Hippocampal volume is reduced in patients with unipolar depression, maybe as a consequence of repeated periods of major depressive disorder. Bipolar patients did not seem to show a reduction in hippocampal volume, but this has been much less investigated.

We have identified factors both strongly associated and non-associated with PTSD following childbirth. While the literature is limited by methodological shortcomings, a hypothesis regarding the development of PTSD is outlined, and recommendations with respect to screening and future research are provided.

This evidence is consistent with the hypothesis that depressive symptoms are caused by dysfunction of regions of the limbic system and the frontal lobes in close connection with the basal ganglia.

A review of the literature on primarily magnetic resonance imaging (MRI) scans of patients with affective disorders is presented. Several studies have indicated an increased ventricle/brain ratio and other signs of cerebral atrophy, as well as an increased frequency of lesions (so-called signal hyperintensities) in the brains of unipolar and bipolar patients. This notion is strongly supported by two meta-analyses performed in the present study. The lesions are often localized in the frontal lobes and the basal ganglia, indicating a defective basal ganglia/frontal circuit, and are correlated with the degree of cognitive impairment seen in these conditions. No studies have indicated that psychoactive drugs or electroconvulsive therapy (ECT) might cause the lesions, but on the other hand they can probably increase the risk of delirium complicating the treatment.

trial are effective in their own right. A further incentive for involvement in the trial is the concept of thèone-stop' (or`twoor`two-stop' in the case of our research clinic) menstrual disorders clinic. This type of clinic had not previously been established in our hospital and women otherwise have their menorrhagia managed routinely in a general gynaecology clinic. On completion of the trial, the dedicated menstrual disorders clinic will continue as a routine clinical service. To answer the question asked by the SMART study trialists-ªshould we disregard evidence based medicine and prescribe such therapies without proof?º No, but we may need to be patient in the arrival at such proof, which could involve meta-analysis of rando-mised trials as SMART and TALIS. References 1. Rogerson L, Duffy S, Crocombe W, Stead M, Dawood D. Management of menorrhagia-SMART study (Satisfaction with Mirena and Ablation: a Randomised Trail)[Correspondence]. Br J Obstet Gynaecol 2000;107:1325±1326. 2. Cooper KG, Parkin DE, Garratt AM, Grant AM. Two-year follow up of women randomised to medical management or transervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes. Br J Obstet Gynaecol 1999;106:1231±1232. 3. Lethaby AE, Cooke I, Rees M. Progesterone/progestogen releasing intrauterine systems versus either placebo or any other medication for heavy menstrual bleeding (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford