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  1. Jason Boland
  1. Senior lecturer and honorary consultant in palliative medicine, Hull York Medical School, UK

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Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial

▶ Sverre Bergh, Geir Selbæk, Knut Engedal. BMJ 2012;344:e1566.

The effect of stopping selective serotonin reuptake inhibitors (SSRIs) in patients with dementia and neuropsychiatric symptoms (but no depression) in Norwegian nursing homes was assessed in a double blind, parallel group, randomised controlled trial. In patients taking SSRIs for 3 months or more, SSRIs were discontinued in 63 patients and continued in 68 patients. The patients who stopped SSRIs had higher scores on the Cornell scale for depression in dementia after 25 weeks. Fifty-four per cent of patients had at least a 30% worsening on the Cornell scale in the discontinuation group compared with 29% in the continuation group. Although this study showed that discontinuation of antidepressant treatment in patients with dementia and neuropsychiatric symptoms leads to an increase in depressive symptoms, a limitation is that 37% patients withdrew from the study early.

Combination therapy for neuropathic pain: a review of current evidence

▶ Vorobeychik Y, Gordin V, Mao J, Chen L. CNS Drugs 2011;25:1023–34.

This review of combination therapy for the treatment of neuropathic pain found only small numbers of clinical studies on this topic. There was clinical evidence that gabapentin and pregabalin combined with an opioid, cyclo-oxygenase-2 inhibitor or …

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