MonthOctober 2015

Reading of the Week: Marijuana Use and Misuse

In the United States, laws and attitudes toward the use of marijuana are changing. Twenty-three states now have medical marijuana laws, and marijuana use is higher in states with such laws than in other states. Four of these states have also legalized marijuana for recreational use. More Americans now favor legalization of marijuana use than in previous years. Further, fewer Americans view marijuana use as risky, although studies have shown that use or early use of marijuana is associated with increased risk for many outcomes, including cognitive decline, psychosocial impairments, vehicle crashes, emergency department visits, psychiatric symptoms, poor quality of life, use of other drugs, a cannabis-withdrawal syndrome, and addiction risk. Further, marijuana use disorders (abuse or dependence) are associated with substantial comorbidity and disability and are consequently of substantial public health concern.

So begins a new paper looking at an old question: how does drug legalization affect use and misuse?

This week’s Reading: “Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013” by Deborah S. Hasin et al., just published online (and ahead of print) by JAMA Psychiatry.

You can find the paper here:

http://archpsyc.jamanetwork.com/article.aspx?articleid=2464591

Columbia University’s Hasin and her co-authors have picked a timely topic. Here’s a quick summary: as laws and public attitude have shifted, looking at U.S. survey data, they conclude that marijuana use has sharply increased. Continue reading

Reading of the Week: Psychiatry and West Africa

KPOVÉ, Togo — The church grounds here sprawled through a strange, dreamlike forest. More than 150 men and women were chained by the ankle to a tree or concrete block, a short walk from the central place of worship. Most were experiencing the fearsome delusions of schizophrenia. On a recent visit, some glared, while others slept or muttered to themselves. A few pushed to their feet and gestured wildly, their cries piercing the stillness.

Until this year, Koffi Gbedjeha, 45, a carpenter and father of four, was one of them — a resident of the Jesus Is the Solution prayer camp here, shackled like the others, his family and camp staff members said. For more than two years, his youngest sister, Akossiwa, 27, tended to him. Rising early each morning, she walked along a cool red-earth path to the human forest; each day, amid the stirring bodies and clinking chains, she emptied her brother’s chamber pot, swept the ground and cooked his meals over a charcoal fire.

So begins a series of articles on mental illness in West Africa.

This week’s Reading: “The Chains of Mental Illness in West Africa” by Benedict Carey, which was published earlier this month in The New York Times.

The selection may seem a bit unusual – Readings, after all, usually draw from journals, not from the Sunday paper. But Carey’s reporting is unusually lucid. If you haven’t read his article, I invite you to read it; if you saw this before, it’s worth re-reading.

You can find the article here:

http://www.nytimes.com/2015/10/12/health/the-chains-of-mental-illness-in-west-africa.html?hp&action=click&pgtype=Homepage&module=photo-spot-region&region=top-news&WT.nav=top-news&_r=0

Benedict Carey Continue reading

Reading of the Week: Of Pills and Placebo – The Pecina et al. paper

High rates of placebo responses are consistently reported across medical conditions, notably mood disorders, Parkinson disease, and pain, but also schizophrenia, substance use disorders, and surgical procedures. Placebo response rates in antidepressant trials average 31% to 45% compared with approximately 50% responses to antidepressants, and they have increased over the last 30 years. The failure of antidepressant responses to separate from placebo has contributed to the reduction or discontinuation of research on new treatments for depression and other neuropsychiatric illnesses, hindering the development of novel neuropsychiatric treatments.

So begins a new paper considering the relationship between placebo and depression treatment.

This week’s Reading: “Association Between Placebo-Activated Neural Systems and Antidepressant Responses Neurochemistry of Placebo Effects in Major Depression” by Dr. Marta Peciña et al., which was just published “online first” by JAMA Psychiatry.

Dr. Marta Peciña

Here’s a quick summary: this is a big paper in a big journal that seeks to better understand the placebo effect and antidepressants, and taps neuroimaging to do so. There is, however, a catch: the number of patients involved is small. Continue reading

Reading of the Week: The Silence of Prozac

In the 1980s, historian of pharmacology Mickey Smith wrote that new blockbuster medicines enter society by a three-step process. First, a wild popular embrace, driven by overestimation of the drug’s potential, leads to overuse; next, the sudden discovery of “problems” with the drug leads to a backlash; and finally, a state of equilibrium is reached, in which the drug is used judiciously, its real benefits and limits seen clearly at last. Smith called these three stages the “law of the wonder drug.”

I remembered Smith’s formula not long ago, while talking to an old friend on a summer ramble around New York City. The substance of our conversation was that antidepressants – a topic we’d bandied back and forth together for almost 20 years, in various states of using them ourselves and not – had begun to seem quaint. Maybe even a little retro, like lava lamps or tube socks.

So begins a short, cutting essay on antidepressants.

The piece is timely: once considered miracle drugs for depression, this medication class has come under sharp criticism, and yet has gained wide acceptance. In my clinical work, I’m surprised by the large number of patients – particularly younger patients – who hesitate about these medications; I’m also surprised by the large number of patients – particularly younger patients – who are on these medications.

This week’s Reading: “The silence of prozac” by author and essayist Katherine Sharpe, which was just published in The Lancet Psychiatry.

Katherine Sharpe

Continue reading