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PG CME Table of Contents   
Year : 2008  |  Volume : 50  |  Issue : 3  |  Page : 209-212
Continuing medical education

Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India

Click here for correspondence address and email

How to cite this article:
Andrade C. Continuing medical education. Indian J Psychiatry 2008;50:209-12

How to cite this URL:
Andrade C. Continuing medical education. Indian J Psychiatry [serial online] 2008 [cited 2021 Sep 23];50:209-12. Available from:

   CME Questions Top

A) Many meta-analyses have recently examined the efficacy of antidepressants in major depressive illness. With this background, mark True or False against each of the following statements:

  1. In adults with major depressive disorder, antidepressant drugs are more effective when depression is severe than when it is mild.
  2. In patients with major depressive disorder, antidepressant drugs are less effective in studies that are placebo-controlled.
  3. In adults with major depressive disorder, the selective serotonin reuptake inhibitors (SSRIs) are comparable in efficacy.
  4. Dual-acting antidepressant drugs are superior to the SSRIs.

B) Advances in medicine and improved healthcare delivery systems have together increased the number of persons who survive into old age. Geriatric psychiatry, and particularly the treatment of the cognitive problems of the elderly, have become important areas of current research. In this context, several novel approaches have been studied towards the prevention or treatment of cognitive deficits in the elderly, in those with mild cognitive impairment, and in those with dementia. With this background, mark True or False against each of the following statements:

  1. The nonsteroidal antiinflammatory drugs (NSAIDs) naproxen and celecoxib prevent cognitive deterioration in old age.
  2. Statins may protect against incident dementia.
  3. Omega-3 fatty acids improve cognition in the elderly.
  4. Disease-modifying treatments for Alzheimer's disease are beyond reach.
  5. Diverting CSF away from the brain can reduce the exposure of the brain to amyloid and tau; this novel approach can benefit patients with Alzheimer's disease.

Click here to view answer. View Answer

   References Top

1.Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008;5:e45.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Sneed JR, Rutherford BR, Rindskopf D, Lane DT, Sackeim HA, Roose SP. Design makes a difference: A meta-analysis of antidepressant response rates in placebo-controlled versus comparator trials in late-life depression. Am J Geriatr Psychiatry 2008;16:65-73.   Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Kennedy SH, Andersen HF, Lam RW. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: A meta-analysis. J Psychiatry Neurosci 2006;31:122-31.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Lam RW, Andersen HF, Wade AG. Escitalopram and duloxetine in the treatment of major depressive disorder: A pooled analysis of two trials. Int Clin Psychopharmacol 2008;23:181-187.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Papakostas GI, Fava M. A meta-analysis of clinical trials comparing milnacipran, a serotonin--norepinephrine reuptake inhibitor, with a selective serotonin reuptake inhibitor for the treatment of major depressive disorder. Eur Neuropsychopharmacol 2007;17:32-6.   Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Papakostas GI, Thase ME, Fava M, Nelson JC, Shelton RC. Are antidepressant drugs that combine serotonergic and noradrenergic mechanisms of action more effective than the selective serotonin reuptake inhibitors in treating major depressive disorder? A meta-analysis of studies of newer agents. Biol Psychiatry 2007;62:1217-27.   Back to cited text no. 6    
7.McGeer PL, Schulzer M, McGeer EG. Arthritis and anti-inflammatory agents as possible protective factors for Alzheimer's disease: A review of 17 epidemiologic studies. Neurology 1996;47:425-32.  Back to cited text no. 7  [PUBMED]  
8.Szekely CA, Thorne JE, Zandi PP, Ek M, Messias E, Breitner JC, et al . Nonsteroidal anti-inflammatory drugs for the prevention of Alzheimer's disease: A systematic review. Neuroepidemiology 2004;23:159-69.   Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.ADAPT Research Group. Cognitive function over time in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT): Results of a randomized, controlled trial of naproxen and celecoxib. Arch Neurol 2008;65:896-905.  Back to cited text no. 9    
10.ADAPT Research Group. Naproxen and celecoxib do not prevent AD in early results from a randomized controlled trial. Neurology 2007;68:1800-8.   Back to cited text no. 10    
11.Andrade C, Singh NM, Thyagarajan S, Nagaraja N, Rao NS, Chandra JS. Possible glutamatergic and lipid signalling mechanisms in ECT-induced retrograde amnesia: Experimental evidence for involvement of COX-2 and review of literature. J Psychiatr Res 2008;42:837-50.  Back to cited text no. 11    
12.Andrade C, Thyagarajan S, Singh NM, Vinod PS, Rao NS, Chandra JS. Celecoxib as an in vivo probe of the mechanisms underlying retrograde amnesia in an animal model of ECT. J Neural Transm 2008;115:1063-70.  Back to cited text no. 12    
13.Wolozin B, Wang SW, Li NC, Lee A, Lee TA, Kazis LE. Simvastatin is associated with a reduced incidence of dementia and Parkinson's disease. BMC Med 2007;5:20.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Sparks DL, Kryscio RJ, Sabbagh MN, Connor DJ, Sparks LM, Liebsack C. Reduced risk of incident AD with elective statin use in a clinical trial cohort. Curr Alzheimer Res 2008;5:416-21.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Cramer C, Haan MN, Galea S, Langa KM, Kalbfleisch JD. Use of statins and incidence of dementia and cognitive impairment without dementia in a cohort study. Neurology 2008;71:344-50.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]
16.Lichtenthaler SF, Haass C. Amyloid at the cutting edge: Activation of alpha-secretase prevents amyloidogenesis in an Alzheimer disease mouse model. J Clin Invest 2004;113:1384-7.  Back to cited text no. 16  [PUBMED]  [FULLTEXT]
17.Morris MC, Evans DA, Bienias JL, Tangney CC, Bennett DA, Wilson RS, et al . Consumption of fish and omega-3 fatty acids and risk of incident Alzheimer disease. Arch Neurol 2003;60:940-6.  Back to cited text no. 17  [PUBMED]  [FULLTEXT]
18.Huang TL, Zandi PP, Tucker KL, Fitzpatrick AL, Kuller LH, Fried LP. et al . Benefits of fatty fish on dementia risk are stronger for those without APOE epsilon. Neurology 2005;65:1409-14.  Back to cited text no. 18    
19.Nurk E, Drevon CA, Refsum H, Solvoll K, Vollset SE, Nygerd O, et al . Cognitive performance among the elderly and dietary fish intake: The Hordaland Health Study. Am J Clin Nutr 2007;86:1470-8.  Back to cited text no. 19    
20.van Gelder BM, Tijhuis M, Kalmijn S, Kromhout D. Fish consumption, n-3 fatty acids, and subsequent 5-y cognitive decline in elderly men: The Zutphen Elderly Study. Am J Clin Nutr 2007;85:1142-7.  Back to cited text no. 20  [PUBMED]  [FULLTEXT]
21.van de Rest O, Geleijnse JM, Kok FJ, van Staveren WA, Dullemeijer C, OldeRikkert MG, et al . Effect of fish oil on cognitive performance in older subjects: A randomized, controlled trial. Neurology 2008;71:430-8.  Back to cited text no. 21  [PUBMED]  [FULLTEXT]
22.Wisniewski T, Konietzko U. Amyloid-beta immunisation for Alzheimer's disease. Lancet Neurol 2008;7:805-11.  Back to cited text no. 22  [PUBMED]  [FULLTEXT]
23.Lannfelt L, Blennow K, Zetterberg H, Batsman S, Ames D, Harrison J, et al . Safety, efficacy, and biomarker findings of PBT2 in targeting A-beta as a modifying therapy for Alzheimer's disease: A phase IIa, double-blind, randomised, placebo-controlled trial. Lancet Neurol 2008;7:779-86.  Back to cited text no. 23  [PUBMED]  [FULLTEXT]
24.Silverberg GD, Levinthal E, Sullivan EV, Bloch DA, Chang SD, Leverenz J et al . Assessment of low-flow CSF drainage as a treatment for AD: Results of a randomized pilot study. Neurology 2002;59:1139-45.  Back to cited text no. 24    
25.Silverberg GD, Mayo M, Saul T, Fellmann J, Carvalho J, McGuire D. Continuous CSF drainage in AD: Results of a double-blind, randomized, placebo-controlled study. Neurology 2008;71:202-9.  Back to cited text no. 25  [PUBMED]  [FULLTEXT]

Correspondence Address:
Chittaranjan Andrade
Professor of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore - 560 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5545.43631

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