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Highlights of this issue

Practice guidelines generally recommend a 6- to 9-month course of selective serotonin reuptake inhibitors following initial recovery after a first episode of depression. Deshauer and colleagues report that their systematic review, which is based on 6 classic long-term randomized controlled trials, supports this recommendation. Previous reviews have been dominated by short-term trials despite the fact that depression is a long-term problem.

In an accompanying commentary, Rush warns us that most trials in depression are too short to gauge the full proportion of patients who will respond or remit.

The lead editorial laments the current state of missing evidence in mental health in which doctors can only guess at best treatments.

View larger version (93K): [in this window] [in a new window]   Photo by: Victor Habbick Visions / Science Photo Library

Angiotensin-converting-enzyme (ACE) inhibitors for congestive heart failure

Enalapril and captopril were associated with about 10%–15% higher mortality than ramipril among older patients with congestive heart failure. This is a finding of a study by Pilote and colleagues, who reviewed large population-based administrative databases of hospital discharge and prescription claims. They studied data for more than 43 000 patients from 3 Canadian provinces who filled their first prescriptions for an ACE inhibitor.

In a related commentary, Hernandez and Harrington write these results suggest that critical differences may exist among the groups of ACE inhibitors commonly used to treat heart failure, and call for a prospective trial to confirm them.

See pages 1303 and 1316

Mental health in Canada

In this Public Health Commentary, Kirby, chair of the Mental Health Commission of Canada, describes the commission and outlines its 3 strategic initiatives: develop a national mental health strategy, conduct a campaign against stigma and build a national centre to exchange knowledge.

See page 1320

The grey zone between no dementia and dementia

This review, the third in our series on dementia, provides physicians with guidance on the diagnosis and treatment of that grey zone between no dementia and dementia. States such as mild cognitive impairment and "cognitive impairment, no dementia" are discussed. The recommendations include close monitoring for progression to dementia, promotion of a healthy lifestyle and treatment of vascular risk factors.

See page 1273

Practice

In this Teaching Case Report, a 46-year-old male forklift operator presents with work-related radicular leg pain, progressive weakness, and signs and symptoms of myelopathy. Its cause is treatable, and his condition improves after surgery (page 1286).

View larger version (67K): [in this window] [in a new window]   Spinal dural arteriovenous fistula and engorged perimedullary vessels in a 46-year-old man.

News

Residents of 1766 small towns, cities or neighbourhoods like trailer parks have been advised by provincial health authorities not to drink their water without first boiling it. In some instances, even boiling the water does not make it potable (page 1261).

Electroconvulsive therapy is increasingly being delivered to Canadians over the age of 70 as a treatment for depression (page 1264).

Related Articles

Bringing a research base to psychiatry

Miriam Shuchman, MD and Paul C. Hébert, MD MHSc
Can. Med. Assoc. J. 2008 178: 1257-1258. [Full Text] [PDF]

This Article Figures Only Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles

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Copyright 1995-2008, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.