Hippocampal volume is reduced in patients with unipolar depression, maybe as a consequence of repeated periods of major depressive disorder. Bipolar patients did not seem to show a reduction in hippocampal volume, but this has been much less investigated.

We have identified factors both strongly associated and non-associated with PTSD following childbirth. While the literature is limited by methodological shortcomings, a hypothesis regarding the development of PTSD is outlined, and recommendations with respect to screening and future research are provided.

This evidence is consistent with the hypothesis that depressive symptoms are caused by dysfunction of regions of the limbic system and the frontal lobes in close connection with the basal ganglia.

A review of the literature on primarily magnetic resonance imaging (MRI) scans of patients with affective disorders is presented. Several studies have indicated an increased ventricle/brain ratio and other signs of cerebral atrophy, as well as an increased frequency of lesions (so-called signal hyperintensities) in the brains of unipolar and bipolar patients. This notion is strongly supported by two meta-analyses performed in the present study. The lesions are often localized in the frontal lobes and the basal ganglia, indicating a defective basal ganglia/frontal circuit, and are correlated with the degree of cognitive impairment seen in these conditions. No studies have indicated that psychoactive drugs or electroconvulsive therapy (ECT) might cause the lesions, but on the other hand they can probably increase the risk of delirium complicating the treatment.

trial are effective in their own right. A further incentive for involvement in the trial is the concept of thèone-stop' (or`twoor`two-stop' in the case of our research clinic) menstrual disorders clinic. This type of clinic had not previously been established in our hospital and women otherwise have their menorrhagia managed routinely in a general gynaecology clinic. On completion of the trial, the dedicated menstrual disorders clinic will continue as a routine clinical service. To answer the question asked by the SMART study trialists-ªshould we disregard evidence based medicine and prescribe such therapies without proof?º No, but we may need to be patient in the arrival at such proof, which could involve meta-analysis of rando-mised trials as SMART and TALIS. References 1. Rogerson L, Duffy S, Crocombe W, Stead M, Dawood D. Management of menorrhagia-SMART study (Satisfaction with Mirena and Ablation: a Randomised Trail)[Correspondence]. Br J Obstet Gynaecol 2000;107:1325±1326. 2. Cooper KG, Parkin DE, Garratt AM, Grant AM. Two-year follow up of women randomised to medical management or transervical resection of the endometrium for heavy menstrual loss: clinical and quality of life outcomes. Br J Obstet Gynaecol 1999;106:1231±1232. 3. Lethaby AE, Cooke I, Rees M. Progesterone/progestogen releasing intrauterine systems versus either placebo or any other medication for heavy menstrual bleeding (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford

Major depression is a mood disorder that is often accompanied by the impairment of cognitive functions. Although suggestive, the large range of existing neuropsychological, neuropsychiatric, and, lately, neuroimaging investigations have not yet given a consistent picture of the psychological and biological disturbances involved in this psychiatric disorder. The present study of the cognitive functions in depression was part of an extensive investigation, including neuropsychological testing, psychiatric examination, and neuroimaging. A representative sample of 40 severely depressed hospitalized patients and a group of 49 closely matched control subjects were tested with an extensive neuropsychological test battery. Results, corrected for various confounding factors, confirmed the current notion that depressed patients suffer from wide-spread cognitive impairments. The group analysis did not allow any hypothesis on a possible pattern to the dysfunctions, but heterogeneity in the test performances calls for further analysis of the data in patient subgroups in relation to neuroimaging results.

BackgroundThe effect of referring patients from a clinical setting to a pragmatic exercise intervention for depressive symptoms, cognitive function, and metabolic variables has yet to be determined.MethodsOutpatients with major depression (DSM-IV) were allocated to supervised aerobic or stretching exercise groups during a three months period. The primary outcome was the Hamilton depression score (HAM-D17). Secondary outcomes were cognitive function, cardiovascular risk markers, and employment related outcomes.Results56 participants were allocated to the aerobic exercise intervention versus 59 participants to the stretching exercise group. Post intervention the mean difference between groups was −0.78 points on the HAM-D17 (95% CI −3.2 to 1.6; P = .52). At follow-up, the participants in the aerobic exercise group had higher maximal oxygen uptake (mean difference 4.4 l/kg/min; 95% CI 1.7 to 7.0; P = .001) and visuospatial memory on Rey’s Complex Figure Test (mean difference 3.2 points; 95% CI 0.9 to 5.5; P = .007) and lower blood glucose levels (mean difference 0.2 mmol/l; 95% CI 0.0 to 0.5; P = .04) and waist circumference (mean difference 2.2 cm; 95% CI 0.3 to 4.1; P = .02) compared with the stretching exercise group.ConclusionsThe results of this trial does not support any antidepressant effect of referring patients with major depression to a three months aerobic exercise program. Due to lower recruitment than anticipated, the trial was terminated prior to reaching the pre-defined sample size of 212 participants; therefore the results should be interpreted in that context. However, the DEMO-II trial does suggest that an exercise program for patients with depression offer positive short-term effects on maximal oxygen uptake, visuospatial memory, fasting glucose levels, and waist circumference.Trial RegistrationClinicalTrials.gov NCT00695552

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