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FILLERS: Olimpia Claudia Pop A depressed gorilla BMJ 2007; 335: 445 [Full text]

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Choice of antidepressant

Martin Duerden   (2 September 2007)

SHOs in the mist?

Eamonn J Clarke   (4 September 2007)

Neglect of Psyhosocial Interventions in a Depressed Gorilla

Dave W H Baillie   (3 October 2007)

Choice of antidepressant 2 September 2007
Martin Duerden, General Practitioner Meddygfa Gyffin, Conwy, North Wales, LL32 8LT Send response to journal: Re: Choice of antidepressant	I was intrigued by the choice of antidepressant for this gorilla. Is escitalopram on the zoo's formulary? It is not on our local NHS formulary. Escitalopram is an s-enantiomer of citalopram which is now off-patent and a recent Drug and Therapeutic Bulletin (DTB)[1] highlighted how such drugs are developed and marketed after the patent expiry of the originator drug, to extend profits. In humans, as pointed out by DTB, there is little evidence that it is any better than any other serotonin-reuptake inhibitors but it is many times more expensive than generic alternatives. Has the gorilla unwittingly been experimented on in this way as a result of drug company marketing? [1] Anon. New drugs from old? DTB 2006;44(10):73-77. Competing interests: I am on the Editorial Board for Drug and Therapeutics Bulletin.
SHOs in the mist? 4 September 2007
Eamonn J Clarke, GP PE14 Send response to journal: Re: SHOs in the mist?	This filler piece seems to raise more questions than it answers: Do senior house officers in psychiatry have the time to spend two hours assessing a troubled gorilla? Presumably this costs more than peanuts. Was the NHS trust reimbursed for this consultation? Do SHOs have their own secretaries now? A polite but great ape looks forward to the author's response. Competing interests: It was Earth all along.
Neglect of Psyhosocial Interventions in a Depressed Gorilla 3 October 2007
Dave W H Baillie, Specialist Registrar in Adult Psychiatry East London and the City Mental Health NHS Trust, Anita House, Wilmer Place, London, N16 0LN Send response to journal: Re: Neglect of Psyhosocial Interventions in a Depressed Gorilla	Given that the serotonin theory of depression has been dismissed as a pharmaceutical industry propagated myth (Lacasse 2005) and given the efficacy of psychosocial interventions, we were surprised that Pop only considered a pharmacological approach in the treatment of a depressed gorilla. While even the most enthusiastic evangelists of NICE-recommended CBT might acknowledge the limitations of cognitive restructuring with a gorilla, more pragmatic activity scheduling and behavioural activation both have a good evidence base as stand alone treatments for depression. Antonio Damasio (1994) conceptualised emotional experience as being embedded within visceral and musculoskeletal states. In depression, reduced efferent activity from the peripheral nervous system can be stimulated by Dance Movement Therapy, another proven therapy for depression (Jeong-Young-Ja, 2005). Ayurvedic philosophy, and more recently Harrison et al (2005), has indicated a relationship between low mood and overcrowding, such as might be the case in Bristol Zoo, and it might be that a letter in support of rehousing, the ubiquitous default intervention of the helpless psychiatrist, could have been useful. Dianne Fossey observed the importance of social hierarchy in gorilla groups and it could be that Pop’s patient’s withdrawal from the role of alpha male precipitated an existential crisis characterised by a failure to negotiate Erikson's final task of development: integrity versus despair. Or in the words of the Jungle Book’s King Louie, “I’m (was) the king of the swingers, the Jungle V.I.P. I’ve got to the top and then had to stop and that’s what’s bothering me”. Pop, IC. A depressed gorilla. BMJ 2007; 335: 445 (1 September). Lacasse JR, Leo J. Seotonin and Depression: A disconnect between the advertisements and the scientific literature. PloS Med (2005) 2 (12): e392 Harrison J, Barrow S & Creed F. Social deprivation and psychiatric admission rates for different diagnostic groups. BJPsych (1995) 167 (4) 456-62 Jeong-Young-Ja, Hong-Sung-Chan, Lee-Myeong-Soo, Park-Min-Cheol, Kim- Yong-Kyu, Suh-Chae-Moon. Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression. The International journal of neuroscience (2005) 115 (12) 1711-20 Antonio Damasio (1994) Descartes Error: Emotion, Reason and the Human Brain. Vintage Books, London. Competing interests: None declared