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The antidepressant drug sertraline is safe when used to treat depression in patients who have unstable angina or who have had a heart attack. Angina is the medical term for chest pain originating in the heart. In a study of 369 patients, sertraline had no adverse effects on the heart when compared to a placebo, or inactive substance.

Background: There is a paucity of service research on the effectiveness of short-term mental health clinics. Aims: To outline the development of the Urgent Consultation Clinic (UCC), an inter-professional, short-term, mental health program in a general hospital, and to evaluate the effectiveness of the UCC from a quality improvement perspective. Method: Participants ( n == 143) completed a battery of validated measures assessing psychological and physical symptoms, quality of life, life satisfaction, and satisfaction with services at three time-points. Inter-professional team members rated participants' overall functioning and severity of mental health problems at intake and termination. Results: The median time from referral to initial UCC visit was 12 days. A significant decline in the severity of mental health symptoms was observed, with 87%% of participants reporting clinically elevated symptoms at intake compared to 71%% at termination. Significant improvements were observed in life satisfaction, overall functioning, and mental quality of life. Sixty-nine percent of participants rated the quality of services as good or excellent. Conclusions: The UCC model of care contributed to improved access to psychiatric evaluation and short-term treatment. This inter-professional model could be applied to other health care settings to meet the needs of patients requiring acute psychiatric services. [ABSTRACT FROM AUTHOR]

Major depressive disorders complicate recovery from acute coronary syndrome in approximately 1 in 5 patients, and have been found to be associated with significant impairments of quality of life and functioning. The aim of the present analysis was to evaluate the efficacy of sertraline in improving quality of life and functioning in patients diagnosed with major depression who had recently been hospitalized for acute coronary syndrome. Three hundred sixty-nine patients hospitalized in the previous month for acute coronary syndrome (myocardial infarction, 74%; unstable angina, 26%) who also met criteria for major depressive disorder were randomized to 24 weeks of double-blind treatment with sertraline (50 to 200 mg/day) or placebo. Quality-of-life and functional status were assessed using the Quality of Life, Enjoyment, and Satisfaction scale (Q-LES-Q) and the Medical Outcomes Study SF-36. Data from the total sample, and the recurrent depression subgroup, were analyzed. Severe baseline impairment was found in the Q-LES-Q and all subscales of the SF-36. A multivariate regression analysis identified depression as the strongest predictor of baseline quality-of-life impairment (partial r, −0.37, p = 0.001). In the recurrent depression group, treatment with sertraline resulted in significantly greater improvement than placebo in the Q-LES-Q total score and SF-36 mental component summary score, as well as the SF-36 role limitations, emotional, and mental health factors. Depression has a substantial negative impact on quality of life and functioning in patients hospitalized for acute coronary syndrome. Sertraline was associated with clinically meaningful improvement in multiple quality-of-life domains in patients with acute coronary syndrome and recurrent depression. [Copyright &y& Elsevier]

Reports issues related to psychiatry in Canada. Development of short-term psychotherapies in the treatment of depression; Promotion of shared mental health care; Etiology of borderline personality disorder.

Background: The Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments partnered to produce clinical guidelines for psychiatrists for the treatment of depressive disorders. Methods: A standard guidelines development process was followed. Relevant literature was identified using a computerized Medline search supplemented by review of bibliographies. Operational criteria were used to rate the quality of scientific evidence, and the line of treatment recommendations included consensus clinical opinion. This section, on Axis I, Axis II, and Axis III comorbidity, is 1 of 7 articles that were drafted and reviewed by clinicians. Revised drafts underwent national and international expert peer review. Results: Comorbid depression on Axis I is particularly prevalent in patients with anxiety disorders, substance use disorders, and eating disorders, but it also occurs in patients with schizophrenia, attention-deficit hyperactivity disorder (ADHD), and dementia. Depressive comorbidity has implications for assessment, management, and outcome. The relation between depression and personality disorders is complex. Patients with this comorbidity often require longer, more intense, and multimodal therapies. Depression is also prevalent in medical illnesses, requires careful diagnosis, and responds to standard antidepressant treatments. Conclusions: Comorbidity can influence the course and outcome of both associated conditions. Depression-specific psychotherapy and/or pharmacotherapy should be considered when comorbid depression is diagnosed. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Managing Depression in Medical Outpatients," in the December 28, 2000 issue.

A letter to the editor is presented about a case of patients, whom after indulging into substance abuse, attempted to burn themselves.