Andrew Mayers

The relationship between sleep disturbance and depression

This paper focuses on several aspects of the relationship between sleep and depression, with particular attention to objective factors and subjective perceptions. It does not address the effect that antidepressants have on sleep, nor does it explore the wider implications of the types and course of depression, age, or other psychiatric conditions. “Normal sleep” is explored, examining typical sleep architecture in individuals without sleep disorders, psychiatric conditions or physical illness. Sleep disorders are reviewed and examined to present the nature of the disturbance and the role that they may play in depression, with particular attention paid to insomnia. Studies have identified a sub-group of insomnia patients (highly distressed poor sleepers), who appear to be less satisfied with their sleep quality than “low distressed poor sleepers”, even though they did not differ on sleep timing perceptions. Recent work has shown that depressed individuals to be less satisfied with sleep quality than healthy controls, even though they did not differ on sleep timing perceptions. The evidence presented here supports the view that subjective sleep perceptions play an important role in depression. Poor subjective perceptions of sleep in depression may be associated with faulty cognitions. This has been found extensively in insomnia, but is under-researched in depression.

Subjective sleep, depression and anxiety: inter-relationships in a non-clinical sample.

Previous research confirms the interdependent relationship between poor sleep and depression, but has often focused on objective measures of sleep and overlooked the importance of subjective factors. Insomnia may be maintained by anxiety and perceptions of poor sleep timing, and depression is associated with poor sleep satisfaction, regardless of perceived sleep timing.

An exploratory study of the relationship between mother-infant interaction and maternal cognitive function in mothers with mental illness

There is evidence for a deleterious effect of maternal mental illness on mother–infant interaction. Presence of mental illness and lowered maternal cognitive function independently predict quality of interaction, but their combined effect on interaction is unclear. A pilot study was conducted to explore the relationship between maternal serious mental illness (SMI), cognitive function, and mother–infant interaction. Six mothers with SMI (two with schizophrenia and four with depression) and 12 mothers with no psychiatric history were recruited, together with their infants (all aged between 5 and 18 weeks). Mother–infant interaction was assessed using the Crittenden Care Index. The Cognitive Drug Research computerised assessment battery provided measures of memory and attention. In support of previous literature, mothers with SMI were significantly less sensitive during interactions with their infants. They also demonstrated impairment relative to controls on an index of speed of memory processing. A hierarchical regression model revealed that presence of maternal mental illness was a significant predictor of maternal sensitivity, but when speed of memory processing was accounted for, the strength of this relationship was reduced, suggesting that the relationship between maternal mental illness and mother–infant interaction may be partially mediated by level of cognitive function. Further study is warranted.

The nourishing soil of the soul-: The role of horticultural therapy in promoting well-being in community-dwelling people with dementia

Two-thirds of people with dementia reside in their own homes; however, support for community-dwelling people with dementia to continue to participate in everyday activities is often lacking, resulting in feelings of depression and isolation among people living with the condition. Engagement in outdoor activities such as gardening can potentially counteract these negative experiences by enabling people with dementia to interact with nature, helping to improve their physical and psychological well-being. Additionally, the collaborative nature of community gardening may encourage the development of a sense of community, thereby enhancing social integration. Despite increasing evidence supporting its therapeutic value for people with dementia in residential care, the benefits of horticultural therapy have yet to be transposed into a community setting. This paper will examine the theoretical support for the application of horticultural therapy in dementia care, before exploring the potential of horticultural therapy as a means of facilitating improved physical and psychological well-being and social integration for people living with dementia within the community.

Quality of case reports of adverse drug reactions with psychotropic drugs: a 25-year review

Case reports of adverse reactions with psychotropic drugs can be useful in raising hypotheses, to be tested with more rigorous study designs. However such reports have significant methodological drawbacks, making it hard to determine causality.

The reported use and effectiveness of Hypericum (St John's wort) on affective symptoms in a depression self-help group

A recent meta-analysis suggested that Hypericum perforatum (St Johns wort) is an effective treatment for mild to moderate depression and may have a superior side-effect profile to some antidepressant drugs. The aim of this study was to assess the use of herbal remedies in treating depressive and anxiety symptoms, as reported by members of the UK self-help organization Depression Alliance using self-completed questionnaires. More than 50% of the 452 respondents reported using Hypericum, one-quarter of whom also reported concurrent use of traditional antidepressants. Most of the sample reported sufficient symptoms for warranting a diagnosis of major depression, with the majority also describing symptoms suggestive of co-morbid psychiatric conditions. One-half of the Hypericum users experienced symptom improvement, which for most occurred within the first 4 weeks of use. Response was better for those with mild as compared to severe symptoms and poorer for those taking Hypericum alongside other antidepressants. The responders were generally older than non-responders. Adverse effects were reported by one-quarter of users and were mostly psychological in nature. This retrospective survey indicated that use of herbal remedies was common in this population. Although often helpful in relieving symptoms, particularly in those with mild depression, there is a risk of adverse events and drug interactions.

Selective serotonin reuptake inhibitors in the treatment of generalized anxiety disorder.

Selective serotonin reuptake inhibitors have proven efficacy in the treatment of panic disorder, obsessive–compulsive disorder, post-traumatic stress disorder and social anxiety disorder. Accumulating data shows that selective serotonin reuptake inhibitor treatment can also be efficacious in patients with generalized anxiety disorder. This review summarizes the findings of randomized controlled trials of selective serotonin reuptake inhibitor treatment for generalized anxiety disorder, examines the strengths and weaknesses of other therapeutic approaches and considers potential new treatments for patients with this chronic and disabling anxiety disorder.

Use of St John's wort (Hypericum perforatum L) in members of a depression self-help organisation: a 12-week open prospective pilot study using the HADS scale

The findings of randomised controlled trials confirm that St Johns wort (Hypericum perforatum L) is effective in reducing symptoms in mild to moderate depression, but few studies have focused on the effect on anxiety symptoms. Most studies have employed observer-rated scales to measure treatment outcome, only few used self-rated scales. We sought to examine these issues in a cohort of members of the depression self-help organisation Depression Alliance UK (n= 39). Hospital Anxiety and Depression (HADS) scales were used at baseline, prior to St Johns wort administration, and for subsequent assessments at weeks 4, 8 and 12. A subject-rated version of the Clinical Global Impression – Improvement (CGI-I) scale was employed at follow-up assessments. HADS scores were significantly reduced after taking St Johns wort, particularly for those reporting milder depression and more severe anxiety. HADS scores compared well with patient improvement ratings, indicating the feasibility of use in this population. Controlled studies are needed in a larger cohort to examine these findings, before definitive conclusions can be made.

Suicide in psychiatric in-patients

with psychiatric services in the year before death. Fourteen per cent receive in-patient care during this year, and around one-fifth of these (3–4% of all suicides) die while in hospital. Suicide rates (based on deaths per admissions per year) among psychiatric in-patients may have increased over the last 50 years. The causes of this possible increase have not been determined, but some explanations include structural changes in psychiatric hospitals; differences in the patient groups admitted to hospital; and increased patient liberty on the ward. It is notoriously difficult to predict suicide risk in psychiatric patients accurately, as factors associated with suicide are also associated with mental illness. Relatively few factors specific to in-patient suicide have been identified, and they have limited predictive value. This paper summarizes previous work on the features of in-patients that kill themselves, examines the clinical value of recent research findings derived from case-control studies, and concludes with an account of recent recommendations on the prevention of in-patient suicide.