Highlights of this issue

Selective serotonin reuptake inhibitors for unipolar depression

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.

See pages 1293, 1313 and 1257

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).

In this issue's Clinical Quiz, a 53-year-old man presents with malaise, weight loss, pleuritic chest pain and productive cough. A radiograph shows a mass in his lung. What is your call (page 1289)?

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).