MonthApril 2015

Reading of the Week: Zen or Zoloft? Mindfulness vs. Meds for Relapse Prevention in Depression

Depression typically has a relapsing and recurrent course. Without ongoing treatment, individuals with recurrent depression have a high risk of repeated depressive relapses or recurrences throughout their life with rates of relapse or recurrence typically in the range 50–80%.

So begins this week’s Reading (which is attached). As is so often the case, the journal writing is understated.

50-80%. Wow.

Having been in practice for some years, many stories come to mind when considering this statistic.

Here’s one: a young woman with a challenging childhood who pulled her life together, kept an unplanned pregnancy, and then tried to do everything right for herself and her daughter. In her late 20s, she fell into a deep depression, attempted suicide, and had a long admission. And, after work on the inpatient unit and in the outpatient department, she returned to her life: free of symptoms, working full time, raising her daughter. Feeling well, she stopped her citalopram, and became sick again (and with an employer keen on her termination because – and this sounds like a 19th century novel – “she told me I look dead on the outside”).

It’s easy to say that she should have stayed on her medications. But many of our patients don’t. The reasons vary – the side effects are too strong, the concept of medications is unappealing, etc. – but the end result is so often the same.

What then are non-medication options for maintenance in patients with depression? This week’s Reading offers an interesting answer: mindfulness-based cognitive therapy.

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Reading of the Week: Can Crowdsourcing Treat Depression?

Social networks aspire to connect people, which is a noble but naive goal. When we uncritically accept connection as a good thing, we overlook difficult, important questions: Are some forms of virtual communication more nourishing than others? Might some in fact be harmful? Is it possible that Facebook, for instance, leaves some people feeling more lonely? No one knows for sure. We tend to build things first and worry about the effects they have on us later.

Robert Morris is taking the opposite approach. Starting with the desired effect of helping people deal with depression, he developed Panoply, a crowdsourced website for improving mental health.

So begins this week’s Reading.

This is not your typical selection. Though the disease discussed is depression, the treatment involves social networks, not sertraline. The article is well written, but it doesn’t appear in the pages of World Psychiatry but Wired. The article details therapy, but with a focus on apps, not Adler. CBT is important, but crowdsourcing is talked about more than cognitive distortions.

Welcome to psychiatry in the 21st century.

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Reading of the Week: Dr. Kurdyak’s Paper on Psychiatry and Practice

A few months ago, a patient walked into my office and immediately broke down. He explained that he had waited so long to see a psychiatrist that he was overwhelmed to finally meet me. For the record, he had never spoken to me before and knew nothing about me – except that I was a psychiatrist and that he needed to see one.

The surprise is that anyone would be surprised by such a story.

Patients often face long wait lists in our health care system. The wait for psychiatric care seems particularly long. But here’s the question: do we have a shortage of psychiatrists in Ontario – or do we have a shortage of creative thinking on how psychiatrists practice in Ontario? The week’s Reading asks this important question, with a surprising conclusion: “increasing psychiatrist supply will have little impact on patients’ access.” Continue reading

Reading of the Week: “36 minutes and 40 seconds”

Cat Stevens’ Tea For The Tillerman is a short album.

11 songs. 36 minutes and 40 seconds. In 2003, Rolling Stone included it in its 500 Greatest Albums of All Time. In 2007, the album was included in The Definitive 200 Albums of All Time. It has appeared in many other lists compiled by sages of the music industry.

And it is the last album my father ever heard.

On Oct 8, 2003, Michael John Hasler (I rarely say his name— it’s nice to type it here) died by suicide. He’d been listening to the CD, which was now still and quiet in the portable stereo close by.

This week’s Reading is a short essay by comedian and playwright Sadie Hasler on the death of her father a dozen years ago, which appears in the latest issue of The Lancet Psychiatry. Continue reading

Reading of the Week: Germanwings, Depression and Violence

Is depression linked to violence? And if it is, what are the clinical implications? This Reading of the Week asks these two questions.

On the Germanwings’ Tragedy

Certainly in light of recent events, the depression-violence link is much discussed. Some have already weighed in. Consider this incredibly offensive newspaper front page.

“Madman.” “Crazed.” And if only that sort of language was restricted to tabloids. Last week, French Prime Minister Manuel Valls said: “everything is pointing towards an act that we can’t describe: criminal, crazy, suicidal.” It’s enough to make us nostalgic for the Sarkozy administration. (Who would have predicted such nostalgia three years ago?)

To be clear, though coverage has been breathless, little is known. In a thoughtful piece in The Atlantic titled “Depressed Doesn’t Mean Dangerous,” Julie Beck notes: “What evidence we have of Lubitz’s mental health or lack thereof is still scant.” Indeed, we can’t answer the most basic questions. Was the ill-fated flight’s co-pilot in active treatment for depression? Was he on medications? What was his mental state in the days leading up to the tragedy? Continue reading