MonthNovember 2021

Reading of the Week: Lithium – Anti-Suicidal Qualities? Also, Dr. Tim Graham on His Illness & Recovery (CMAJ)

From the Editor

Our patients complain about the hand tremor. Some feel fatigued when they take this medication. And toxicity is always a risk.

Lithium, in other words, is tough to work with – the Callas or Pavarotti of psychotropic medications, if you will. And yet, it’s arguably the best mood stabilizer, helping people with bipolar get back their lives. Some have gone so far as to claim that all of us should take a little lithium.

Among the purported benefits of lithium: anti-suicidal effects. But does this medication really help our suicidal patients? In a new paper, Dr. Ira R. Katz (of the University of Pennsylvania) and his co-authors ask this question, armed with an impressive dataset. In a JAMA Psychiatry paper, they report the findings of a double-blinded, placebo-controlled randomized clinical trial. “The addition of lithium to usual Veterans Affairs mental health care did not reduce the incidence of suicide-related events in veterans with major depression or bipolar disorders who experienced a recent suicide event.” We consider the paper and its clinical implications.

photo-1567693528052-e213227086bbLithium: the psychotropic that’s as old as the earth

In the second selection, Dr. Tim Graham (of the University of Alberta) writes about his training and work as an ED physician, and his burnout. In a raw, highly personal essay for CMAJ, he speaks about his suicidal thoughts – and the decision to get help. He writes: “If you die tomorrow, your employer will replace you, but your loved ones cannot.” Dr. Graham also offers some practical suggestions for staying well.

DG

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Reading of the Week: Plant-based Medicines – What’s the Evidence? Also, Wearables, New Technologies & Mental Health Care (Quick Takes)

From the Editor

Kava. Ginkgo. St John’s wort.

These plant-based medicines (or phytoceuticals) have gained popularity in recent years. Patients ask about them; in some pharmacies, they are now sold prominently and side by side with other products; celebrities talk up their helpfulness. Plant-based medicines are having a moment.

But what’s the evidence? In the first selection, Jerome Sarris (of the Western Sydney University) and his co-authors consider phytoceuticals for psychiatric disorders in a new Canadian Journal of Psychiatry paper. They draw on meta-analyses of RCTs reporting on the efficacy and effectiveness of these medicines. What did they find? “This ‘meta-synthesis’ of the data from 9 meta-analyses showed positive findings for a variety of plant-based medicines in a range of psychiatric disorders, albeit limited by the quality of source data.” We consider the big paper and its clinical implications.

6900b40570a828ff1775d282eb2605e6St. John’s wort – pretty flower, but evidenced?

In this week’s second selection, we look at wearables and new technologies. Dr. John Torous (of Harvard University) joins me for a Quick Takes podcast interview. We discuss their potential for mental health care including how data captured on devices (especially data related to sleep and exercise) can potentially improve care – and overall health. “Could we be using the step count on a patient’s phone for mental health? Could we transform GPS into something like studying green space to learn about its impact on mental health?” And, yes, we do talk about Star Wars.

DG

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Reading of the Week: Dr. Ari Zaretsky on the Life & Legacy of Dr. Aaron Beck

From the Editor 

The fourth child of Russian Jewish immigrants. A Yale medicine graduate. A snappy dresser who loved bow ties.  

Dr. Aaron Beck, who died last week at the age of 100, was also a psychiatrist who significantly changed the way we treat patients and learn to treat themToday, millions have broken the shackles of mood and anxiety problems by using cognitive behavioural therapy; residents of psychiatry learn about the Beck’s Cognitive Triad as a core part of their training.  

aaron_beck_2016Dr. Aaron Beck 

I asked Dr. Ari Zaretskythe Psychiatrist-in-Chief and Vice President Education of the Sunnybrook Health Sciences Centre, to write about him – his work and legacy. In his essay, Dr. Zaretsky notes: His life story is that of a former psychoanalyst who rejected the dogmatism of mainstream Freudian psychoanalysis during the 1950s and 1960s and in doing so permanently changed the paradigm and transformed psychotherapy.” 

For those who wish to read more about Dr. Beck, I’ve included links, including to The New York Times obituary.  

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Reading of the Week: Measurement-based Care – What’s the Evidence? Also, Goldbloom on the Joy of Jabbing

From the Editor

Well, he looks better.

So often our conversations about patients – in our emergency rooms, wards, and clinics – focus on soft evidence of improvement. No wonder: psychiatry lacks biomarkers. And so, while our colleagues in medicine talk about blood sugars and white blood cell counts, we often discuss other things, like how our patients look and sound.

The promise of measurement-based care: objective evidence of change (or lack thereof). The idea is having a moment, with more and more interest. But what does the literature say?

In the first selection, Maria Zhu (of the University of British Columbia) and her colleagues consider RCTs. In a systematic review and meta-analysis, they look at the efficacy of measurement-based care for depressive disorders. They conclude: “Although benefits for clinical response are unclear, MBC is effective in decreasing depression severity, promoting remission, and improving medication adherence in patients with depressive disorders treated with pharmacotherapy. The results are limited by the small number of included trials, high risk of bias, and significant study heterogeneity.” We discuss the big paper.

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The pandemic has changed much with day-to-day practice, including with the rapid virtualization of mental health care. Remember a time when you didn’t need to talk about “being on mute?” And some psychiatrists have been on the front lines of the vaccine effort. In the second selection, Dr. David Goldbloom (of the University of Toronto) writes about his experiences working in a vaccine clinic. His Toronto Lifeessay details the YouTube video he watched to remind himself of how to administer shots, his family ties to vaccinations, and his fondness for the work. “I will always be grateful to have experienced the joy of jabbing.”

DG

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