Brief version permits juxtaposing of baseline and outcome interviews during the same viewing session thereby reducing the role of memory in the rater's observations. The method provides measures of behavioural components and four new severity dimensions, Social withdrawal-motor retardation, Anxiety-agitation, Hostility, Depressive mood-cognitive impairment. Viewing a patient's series of baseline, during treatment, and outcome interviews can be conducted in about 1 h. This study compared the VIBES with the Hamilton Depression Rating Scale (HAMD) in (1) assessing the efficacy of the selectively targeted ADs, desipramine and paroxetine, and placebo in depressed in-patients and (2) determining onset and nature of the drugs' early behavioural actions. The findings showed (1) components of the method to be reliable; (2) the VIBES to be more sensitive than the HAMD in measuring efficacy; (3) the methods to be equally sensitive in detecting early clinical actions of the two drugs; (4) the VIBES more informative in identifying discrete behavioural aspects of the disorder that are impacted by the drugs; and (5) that in differentiating the drugs' behavioural actions, desipramine was indicated to initially 'stimulate', i.e. effect motor activity and depressed mood, and paroxetine to reduce global severity and anxiety. The study shows the VIBES to be capable of uncovering behavioural mechanisms underlying AD's capacity to resolve depressive disorder.

Antidepressive Agents↗