MonthFebruary 2018

Reading of the Week: Rahael Gupta on Medical Students & Depression (& her Depression)

From the Editor

Once—and I have never shared this before—I stepped into the street on my walk home from the library. I knew that the bus hurtling through the night would not have time to stop before colliding with my darkly dressed frame, fracturing my bones and scattering my belongings. I imagined my head hitting the asphalt and my brain banging around inside of my skull, bruising irreparably with each impact. I imagined the bus driver’s horror as he turned off the ignition with shaking hands and leapt out of the vehicle to locate my body. It would be a catastrophe that the trauma surgeons could not salvage. I would die.

Rahael Gupta is many things. She’s a graduate of Stanford University, and also Columbia. She’s a medical student. She’s a self-described optimistic. She’s a marathon runner.

And she’s a person who has struggled with depression.

michigan-med-l-med-student-depression-keyvisual

In this week’s Reading, we consider her essay in JAMA. It’s moving and clever and important.

DG

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Reading of the Week: Prazosin for PTSD & Nightmares – No Better Than Placebo? The New NEJM Paper

From the Editor

It’s like the script of a movie: a doctor seeks a treatment for the nightmares so common in vets with PTSD. He finds an old blood pressure medication that seems to work. Then, after years of use and with some money from a not-for-profit, he does the definitive study, landing a big paper in one of the biggest psychiatric journals.

Dr. Murray Raskind had explained his interest in prazosin simply – he theorized that if he calms the brains of veterans, they would have fewer nightmares. To that end, he sought a medication that would block norepinephrine and found just one antihypertensive that did that, and crossed the blood-brain barrier. And so began a 20-year interest in an old antihypertensive.

But is there a twist in the plot? A new study just published in The New England Journal of Medicine suggests yes. “This 26-week trial involving military veterans with chronic PTSD failed to show a benefit of prazosin over placebo in reducing the frequency and intensity of trauma-related nightmares.”

And, by the way, the lead author of this study is Murray Raskind.

New pill, same old problem?

In this week’s Reading, we consider the Raskind et al. study. We also consider the accompanying Editorial that calls the results: “surprising and disappointing.”

DG

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Reading of the Week: ECT in America – Uncommon, Uneven, and Underappreciated? The New Wilkinson Paper; Also, Cope’s Challenge to Corporate Canada

From the Editor

It’s difficult not to be excited about Bell Let’s Talk. Last week’s event set a fundraising record. Pause for a moment and appreciate how far we have traveled: a major Canadian corporation is promoting mental health awareness, raising millions of dollars in the process, and gathering praise from many, including the Prime Minister. The decline of stigma is seen across the west, with talk of tackling the opioid epidemic in New Hampshire, US, and of bettering psychological interventions in Hampshire, UK.

But how accessible is evidence-based care?

In the first selection, we consider a paper just published on ECT in the United States. Drawing on a massive database, the authors of this Psychiatric Services paper find ECT is used rarely and unevenly. In this Reading, we compare the American data to Canada’s – and draw a similar conclusion.

flag_map_of_the_contiguous_united_states_1912-1959A large country with many people – but not much ECT

And speaking of Bell Canada, in our second selection, we consider a Globe article on CEO George Cope’s recent Canada Club speech. In it, Cope challenges other businesses to implement a mental health strategy. “For business leaders… here’s the call-out: The numbers are self-funding. There’s no reason not to adopt a program in your company.”

DG

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Reading of the Week: AI & Mental Health – Gordon Parker Looks Ahead; Also, Remembering Ronald Fieve

From the Editor

As artificial intelligence advances, what role will computers play in mental health care?

Today, computers touch practically every aspect of our lives – from suggesting books that may be of interest to us on Amazon to helping fly our planes to tropical destinations. But will computers soon help us with diagnosing and treating our patients? Will some parts of clinical medicine be replaced or assisted by computers?

This week, we look at a new paper from Acta Psychiatrica Scandinavica considering AI and care. University of New South Wales’ Professor Gordon Parker sees a role for computers to help humans with diagnosis – but not more. “[R]ather than seeking to develop a computer program that will have diagnostic superiority to an ace clinical psychiatrist, it may be more important to develop programs that complement the psychiatrist’s judgement.”

AI: The next great doctor – or just a pretty face?

And in the second selection, we look back, not forward, and consider the career and contributions of psychiatrist Ronald R. Fieve, who recently passed. Dr. Fieve’s work helped bring lithium to North America.

DG

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