TagThe New York Times

Reading of the Week: Perceived Helpfulness of Depression Treatment – the New JAMA Psych Paper; Also, Friedman on Boredom & the Pandemic (NYT)

From the Editor

How helpful do people find treatment for depression?

This question is broad but new work (drawing on WHO surveys) ambitiously attempts to answer it across different countries, including some that are low income.

In the first selection, we consider a paper from JAMA Psychiatry. Meredith G. Harris (of The University of Queensland) and her co-authors report on WHO data. The good news? Many people do find treatment for depression helpful. The bad news? Many providers are needed for people to believe that they had received helpful treatment.

4anvfzqDepression treatment: helpful, like a lift from a friend?

In the second selection, we look at a new essay by Dr. Richard A. Friedman (of Weill Cornell Medical College). Writing in The New York Times, he discusses the pandemic and the possibility of “a mental health epidemic of depression and anxiety.” Dr. Friedman argues that we are seeing mass boredom, not a rise in disorders like depression. While he can’t fully rule out that the pandemic will bring about an increase in mental health problems, he writes: “let’s not medicalize everyday stress.”

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Reading of the Week: Depression Outcomes: What Matters to Patients (Lancet Psych)? Also, NYT on Mental Health Apps and Startup Culture

From the Editor

“US Food and Drug Administration accepts only three outcome measures as primary endpoints in phase 3 studies to support an indication for major depressive disorder: the Hamilton Depression Rating Scale, the Montgomery-Åsberg Depression Rating Scale, or the Children’s Depression Rating Scale.”

The editors of The Lancet Psychiatry make this point in in the August issue of that journal. Their concern: the FDA view is very narrow and confined to these three scales.

In the first selection, we look at a new paper from The Lancet Psychiatry. Dr. Astrid Chevance (of the Center for Epidemiology and Statistics Paris Sorbonne) and her co-authors consider depression outcomes. To understand different perspectives, they draw on three groups: providers, patients, and caregivers. For the record, the resulting paper is fascinating and includes outcome measures that aren’t captured by these three scales. We consider the paper and the editorial that runs with it.

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In the second selection – also on the topic of depression – Kashmir Hill and Aaron Krolik report for The New York Times on a popular therapy app. They note that Talkspace has good marketing and a growing client base. But should you recommend the app to your patients?

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Reading of the Week: Can Light Therapy Help with Bipolar Depression? Also, the Racism of COVID (BJP) & Gottlieb on the Toilet as the New Couch (NYT)

From the Editor

After his manic episode, the first patient I treated with bipolar disorder was low in mood for months, able to get out of bed, but not able to work. I remember him sitting in my office talking about feeling overwhelmed. For many people with bipolar disorder, the depressive episodes are long and debilitating. And for us clinicians, these episodes are difficult to treat. (I remember feeling overwhelmed, too.)

Can light therapy help?

The first selection seeks to answer that question. Light therapy, after all, has shown its utility in depression, including for those with a seasonal pattern to their lows. But bipolar depression? In a new Canadian Journal of Psychiatry paper, Dr. Raymond W. Lam (of UBC) and his co-authors do a systematic review and meta-analysis. They included seven papers. “This meta-analysis of RCTs found positive but nonconclusive evidence that light therapy is efficacious and well tolerated as adjunctive treatment for depressive episodes in patients with BD.”

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Is the virus racist? In the second selection, we look at a provocative paper from The British Journal of Psychiatry written by Drs. Anuj Kapilashrami and Kamaldeep Bhui (both of Queen Mary University of London). Considering how COVID-19 affects certain groups more than others, they also note that mental illness is more common among minorities, and they argue that: “societal structures and disadvantage generate and can escalate inequalities in crises.” They offer a word of caution: “What is surprising is it takes a crisis to highlight these inequalities and for us to take note, only to revert to the status quo once the crisis is over. ”

Finally, we consider an essay from The New York Times. Lori Gottlieb, a psychotherapist, discusses her practice in a world of pandemic. “Suddenly, her sobs were drowned out by a loud whooshing sound.” She wonders if the toilet is the new couch.

DG

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Reading of the Week: COVID & Suicide (JAMA Psych); also, Digital Mental Health (JMIR) and Solomon on COVID & Depression (NYT)

From the Editor

Will suicide rates rise with COVID? How will mental health care delivery change? Are we overlooking the most vulnerable?

This week’s Reading will focus on the latest in the literature on the COVID and mental health care, with three selections.

In the first, we consider a paper on COVID and suicide. In a JAMA Psychiatry paper, Mark A. Reger (of University of Washington) and his co-authors consider the impact of the global emergency on suicide. They are practical, and explain that there are clear opportunities for suicide prevention. In responding to COVID, they call for a “comprehensive approach that considers multiple US public health priorities, including suicide prevention.”

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What is the role of digital mental health during and after this pandemic? In the second selection, we consider a new JMIR Mental Health paper. Dr. John Torous (of Harvard University) and his co-authors note the greater use of telemental health, apps, and other forms of e-mental health care. They write: “The COVID-19 crisis and global pandemic may be the defining moment for digital mental health, but what that definition will be remains unknown.”

Finally, in the third selection, we look at an essay by Andrew Solomon. The Pulitzer Prize-finalist author discusses pandemic and mental health, worrying that those in need may be overlooked. “When everyone else is experiencing depression and anxiety, real, clinical mental illness can get erased.”

DG

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Reading of the Week: Exposure to COVID & Mental Health (JAMA Netw Open); Also, the Psych Impact of Quarantine (Lancet) and Inspiring Docs (NYT)

From the Editor

We read often about the physical health effects of COVID. But how does this pandemic affect mental health?

This week’s Reading has three selections, with two focused on this question.

In the first selection, we consider the psychological effects of COVID on health care workers. In a new JAMA Network Open paper, Jianbo Lai (of Zhejiang University School of Medicine) and co-authors look at mental health outcomes and the factors associated with them in China. “Among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.”

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During this pandemic, many Canadians are self-isolating; in the coming weeks, many could be quarantined. In the second selection, we consider a new Lancet paper on quarantine and its psychological impact. Samantha K. Brooks (of King’s College London) and her co-authors write: “Given the developing situation with coronavirus, policy makers urgently need evidence synthesis to produce guidance for the public. In circumstances such as these, rapid reviews are recommended by WHO.”

Finally, in the third selection, we look at a NYT essay by Dr. Donald Berwick (of Harvard Medical School). He discusses the way health care providers have risen to the challenge of COVID. “We are witnessing professionalism in its highest form, skilled people putting the interests of those they serve above their own interests.”

DG

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Reading of the Week: Innovation & Pandemics (NEJM); Also, Telemental Health & Practice (QuickTakes) and Scott on Isolation (NYT)

 

From the Editor

After a short break, the Readings are back. And the world has changed over these past weeks.

We are all dealing with the stress of the pandemic, both at home and at work. I spoke recently with a physician who is a young mother, and she talked about balancing her different obligations, and working to keep her patients and family safe.

These are challenging times.

I want to acknowledge the frustration that we all have, particularly the PGY5s, who are so close to completing their studies but have had their Royal College examination postponed. It’s a tough moment for our young colleagues. But I have a few grey hairs, and have seen tough moments come and go – and I believe that things will work out just fine.

This week’s Reading includes three selections.

In the first selection, we consider innovation in the age of pandemic, with a new NEJM paper by Drs. Judd E. Hollander (of Thomas Jefferson University) and Brendan G. Carr (of Sinai). They discuss telemedicine and COVID. “Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients.”

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Then, we take a practical turn. Many of us clinicians use telemental health; with COVID, many more are thinking about taking the virtual care plunge. In the second selection, we consider a new podcast discussing telemental health. I talk with Dr. Allison Crawford of the University of Toronto. And, yes, she has tips on how to up your virtual care game. And to those thinking about using telemental health, she offers simple advice: “Do it. Try it.”

Finally, in the third selection, we look at a NYT essay by an astronaut. Thinking about his time and isolation in space, Scott Kelly provides some clever advice. “I’ve found that most problems aren’t rocket science, but when they are rocket science, you should ask a rocket scientist.”

DG

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Reading of the Week: Social Media & Youth Mental Health – the New CMAJ Paper; Also, Antonetta and Her Illness (NYT)

From the Editor

Politicians tout their opinions on social media. Celebrities use it to tell us about their lives. And for everything from cute kid pics to debates over big issues, social media is part of our way of communicating with the world.

But what are the implications to the mental health of adolescents? Many have an opinion, but what can we glean from the literature? This week, we have a couple of selections. In the first and main selection, we look at a review paper from CMAJ. Dr. Elia Abi-Jaoude (University of Toronto) and his co-authors consider the literature on social media. Then, pulling the different studies together, they offer some clinical advice.

social_media_picSocial media: many options, many problems?

In the second selection, we look at an essay by author Susanne Antonetta. She discusses her psychosis and recovery. “There’s difference between psychosis and physical ailments: In the case of psychosis, no one is likely to stop by with a casserole.”

DG

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Reading of the Week: More Sleep, Fewer Suicidal Thoughts? New AJP Paper; Also, Is Depression like Cancer (NYT)? Admissions & Ethnic Minorities (EPS)

From the Editor

Can a sleep intervention reduce suicidal thoughts in those with depression and insomnia?

When seeing people with depression, we often tend to focus on the Big Problem: that is, the major depressive disorder itself. But should we also consider trying to provide early symptomatic relief, with, say, a sleep medication?

In the first selection, we look at a new paper from The American Journal of Psychiatry. Dr. William V. McCall of the Medical College of Georgia at Augusta University and his co-authors write about the REST-IT study, a randomized controlled trial of zolpidem-CR for those with MDD and insomnia. “The results do not support the routine prescription of hypnotic medication for mitigating suicidal ideation in all depressed outpatients with insomnia…”

sleeping-babySleeping Like a Baby: Fewer Suicidal Thoughts?

In the second selection, the University of Western Ontario’s Rebecca Rodrigues and her co-authors consider involuntary psychiatric admissions and ethnic minority groups in the context of early psychosis. Spoiler alert: “African and Caribbean groups were the most likely to experience an involuntary admission…”

And in the third selection, phyisician Jill Halper wonders: is depression like cancer? “My rabbi said that my husband, like a dying cancer patient, had been in hospice care. We just didn’t realize it.”

DG

 

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Reading of the Week: Postsecondary Students & Mental Illness (CJP), a New Podcast (CAMH), and Bipolar & Social Media (NYT)

From the Editor

Social media. An uncertain job market. Increasing academic demands.

Is life for our postsecondary students harder than ever? And are we seeing a surge in mental health disorders as a result?

In the first selection, we consider a new Canadian Journal of Psychiatry paper on postsecondary education and mental illness. While many have opinions on this topic, the University of Toronto’s Kathryn Wiens and her co-authors seek to add data to the discussion. Drawing on the Canadian Community Health Survey, they find: “The results do not imply the emergence of a mental health crisis among postsecondary students.”

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In the second selection, we look at a new podcast considering technology and education. I interview some accomplished educators, including the University of Toronto’s David Goldbloom. “This is about challenging our own norms, values and expectations as clinicians.”

And in the final selection, we consider a New York Times essay on bipolar and social media. “Facebook snitched our big family secret: Roland, the literary prodigy, the tenderhearted musician, the Ivy League grad, was bipolar.”

DG

 

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Reading of the Week: PTSD – More Common in High-Income Countries? The New BJP Open Paper; Also, the Trauma of 911 & Torrey on His Sister

From the Editor

Is there more PTSD in countries like Norway and Canada?

The question seems odd since we typically don’t associate major mental illness with affluence (though, of course, not everyone in an affluent society is affluent). Yet there is a literature suggesting that high-income countries may have more PTSD.

This week, we look at a new paper on the topic. The University of Oslo’s Trond Heir and co-authors consider PTSD in Norway. Drawing on a survey, they find significant rates of PTSD, higher than found in low-income countries. “A possible explanation may be that high expectations for a risk-free life or a happy life can lead to a low threshold for perceiving adverse events as life-threatening or as violating integrity.”

norway-aurlands-fjordenNorway: High incomes, universal health care, many fiords, and more PTSD?

In the next selection and continuing on the topic of PTSD, New York Times reporter James Barron writes about the other victims of September 11 – those who survived, but have struggled with PTSD. As a Long Island clinician notes: “So many suffer in silence. It’s 18 years later, and to some it’s pretty new.”

And in the third selection, Dr. E. Fuller Torrey, a psychiatrist and accomplished researcher, considers his career. He notes that his sister’s psychosis pushed him to choose psychiatry, though he had originally planned to be a family doc.

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