BackgroundMajor depression is highly recurrent. Antidepressant maintenance treatment has proven efficacy against recurrent depression.AimsComparison of prophylactic efficacy of citalopram versus placebo in unipolar, recurrent depression.MethodsPatients 18–65 years of age with recurrent unipolar major depression (DSM–IV), a Montgomery–åsberg Depression Rating Scale score of ≥ 22 and two or more previous depressive episodes, one within the past 5 years, were treated openly with citalopram (20–60 mg) for 6–9 weeks and, if responding, continued for 16 weeks before being randomised to double-blind maintenance treatment with citalopram or placebo for 48–77 weeks.ResultsA total of 427 patients entered acute treatment and 269 were randomised to double-blind treatment. Time to recurrence was longer in patients taking citalopram than in patients taking placebo (P < 0.001). Prophylactic treatment was well tolerated.ConclusionsCitalopram (20, 40 and 60 mg) is effective in the prevention of depressive recurrences. Patients at risk should continue maintenance treatment at the dose necessary to resolve symptoms in the acute treatment phase.

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With increasing severity, burnout corresponds to a state of significant suffering with impaired social functioning, decreased quality of life, and psychosomatic complaints. The present study investigates (a) how former patients of an inpatient clinic for burnout therapy can be grouped on the basis of their psychological characteristics and (b) whether these groups correspond to different levels of residual symptoms (depression and burnout) and general mental health. Cluster analysis of psychological characteristics was used to form groups. Four specific groups could be identified (functionals, dysfunctionals, straightforward pragmatists, unhappy altruists). This grouping, with subsequent characterization according to symptom levels, provides important information indicating possible needs for aftercare and suggests areas for improvement of previous care.

A representative cohort of Swiss adults recruited at age 20 years and interviewed at ages 23, 28 and 30 years was studied regarding the symptomatology, prevalence and longitudinal course of functional gastrointestinal symptoms and their association with psychiatric syndromes. A functional gastrointestinal complaint was identified if a proband reported symptoms at least eight times in the past year or for a duration of at least 2 weeks without medical explanation and with a moderate degree of distress. Of the population, 9.4-17.7% was found to suffer from functional stomach complaints and 4.9-16% from functional intestinal complaints. Women reported functional gastrointestinal complaints two to three times more often than men, and increasingly so with age. The overlap of stomach and intestinal complaints was modest with 2.0-6.7%. Cross sectionally, functional stomach complaints were significantly associated with major depression (DSM-III-R), recurrent brief depression (RBD), subthreshold RBD and dysthymia, and with subthreshold panic disorder, agoraphobia, social phobia and recurrent brief anxiety. Functional intestinal complaints showed a consistently significant association with RBD, dysthymia, major depression, subthreshold RBD, panic disorder, subthreshold panic disorder, agoraphobia, simple and social phobia and generalized anxiety disorder. Individuals who at younger ages suffered from functional gastrointestinal complaints did not show an increased risk for a subsequent development of an anxiety or depressive disorder. Functional gastrointestinal complaints reflect an unspecific concomitant vegetative disturbance common to depression and anxiety; they do not reflect a risk factor for the development of a specific anxiety or depressive disorder.

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