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Reading of the Week: MDMA for PTSD – the New Lancet Psychiatry Paper; Is the Club Drug Really a Breakthrough Drug?

From the Editor

“When it kicked in, it was like an epiphany. I could see all these things from combat I was afraid to look at before, and I had a totally new perspective. I relived the parts of me I had lost. I realized I had viewed myself as a monster, and I was able to start to have some compassion for myself. It was a turning point, and for the next year I continued to get better.”

In a recent article on MDMA (often called Molly or Ecstasy), The New York Times quotes U.S. Marine Nigel McCourry, who has PTSD, talking about his experience taking the drug. So – is there a role for MDMA in the treatment of PTSD? In a new paper published in The Lancet Psychiatry, researchers seem to find there is. In the study, therapy sessions were enhanced with MDMA; after the sessions, 68% of the patients no longer met the clinical criteria for PTSD.

The paper has gained international attention. The New York Times covered it (and quoted McCourry). So did Global News with an online article headlined: “‘Party drug’ MDMA touted as breakthrough therapy for PTSD patients.” The Independent’s story begins: “MDMA ‘cures’ sufferers’ post-traumatic stress disorder in a few weeks during study.”

mdma-pills-ecstasy-600x500MDMA: Colourful pills – helpful pills?

In this Reading, we consider the paper behind the headlines, and the Comment piece that accompanies it. We also consider what to tell patients if they ask about MDMA for PTSD.

DG

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Reading of the Week: Depression and Its Management — The American Journal of Psychiatry on Exercise and Long-term Use of Medication

From the Editor

It’s one of the most common and disabling illnesses. But how to treat depression in the long term?

In the first selection, we consider a paper just published by The American Journal of Psychiatry. In it, LaSalle University’s Felipe B. Schuch and his co-authors present a meta-analysis on exercise and depression. Drawing on 49 studies, they find that physical activity can protect against the development of depression, regardless of age and geographical region.

treat-alternative-exercise_an_alternative_adhd_treatment-article-3280a-man_running_sunset-ts_451886305-3Exercise: good for the heart, the lungs, and the prevention of depression?

In the second selection, Harvard University’s Roy H. Perlis writes a commentary for The American Journal of Psychiatry responding to a recent New York Times article that questioned the long-term use of antidepressants. He writes: “The informative analogy might be treatment of type 2 diabetes. While diet and exercise have a substantial impact on disease course (notably, results far more compelling than those in depression), it is hard to envision front-page articles in the New York Times about the dangers of long-term diabetes treatment.”

DG

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Reading of the Week: Suicide & the News – the New CPA Media Guidelines for Reporting on Suicide

From the Editor

“Hemingway Dead of Shotgun Wound; Wife Says He Was Cleaning Weapon.” So reads the headline from the front page of The New York Times reporting the death of author Ernest Hemingway. It quotes Frank Hewitt, the Blaine County Sheriff, who comments that the death “looks like an accident… There is no evidence of foul play.”

It is well known that writer Ernest Hemingway died by suicide – the sheriff didn’t want to say it. As we as a society discuss mental illness more and more, how do we discuss topics like suicide? For years, of course, we didn’t – or, if we did, reporting was often insensitive.

In last month’s Canadian Journal of Psychiatry, Sunnybrook Hospital’s Mark Sinyor and his co-authors, including other psychiatrists and journalists, suggest guidelines for the reporting of suicide. The effort provides an update of a past report, and includes recommendations for social media.

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In this Reading we look at the guidelines, and consider the opportunities and problems of the Twitter era.

DG

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Reading of the Week: Big Buzz, Big Impact? Considering Bell Let’s Talk and Other Awareness Campaigns

From the Editor

Bell Let’s Talk generates incredible attention. The annual effort raised almost $7 million this January, with tens of millions of social media interactions. It was praised by many, including the Prime Minister.

But do awareness campaigns like Bell’s actually result in people seeking care? And are awareness campaigns ultimately helpful? In this week’s Reading, we have two selections that consider these questions.

In the first selection, the study authors look at the Bell campaign, as well as outpatient visits for mental health, tapping Ontario databases. “The 2012 Bell Let’s Talk was temporarily associated with increases in the trends of outpatient mental health visits, especially within the adolescent female cohort.”

The second selection is an interview with Dr. Simon Wessely, one of the most prominent psychiatrists in the U.K., and the president of the Royal Society of Medicine. In a BMJ interview, he weighs in on integrating mental health and physical health services, his choice of psychiatry as a profession, and – yes – the role of awareness campaigns. “Every time we have a mental health awareness week my spirits sink. We don’t need people to be more aware. We can’t deal with the ones who already are aware.”

bell1Big campaign, big impact?

So are awareness campaigns worthwhile? You can read these selections and draw your own conclusions.

DG

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My Interview with Residents Psyche Newsletter

I did an interview with Dr. Nadia Daly, a senior resident in psychiatry, for the Residents Psyche Newsletter – a Canadian Psychiatric Association project.

We talked about important papers, my psychiatry blogging, and my favourite psychiatry-related movie (spoiler alert: I don’t have one). Dr. Daly asks good questions, and I enjoyed the opportunity.

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You can find the interview here: https://www.cpa-apc.org/residents-psyche-minutes-mentor-dr-david-gratzer/.

Reading of the Week: The Big NYT Article on Antidepressants & Withdrawal – Our Vioxx Moment?

From the Editor

“Many People Taking Antidepressants Discover They Cannot Quit.”

The New York Times. Front page. Sunday edition.

One of the most read newspapers in the world just ran a story suggesting that antidepressants may be linked to significant withdrawal symptoms. That news article is, well, news. Journalists Benedict Carey and Robert Gebeloff interview a mother of four who says, “Had I been told the risks of trying to come off this drug, I never would have started it.”

istock_000017711523xlargeAntidepressants: small pills but big problem?

This week’s Reading looks at the big article and considers its big implications.

DG

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Reading of the Week: Three Essays on Mental Illness

From the Editor

As stigma fades, we are as a society talking more and more about mental illness. And we are also writing more on the topic.

This week, the Reading features three essays that ask three provocative questions. Does naloxone access save lives? What’s it like to be depressed and in medical school? How do involuntary commitment laws affect the families of those with mental illness?

These essays are very different in part because they reflect very different perspectives on our collective experience with mental illness: the perspectives of providers, patients, and families.

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Enjoy.

DG Continue reading

Reading of the Week: Is Lithium Underrated? Preventing Rehospitalization with Bipolar – the New JAMA Psychiatry Paper

From the Editor

From the perspective of the treatment team, a rehospitalization is a failure – a patient returning to the system, unwell again. From the perspective of the patient and her or his family, a rehospitalization can be frightening and humiliating.

How best to keep people with bipolar affective disorder out of hospital? In a new JAMA Psychiatry paper, the University of Eastern Finland’s Markku Lähteenvuo and his co-authors attempt to answer this question – not by using a RCT, but instead by tapping Finnish national databases.

For the record, they find one medication works better than the others: lithium.

800px-central_hospital_of_central_finlandFinland’s Central Hospital: adequate architecture but good data

In this Reading, we consider the new paper by Lähteenvuo et al., and also consider their approach.

DG

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Reading of the Week: Early Psychosis Intervention – Lifesaver? The New Anderson Paper from the AJP; Also, Michael Weinstein’s Burnout

From the Editor

The argument is simple: intervene early and outcomes will ultimately be better.

For people with psychosis, early intervention programs have been tried for more than two decades. In our first selection, we look at a new American Journal of Psychiatry paper considering early psychosis intervention and outcomes. This paper is particularly interesting because it draws on the real-world experience – and 17 years worth of data. (Bonus: the data is Canadian.) The lead author, Western University’s Prof. Kelly K. Anderson, looks at several outcomes.

She and her co-authors conclude that patients had faster access to psychiatrists and used EDs less. More importantly: early intervention was a lifesaver, with the rate of death being four times lower than those who didn’t use the program.

caa58b79-155d-451f-6734f0c9af79d4c2Does Franklin’s comment about an ounce of prevention being worth a pound of cure apply to first episode psychosis?

And in our other selection, Dr. Michael Weinstein writes about his career as a trauma surgeon – and his depression. “I have learned that many of us suffer in silence, fearing the stigma associated with mental illness,” he observes in The New England Journal of Medicine.

Please note that there will be no Readings for the next two weeks.

DG

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Reading of the Week: Do Antidepressants Work? The New Cipriani Study

From the Editor

Last week, I spoke to a patient about antidepressants. “But do they really work?” she asked. While antidepressants are commonly prescribed, many patients wonder about them. That’s not surprising: in popular culture, these medications are often portrayed as risky and unhelpful. Just a few weeks ago, the most popular women’s fitness magazine in the world described fawningly how a woman quit her medications and felt better (“I felt more alive and in control of my emotions with each passing day”). A few years ago, a major study suggested that antidepressants basically match placebo in efficacy; 60 Minutes covered it.

And now there is the new Cipriani et al. paper. “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder…”

Is this the biggest psychiatry paper of the year? Certainly, it may be one of the most impressive. It took six years of effort. Oxford University’s Andrea Cipriani and his co-authors drew from all available data – published and unpublished, and covering more than 500 trials.

The media coverage has been incredible. The Guardian summarized the paper with the first two words of its article: “Antidepressants work.”

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In this Reading, we look at the big study and mull the big implications.

DG

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