Discovering endophenotypes for major depression.

Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability.

Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed to reach consensus where the evidence and/or clinical experience was considered adequate or otherwise to flag the area as a direction for future research. A draft of the proceedings was then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.

/pdf/british-association-for-psychopharmacology-consensus-13n5tskvgg.pdf

British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders.

A revision of the 2000 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in May 2006. Key areas in treating depression were reviewed, and the strength of evidence and clinical implications were considered. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is provided, which identifies the quality of evidence to inform the recommendations, the strength of which are based on the level of evidence. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse, and stopping treatment.

/pdf/evidence-based-guidelines-for-treating-depressive-disorders-2py43vtx76.pdf

Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines

A revision of the British Association for Psychopharmacology guidelines for treating depressive disorders with antidepressants was undertaken in order to specify the scope and target of the guidelines and to update the recommendations based explicitly on the available evidence. A consensus meeting, involving experts in depressive disorders and their treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is given which identifies the quality of evidence followed by recommendations, the strength of which are based on the level of evidence. The guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing, management when initial treatment fails, continuation treatment, maintenance treatment to prevent recurrence and stopping treatment.

Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines:

Total and free tryptophan concentration in the plasma of depressive patients

Thyrotrophin-releasing hormone in the treatment of depression

Tryptophan concentration in the cerebrospinal fluid of depressive patients.

[Methylene- 14 C]-L-tryptophan was administered intravenously to five patients suffering from severe depression before and after clinical recovery, and to six control subjects; all subjects were tested while on a standard diet. [ 14 C]-5-Hydroxyindoleacetic acid and [ 14 C]-indoleacetic acid were isolated from urine during the following 48 hours and purified to constant specific radioactivity (SA). From the SA and the determination of the total excretion of the two acids their percentage conversion from labelled tryptophan was estimated. There was no consistent difference found, in patients before and after recovery, or between patients and controls, in the conversion of tryptophan to these indole acids. In another series of 11 depressive patients and 11 controls, plasma total (acid-soluble) tryptophan was measured at frequent intervals up to three hours after intravenous administration of a loading dose (1 g) of L-tryptophan. The height of the curves of plasma tryptophan throughout the three hour period was greater than in the depressive patients, even after they had recovered, than in the controls. It is concluded that the apparent volume of distribution of tryptophan is reduced in depressive individuals. This is consistent with other findings of increased protein-binding of plasma tryptophan and reduced CSF tryptophan levels in depressive patients.

Tryptophan metabolism in depressive illness.

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