Under the new proposals, doctors will be able to order patients detained in hospital with mental health problems to be subject to so-called supervised community treatment when they are discharged.

This will require them to return to hospital if doctors think they need further treatment.

At present authorities have to apply for a discharged patient to be compulsorily sectioned again if they want them back in hospital.

The government says that for many patients supervised community treatment will be preferable to continuing detention in hospital.

At any one time there are around 14,000 people with mental health problems so serious they have to be detained in hospital.

"This bill will help ensure that people with serious mental health problems receive the treatment they need to protect them and others from harm," Winterton said.

"It will also strengthen patient safeguards and ensure human rights are protected."

But mental health campaigners fear the supervision provisions will become a kind of "mental health anti-social behaviour order", imposing restrictions on the freedom of patients, which will do nothing to improve their mental health.

"They want to tell people when they might have to get home at night, where they can live, where they can't go," Jane Harris of charity Rethink told BBC television.

"If you've got a mental illness, you want care and treatment. You don't want a piece of paper telling you what you should be doing."

A spokesman for the Mental Health Alliance told Reuters it wanted the wording of the bill amended to restrict the powers available under supervised treatment orders.

"It is very possible, with the kind of defensive atmosphere in which mental health services are forced to work, that people could be kept on these for longer than is absolutely necessary, in the way the law is proposed to be written.

"You can't leave something like this too loose -- it's about depriving someone of their liberty."

The bill is an amended version of government proposals scrapped in March after vigorous campaigning from mental health groups.

It is likely to face further opposition as it passes through parliamentary scrutiny.

Conservative health spokesman Tim Loughton said the bill was an attack on civil liberties.

"This bill is designed to do the work of the Home Office instead of protecting people in severe mental distress," he said.

The Mental Health Alliance, which brings together 78 organisations, plans to lobby parliament later this month.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Lexapro curbs risk of recurrent depression

Last Updated: 2006-11-17 11:14:22 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Maintenance therapy with the antidepressant Lexapro (also known as escitalopram) significantly reduces the risk for recurrent depression, according to study findings.

"Escitalopram is another treatment option that has now been shown to be effective for maintenance treatment of major depressive disorder," Dr. Susan G. Kornstein from Virginia Commonwealth University, Richmond, told Reuters Health.

"This study also reinforces the importance of maintenance antidepressant therapy for patients with recurrent major depressive disorder in order to prevent future recurrences of depression."

Kornstein and colleagues investigated the preventive effect of escitalopram maintenance treatment in 139 patients who had responded to treatment with another similar antidepressant and maintained that response when switched to escitalopram for continuation therapy.

"All patients with a major depressive episode need acute phase treatment to get their symptoms into remission, followed by continuation phase treatment to prevent that episode from returning (which would be called a relapse)," Kornstein explained.

"Then, for patients who have had a recurrent course of illness, which is the case for most patients with major depressive disorder, maintenance treatment is also needed in order to prevent future episodes of depression."

Time to recurrence of depression in the current study was significantly longer for escitalopram-treated patients -- on average 252 days with escitalopram versus 130 days with placebo, the authors report.

Cumulative recurrence rates were 27 percent for the escitalopram group and 65 percent for the placebo group.

Escitalopram treatment was safe and well tolerated, the researchers note.

"Escitalopram continuation treatment over a period of 36 weeks has been previously shown to prevent relapse of depression. The current study extends those findings to demonstrate the efficacy of escitalopram in maintenance treatment," the team concludes.

"I have no particular reason to believe," Kornstein emphasized, "that escitalopram would be better for maintenance treatment than another SSRI (selective serotonin reuptake inhibitor), but there have been no studies comparing one SSRI with another for maintenance treatment, so we can't really answer that question."

"But even if a study were done and didn't show an overall difference, there may be differences for individual patients in treatment response with one drug versus another -- even ones from the same class -- so it's important to have a number of different options to offer patients."

SOURCE: Journal of Clinical Psychiatry, November 2006.

Copyright © 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.