Tagdepression

Reading of the Week: Depression, Pills & Adherence – the Sirey et al. Study on Improving Depression Treatment

From the Editor

The patient is depressed. The doctor has prescribed medications. But the patient doesn’t take them.

As a clinician, this scenario is too familiar with results that are too familiar – the patient doesn’t get better. What can we do to improve adherence?

In this week’s selection, we look at a new paper by Weil Cornell Medicine’s Jo Anne Sirey et al., considering this question. The authors do a randomized controlled trial with “a brief psychosocial intervention designed to improve adherence to pharmacotherapy for patients with depression.” So, is this intervention a game-changer? The authors find a five-fold increase in adherence during the first 6 weeks of care – but not much change in overall depressive symptoms.

153745515Pretty pill bottle: But how can we get patients to take the pills?

In this Reading, we review the paper.

DG

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Reading of the Week: Stressed & Expensive – the Chiu et al. Study on the Health-Care Costs of Distress and Depression

From the Editor

He isn’t able to work. He often can’t get out of bed. His partner is beside herself. And his diabetic management is poor.

He’s the sort of patient who we see often – in specialist offices (like mine) and in family medicine clinics, and also in emergency departments and on hospital wards. His depression is affecting his life, his family, his workplace – and, yes, his health. Here’s a quick question: how much higher are his health-care costs than those who don’t struggle with depression?

In this week’s selection, we look at a new paper by Maria Chiu et al., considering the costs of depression and distress.

business-comment_01_temp-1382010303-525fcdbf-620x348Distress and depression: Painful to patients – and costly to the system?

In this Reading, we review the paper, and consider the larger context.

DG

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Reading of the Week: ECT and Inpatients – An Underused Tool?

From the Editor

It’s a powerful tool that helps people with refractory depression and other illnesses.

It’s a treatment that carries a heavy stigma, and is used less today than even a decade ago.

Both statements describe electroconvulsive therapy (or ECT) – perhaps the most controversial intervention in psychiatry. And while it has been studied for decades, little work has been done considering the impact of ECT on inpatient readmissions. In this week’s Reading, we look at a new JAMA Psychiatry paper that studies ECT and readmissions.

Spoiler alert: the study authors found it decreased readmits.

Electroconvulsive therapy at Winwick Hospital in 1957: relevant then as now?

The paper begs a larger question: is an important tool in the treatment of those with mental illness being underutilized as newer (and less effective) treatments are chosen?

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Reading of the Week: Is ‘New’ Overrated? Antipsychotics in the Real World

From the Editor

Is new better?

You may be reading this on an iPhone 7, having driven to work this morning in a 2017 Hybrid Prius. So should your patients be taking a medication that became available four-and-a-half decades ago – when people drove gus-gusling eight-cylinder Oldsmobiles and smartphones didn’t even exist in science fiction novels.

This week, we look at a just-published JAMA Psychiatry paper which promises to look at the “real-world” effectiveness of antipsychotics. The authors tapped Swedish databases to consider outcomes for nearly thirty thousand people with schizophrenia.

Sweden: elaborate welfare state, beautiful historic buildings, and – yes – rich databases

Spoiler alert: new wasn’t better. That is, newer antipsychotics tended to underperform clozapine and depot medications.

We also look at similar “real-world” work drawing from a Finnish database considering treatment of depression.

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Reading of the Week: Technology & Mental Health – Depression and Internet-based CBT; Also, Finnish e-Therapy

From the Editor

VR. e-therapies.

New technology is changing the way we think about the delivery of psychiatric services. But new isn’t necessarily better. Can care really be transformed? What does the literature say?computere-therapy: more than clever pictures of computers and stethoscopes?

In a two-part Reading of the Week, we look at technology and psychiatry.

Last week, Virtual Reality.

This week, e-therapies.

This week, we consider a new paper that has just been published. Its looks at self-guided Internet-based CBT showing that for every eight people treated, one benefits (consider this in the context of minimal cost).

And, in the other selection, we look at the Finnish experience with Internet-based CBT.

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Reading of the Week: Breaking the Stigma – Dr. Adam B. Hill on his Depression and Addiction

From the Editor

“My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic.”

So begins this week’s selection, which is an essay written with remarkable candor and honesty.

1docDiscussing what we should discuss

In this Reading, Dr. Adam Hill writes in The New England Journal of Medicine about his struggle with mental illness.

It is moving and important.

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Reading of the Week: Can a Fake Intervention Help Real Pain? Also, Preventing Depression

From the Editor 

“To a degree which has never been suspected, what powerful influence upon diseases is produced by mere imagination.” British physician John Haygarth wrote those words more than two centuries ago when considering the placebo effect.

Is it possible to successfully treat people with placebo in an open-label trial? That is, if people know they are taking placebo, will they still experience the benefit of placebo?

painCan a fake intervention help real pain?

In this week’s selection, we look at a new study where participants were offered placebo for back pain. Spoiler alert: it worked.

And, in a new feature for the Reading of the Week, we include an invited letter to the editor from Dr. Albert H. C. Wong who writes about the best way of preventing depression.

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Reading of the Week: Mood & Anxiety in Four Countries – More Care, Better Outcomes? The Jorm et al. Paper

From the Editor

Earlier this month, the Commonwealth Fund released a report that surveyed 11 countries for the performance of their health-care systems; it received much media attention. Their work helps provide perspective on our system’s strengths and weaknesses.

International comparisons are relevant in mental health, of course. As stigma fades and as evidence-based treatment options have expanded, we can ask: are people with common mental health problems getting better? And are there lessons to learn from our national experiences?

Four countries, one big problem?

This week, we look at a study that has just been published in World Psychiatry, drawing data from four countries. In the paper, Jorm et al. find that – looking at the prevalence of mood and anxiety disorders and symptoms – people aren’t better off today. The authors consider several explanations.

This paper hasn’t gather much attention here in Canada. But as we look to increase funding for mental health services, it’s an important and relevant paper.

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Reading of the Week: Can We Predict Relapse in Depression? The Judd et al. Paper from The American Journal of Psychiatry

From the Editor

Is he going to get sick again?

It’s a question that we often ask when a patient overcomes depression and happily leaves our office. For many patients, depression is a chronic illness – and so, remission is followed by relapse. Is it possible to predict patients with depression who are in remission but at risk of relapse?

Can we predict a future relapse – or is this an exercise in fortune-telling?

This week’s Reading is a paper from The American Journal of Psychiatry. Drawing on a long-term study, they look at the pattern of acute illness, remission, and relapse. Using statistical analyses, the authors seek to find a way of predicting relapse.

Spoiler alert: they do.

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Reading of the Week: The New CANMAT Guidelines for Depression

From the Editor

What’s new in depression treatment?

The new guidelines

This week, we look at the new CANMAT guidelines. Published in September in The Canadian Journal of Psychiatry, the papers – six in all – speak to the latest in depression management.

What should you think about the new antidepressants? What alternatives are there to CBT? What to do when everything else fails? Spoiler alert: this week’s Reading answers all these questions and more.

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