Minerva

Itching is a poorly understood but distressing symptom of anorexia nervosa that often resolves with weight gain (British Journal of Dermatology 1999;140:453-6). In one study of 19 severely anorexic women, just over half had itching for which no cause could be found. The authors speculate that mild eczema, changes in blood flow to the skin, or endogenous opioids might be to blame, and they suggest a clinical trial of naloxone.

Antidepressant drugs work well for people with endogenous depression, but what about people who are depressed because they have cancer, severe coronary heart disease, or HIV infection? A Cochrane review of 18 randomised trials concludes that people with physical illness do benefit from drug treatment of low mood, but it's still unclear which class of drug works best (Cochrane Library 1999; issue 1). The drugs had no impact on participants' underlying disease, with one notable exception: Nortryptiline seemed to worsen glycaemic control in people with diabetes.

Another review of antidepressant drug trials, this time looking for optimum doses, finds that drug treatment for depression looks surprisingly ineffective when trials are analysed properly by “intention to treat” (British Journal of Psychiatry 1999;174:297-303). A close look at 33 trials of all classes of drug shows that only about half …