You're about to be the base doctor at Halley Research Station in Antarctica for a year. For ten months, no one gets in or out. Fourteen lives are in your hands, including your own. What do you put in your medical kit? And how do your choices differ from those of your predecessors (Eric Marshall and Edward Wilson) a century ago?
Falling STAR*D?: It is common practice for psychiatrists to switch depressive patients between different antidepressants if their current drug does not evince a symptomatic response. Despite clinical wisdom supporting this, little empirical, controlled evidence exists to direct “switching” protocols (e.g. if a patient with Z characteristics is on drug X, is it usually better to switch to drug A, B, or C? Will switching help at all?) in the psychopharmacological treatment of depression. The NIMH-funded STAR*D (Sequenced Alternatives to Relieve Depression) study aimed to address these questions of treatment direction in a very large (n>4000), “real-world” sample using a multi-phase treatment plan with different drugs (and cognitive therapy) at every step to maximize chances of eventual remission. Overall, the NIMH reported that about 67% of patients eventually achieved remission, with few differences in effectiveness between different types of treatment at each step. However, researchers and commentators have raised concerns regarding inconsistent reporting of outcomes, after-the-fact changes in study design and analysis, and other issues that may have inflated, partially invalidated, or misrepresented widely reported treatment outcomes. These inequities may also have implications for the secondary moderator analyses (i.e. does trait A predict switching to X or Y is better?) that were a major reason for the study. [more inside]
One in every 8 babies born in the US is premature. A new study (pdf/via) published online Wednesday in Ultrasound in Obstetrics and Gynecology indicates that vaginal progesterone gel can help women who are pregnant for the first time and at risk of premature birth extend their pregnancies, reduce potential complications and boost the health of their newborns. [more inside]
Towards responsible use of cognitive-enhancing drugs by the healthy - a commentary in Nature that says, "we call for a presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs". Farkesque debate here. [more inside]
Nootropics ("smart" drugs) - all wish to be smarter, correct ? And - while exercise, nutrition, learning, travel, and social interaction (the last 3 via release of neurotrophins) effectively do this, Nootropic drugs have been researched since the 1950's and have been shown to cause at least short term cognitive function enhancement. Piracetam, the first of this drugs, shows promise in the treatment of Alzheimer's and Attention deficit Disorder. Alas, as with poor little Algernon, the effect seems temporary. Nootropics can be a little difficult to acquire in the US. Beer is not a nootropic, but sex on the other hand.....