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Purpose A breast cancer diagnosis can threaten every aspect of a woman’s wellbeing, including her mental health. With the growing number of breast cancer survivors, longitudinal studies addressing mental health in this population are of increasing importance now more than ever. Therefore, the current study investigated trends in emotional functioning and psychosocial wellbeing of breast cancer survivors, and the demographic and treatment characteristics that may influence these trends. Methods Prospectively collected data of women treated for breast cancer at the Erasmus MC was analyzed in this study. Emotional functioning was measured using the EORTC-QLQ-C30, while psychosocial wellbeing was measured using the BREAST-Q. Type of surgery, age, family status and employment status of study participants were retrieved from patient files. Multilevel analysis was performed to identify trends in emotional functioning and psychosocial wellbeing and to determine the relationship between aforementioned characteristics and these trends. Results 334 cancer survivors were analyzed. Psychosocial wellbeing declined, but emotional functioning showed a steady improvement over time. Type of surgery was associated with changes in emotional functioning and family status with changes in psychosocial wellbeing: women who underwent breast reconstruction showed a steeper increase in their emotional functioning and women with no partner or children showed a greater decline in psychosocial wellbeing between baseline and 12 months after surgery. Conclusion These findings can be utilized by healthcare teams to identify breast cancer patients at risk for emotional problems and to provide adequate psychological support to those women who need help dealing with their emotions and self-concept in order to optimize clinical treatment.

Objective We aimed to systematically compare patients with major depressive disorder from three different treatment settings (a primary care outpatient, a secondary care outpatient and one inpatient sample), with regard to metabolic syndrome (MetSyn) prevalences, individual MetSyn components and related metabolic variables. Method The outpatient samples were drawn from the ongoing Netherlands Study of Depression and Anxiety (302 primary care and 445 secondary care outpatients). The inpatient sample ( n =80) was recruited from five Dutch mental health hospitals. The assessments of MetSyn and related variables [waist circumference (WC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, glucose, systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), waist–hip ratio (WHR), LDL and total cholesterol (TC)] were compared using analysis of (co)variance and regression analysis, whereas medication analyses examined the extent to which clinical differences (e.g., depression severity or medication use) mediated the observed metabolic differences across setting. Results MetSyn prevalences (26% primary, 24% secondary care and 28% inpatients) did not significantly differ ( P =.71). WC, BMI, LDL cholesterol, glucose and DBP were not significantly different across settings. However, WHR, TC and triglyceride levels were higher in inpatients than in both outpatients groups, while HDL cholesterol levels and SBP were lower. There was some mediating role for tricyclic and non-selective serotonin-reuptake inhibitor antidepressant use, but overall, the mediating role of clinical differences was limited. Conclusions Although overall MetSyn prevalences did not differ, patterns of individual MetSyn-related variables differed more markedly across depressed inpatients and outpatients. Inpatients showed more adverse WHR and serum lipid profiles, while SBP levels were lower.

Objective: Women with a history of bipolar disorder or postpartum psychosis are at extremely high risk of relapse postpartum. Although lithium prophylaxis has demonstrated efficacy in reducing postpartum relapse, the timing of prophylaxis remains controversial given the balance of risks and benefits for the mother and fetus. The authors compared lithium use during pregnancy to its initiation postpartum in women at high risk for postpartum psychosis. Method: Between 2003 and 2010, 70 pregnant women at high risk for postpartum psychosis were referred to the authors' psychiatric outpatient clinic. Women who were initially medication free were advised to start lithium prophylaxis immediately postpartum. Women already taking maintenance lithium during pregnancy were advised to continue treatment. Results: All women with a history of psychosis limited to the postpartum period (N=29) remained stable throughout pregnancy despite being medication free. Of the women with bipolar disorder (N=41), 24.4% relapsed during pregnancy, despite prophylaxis use by the majority throughout pregnancy. The postpartum relapse rate was highest in women with bipolar disorder who experienced mood episodes during pregnancy (60.0%). In contrast, none of the 20 women with a history of postpartum psychosis only wh Conclusions: The authors recommend initiating prophylactic treatment immediately postpartum in women with a history of psychosis limited to the postpartum period, to avoid in utero fetal exposure to medication. Patients with bipolar disorder require continuous prophylaxis throughout pregnancy and the postpartum period to reduce peripartum relapse risk.

Rationale There is an ongoing discussion on the relation between risk of violent behaviour and the use of antidepressants. The claim that the use of antidepressants can cause violent behaviour would gain credibility if a positive association between the two could be established. Objective The objective of this study is to evaluate the relationship between homicide, suicide and homicide–suicide rates and the rates of antidepressant use by gender and age group. Method Nationwide data from the Netherlands on antidepressant prescriptions (ADs, SSRI and venlafaxine) and lethal violence were analysed over the 15-year period from 1994 to 2008. Results The findings indicated a significant negative association between lethal violence (homicide and suicide) and prescription of antidepressants in the Netherlands, indicating that in a period in which the exposure of the Dutch population to antidepressants increased, rates of lethal violence decreased. Conclusions These data lend no support for an important role of antidepressant use in lethal violence.

Context: Association between obesity and depression has repeatedly been established. For treatment and prevention purposes, it is important to acquire more insight into their longitudinal interaction. Objective: To conduct a systematic review and meta-analysis on the longitudinal relationship between depression, overweight, and obesity and to identify possible influencing factors. Data Sources: Studies were found using PubMed, PsycINFO, and EMBASE databases and selected on several criteria. Study Selection: Studies examining the longitudinal bidirectional relation between depression and overweight (body mass index 25-29.99) or obesity (body mass index ≥30) were selected. Data Extraction: Unadjusted and adjusted odds ratios (ORs) were extracted or provided by the authors. Data Synthesis: Overall, unadjusted ORs were calculated and subgroup analyses were performed for the 15 included studies (N=58 745) to estimate the effect of possible moderators (sex, age, depression severity). Obesity at baseline increased the risk of onset of depression at follow-up (unadjusted OR, 1.55; 95% confidence interval [CI], 1.22-1.98; P

We aimed to systematically compare patients with major depressive disorder from three different treatment settings (a primary care outpatient, a secondary care outpatient and one inpatient sample), with regard to metabolic syndrome (MetSyn) prevalences, individual MetSyn components and related metabolic variables.The outpatient samples were drawn from the ongoing Netherlands Study of Depression and Anxiety (302 primary care and 445 secondary care outpatients). The inpatient sample (n=80) was recruited from five Dutch mental health hospitals. The assessments of MetSyn and related variables [waist circumference (WC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, glucose, systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), waist-hip ratio (WHR), LDL and total cholesterol (TC)] were compared using analysis of (co)variance and regression analysis, whereas medication analyses examined the extent to which clinical differences (e.g., depression severity or medication use) mediated the observed metabolic differences across setting.MetSyn prevalences (26% primary, 24% secondary care and 28% inpatients) did not significantly differ (P=.71). WC, BMI, LDL cholesterol, glucose and DBP were not significantly different across settings. However, WHR, TC and triglyceride levels were higher in inpatients than in both outpatients groups, while HDL cholesterol levels and SBP were lower. There was some mediating role for tricyclic and non-selective serotonin-reuptake inhibitor antidepressant use, but overall, the mediating role of clinical differences was limited.Although overall MetSyn prevalences did not differ, patterns of individual MetSyn-related variables differed more markedly across depressed inpatients and outpatients. Inpatients showed more adverse WHR and serum lipid profiles, while SBP levels were lower.

In their letter, Healy and Dehue describe several issues that might cast doubt on the soundness and the conclusion of our study on antidepressants and lethal violence (Bouvy and Liem 2012). We are of the opinion that some of the issues brought forward are simply not about our study, some are only partially relevant and some are incorrect. It is quite surprising to read the statement that the Dutch television program Tros Radar (broadcast in November 2009) was broadcasted “before the possible relation between antidepressant consumption and aggression was widely discussed in the Dutch media”, since Dehue wrote a large article on the subject in a leading national Dutch newspaper in June 2009 [Dehue T, van Grootheest K. Pil tegen depressie kan leiden tot moord (Drug against depression can lead to murder) NRC, 20 June 2009]. The authors’ comment on the falling numbers of young men in most Western populations, leading to lower rates of violence, may be true in general. In our study, however, men aged between 15 and 30 years were analysed as a separate group. In addition, we used ratios instead of absolute numbers. They further suggest that autopsy rates have declined since the early 1980s, and that this decline may play a role in the decline in the total number of suicides, but we fail to see how this can have affected the number of homicides. Our study shows a striking parallel in results for both suicide and homicide. Healy and Dehue are absolutely right in their statement that the associations shown in our study cannot be regarded as causal relations. One must be careful with interpreting these associations and the risk of ‘ecological fallacy’ can never be ruled out in a single study. However, the way in which Healy and Dehue disqualify our study by referring to the debate in the 1960s on the risks of cigarette consumption is misleading. Suggestions linking antidepressants to suicide and homicide are based on case reports and datasets on reported adverse effects. Studies based on these datasets have their own methodological problems. The issue at stake here is whether these suggestions need confirmation from other lines of research. We believe they do. One of them is epidemiology. The claim that antidepressants can cause lethal violence would gain credibility if we had found a positive association instead of a negative one. In the case of cigarette smoking, in the end, the different lines of research pointed in the same direction (Talley et al. 2004). Our results on suicide are in line with previous research; our results on homicide are new and need replication in other populations. The future will show whether our study is an ecological fallacy or not. However, if other factors were to cause the associations we found, these other factors must have a much larger effect on suicide and homicide than the consumption of antidepressants.

Objective: To investigate the association between depression and anxiety symptoms and the metabolic syndrome (MetSyn), using a dimensional approach. The association between depression and anxiety, on the one hand, and the MetSyn as a cluster or its individual components, on the other hand, is equivocal. The categorical nature of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition might partly explain the inconsistent findings. Methods: In 2,433 Netherlands Study of Depression and Anxiety participants (mean age, 42.3 years; 33.1% male), three symptoms dimensions-lack of positive affect (PA, depression specific); negative affect (NA, aspecific); and somatic arousal (SA, anxiety specific)-were assessed by a shortened adaptation of the Mood and Anxiety Symptom Questionnaire. The association between symptom dimensions and MetSyn components (waist circumference, triglycerides high-density lipoprotein cholesterol, glucose, and mean blood pressure) was analyzed, using linear regression analysis. Results:: The occurrence rate of the MetSyn was 20.1% (n = 490). SA, but not PA and NA, was strongly associated with four out of five MetSyn components, especially waist circumference, triglycerides, and blood pressure (beta = 0.046, p = .01; beta = 0.077, p

The addition of benzodiazepine hypnotics to a treatment with tricyclic antidepressants has received little systematic study. In a double-blind placebo-controlled design, the effects on mood and on sleep of two benzodiazepine hypnotics (lormetazepam and flunitrazepam) were studied in patients with major depression who were also treated with maprotiline or nortriptyline. After 4 weeks of combined treatment, lormetazepam resulted in a significantly greater decrease in the score on the Hamilton Depression Subscale than placebo, while there was a non-significant trend in favour of lormetazepam in comparison with flunitrazepam. With respect to sleep EEGs, lormetazepam resulted in a significantly greater suppression of REM sleep. The differences between lormetazepam and flunitrazepam may be partly explained by the shorter half-live of lormetazepam.

In a double-blind study the selective monoamine oxidase-A inhibitor brofaromine was compared with the classical MAOI tranylcypromine in 39 patients with major depression resistant to treatment with tricyclic antidepressants. Concerning efficacy no significant differences were found. Ten out of 22 patients responded to brofaromine and 5 out of 17 patients to tranylcypromine. Adverse effects favoured brofaromine. Although orthostatic hypotension occurred in both groups, severe decrease in blood pressure and dizziness occurred significantly more with tranylcypromine. Both MAOIs caused a decrease in stage 4 and REM sleep and an increase in REM latency. In most patients receiving tranylcypromine REM sleep was completely abolished.