MonthApril 2021

Reading of the Week: Psilocybin for Depression – The New NEJM Paper

From the Editor

Is this the breakthrough we have been waiting for?

This week, we look at the new study from The New England Journal of Medicine considering psilocybin (a naturally occurring psychedelic compound found in some mushrooms) and escitalopram for depression. The paper, written by Robin Carhart-Harris (of Imperial College) and his co-authors, has received much attention. One online news source quipped: “Tripping may be as effective as your antidepressants.”

In this study, psilocybin was compared to the SSRI with a double-blind, randomized, controlled trial. Carhart-Harris et al. find: “On the basis of the change in depression scores on the QIDS-SR-16 at week 6, this trial did not show a significant difference in antidepressant effects between psilocybin and escitalopram in a selected group of patients.”

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We consider the paper and the editorial that runs with it by Dr. Jeffrey A. Lieberman (of Columbia University). We also ask Dr. Ishrat Husain (of the University of Toronto) for his thoughts. Finally, we mention other cutting-edge treatments.

DG

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Reading of the Week: Aromatherapy for Insomnia? Also, Ramadan and Mental Health and Responding to Vaccine History

From the Editor

“Sleep is one of the indispensable needs of human beings and is essential for maintaining physical and mental health.”

So writes Yueheng Tang (of the Huazhong University of Science and Technology) and co-authors in a new paper on insomnia. That topic is always relevant; with a third wave and the ongoing stresses of the pandemic, more people than ever seem to be struggling with insomnia. In the past few weeks, I’ve received a flurry of questions from patients and non-patients about remedies for insomnia.

What to make of aromatherapy? It’s trendy – but is it evidence based? In a new paper for the Journal of Affective Disorders, Tang et al. consider aromatherapy which “has a long history in China, and it has been used to strengthen the body and treat diseases since ancient times.” They conduct a meta-analysis, drawing on sixteen articles. They find: “Aromatherapy has a significant effect on improving sleep quality.” We consider the paper and ask: should we recommend this to our patients?

aromatherapy

In the second selection, we look at a new podcast that explores Ramadan and its clinical implications. In this Quick Takes episode, I’m joined by Drs. Juveria Zaheer and Zainab Furqan (both of the University of Toronto). They discuss fasting, mental disorders, and offer some suggestions. For example, with drug regiments: “if a medication is dosed twice daily, we can ask if it can be given safely during the interval when the interval between doses is shortened? So can we give it then in the evening or at dawn and then at sunset again? Or can we give it as one dose? And we need to think about the side effects of the medication.”

Finally, in our third selection, a reader writes us. Dr. Suze G. Berkhout (of the University of Toronto) responds to the paper by Drs. Angela Desmond and Paul A. Offit considering the history of vaccines. “The story the authors tell is history as it is written by the victors: emphasizing the hard work and successes of scientists, while failing to acknowledge the ways in which vaccine technologies have also been part of an exclusionary politics of biomedicine.”

Note that there will be no Reading next week.

DG

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Reading of the Week: A Therapy for Pandemic Loneliness? Also, Getting Digital Psychiatry Right (Lancet Psych) and the History of Vaccines (NEJM)

From the Editor

I saw an older patient in the emergency room recently. He described feeling overwhelmed. Fearful of the pandemic, he explained that he had rarely left his apartment since it began. “I’m so isolated.”

Many find themselves in a similar situation. What could help? In a new JAMA Psychiatry paper, Maninder K. Kahlon (of The University of Texas at Austin) and co-authors describe a focused intervention involving laypeople doing an empathy-focused program by phone. Do the calls work? They found it reduced loneliness, anxiety, and depression. They note the potential: “The use of lay callers, deliberate but brief approach on training, and the use of ubiquitous telephones made the approach easily deployable and scalable.”

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In an editorial, The Lancet Psychiatry considers our digital moment. Though they note the trendiness of the idea of digital psychiatry, they urge us to push: “Come 2 years or 20, we want to stop talking about digital psychiatry’s potential for improving public mental health and start marking its clear clinical progress.”

Finally, in our third selection, we look at a new paper from The New England Journal of Medicine. Drs. Angela Desmond and Paul A. Offit (both of the University of Pennsylvania) consider the history of vaccines, and look ahead: “With the recent authorization of mRNA vaccines, we have entered the fifth era of vaccinology.”

Please note that there will be no Reading next week.

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On a pivot –

Since 2014, the Reading of the Week has been providing summaries and commentary on the latest in the psychiatric literature. Two years ago, we conducted a short survey to get your feedback. We are hoping to get feedback again to improve the Readings.

We would like to invite you to join one of our online focus groups to hear your opinions and suggestions. If you are interested in participating, please email smit.mistry@camh.ca by April 12 with your preferred time slots from the following options – psychiatrists: April 21 at 4 pm or April 22 at 4 pm; residents: April 28 at 4 pm and April 29 at 4 pm. (Note: all times are in EST.) Time commitment: under an hour. If the above time slots do not work for you, please email Smit to arrange an interview time at your convenience, preferably between April 21 and April 30, 2021.

DG

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