MonthJune 2022

Reading of the Week: Cannabis for Mood Disorders – the New CJP Paper; Also, Dr. Insel on Mental Health (QT) and Transgender Adolescents & Suicidality (CMAJ)

From the Editor

He smokes before bed to help with sleep; she finds that the edibles take an edge off from her lows.

Our patients routinely tell us about the benefits of cannabis for mood disorders. But is there any evidence in the literature? In the first selection from The Canadian Journal of Psychiatry, Dr. Smadar V. Tourjman (of the Université de Montréal) and her co-authors consider that question with a systematic review, drawing on data from 56 studies, focused on bipolar and major depressive disorders, for a CANMAT task force report. They conclude: “cannabis use is associated with worsened course and functioning of bipolar disorder and major depressive disorder.” We consider the paper and its implications.

In this week’s second selection, we look at new Quick Takes podcast interview with Dr. Thomas Insel (of the Steinberg Institute). Dr. Insel, a psychiatrist and former director of NIMH, speaks about the progress in neuroscience but the need for mental health reform. “We must think about more than just the classic medical model borrowed from infectious disease: simple bug, simple drug.”

Finally, in the third selection, Mila Kingsbury (of the University of Ottawa) and her co-authors consider the risk of suicidality among trangender and sexual minority adolescents; they draw from a nationally representative, cross-sectional survey. “Gender and sexual minority adolescents, particularly those who identify as transgender and gender-nonconforming, appear to be at greater risk of suicidal ideation and suicide attempt than their cisgender and heterosexual peers.”

There will be no Reading next week.

DG

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Reading of the Week: Mental Health Literacy & Skills for Students – the New CJP Paper; Also, Benzodiazepine Use and the Latest Mental Health Headlines

From the Editor

Postsecondary education can be incredibly stressful for students – and, not surprisingly, mental health problems may surface. Is it possible to inform (and thus empower) students with a simple intervention?

In the first selection, Yifeng Wei (of the University of Alberta) and her co-authors consider a trial of Transitions, a program that includes both mental health literacy and comprehensive life skills resources “for those transitioning from secondary to postsecondary education.” In a new Canadian Journal of Psychiatry paper, they describe a study involving nearly 2 400 students across five institutions. “Students in the intervention significantly improved mental health knowledge, decreased stigma against mental illness, increased positive attitudes toward help-seeking, improved help-seeking behaviours, and decreased perceived stress compared to the control group.” We review the paper.

Beautiful campus – and a place to reduce stigma?

In the second selection, Christine Timko (of Stanford University) and her co-authors consider benzodiazepine use. In a new Psychiatric Services paper, they note: “This study’s findings suggest that challenges remain in discontinuing long-term benzodiazepine use among patients who are older than 45 years, White, taking higher doses for longer, and diagnosed as having anxiety, PTSD, bipolar disorder, or psychosis.”

And finally, in a new section, we consider some recent news items relevant to those of us in mental health care. Our aim: not simply to draw from interesting reports, but to include those that our patients may read and bring up. This week: the focus (and TikTok videos) on the vagus nerve, the Freud who hated Freud, and ADHD in adults.

DG

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Reading of the Week: No Better Than Placebo? Debating Antidepressants and ECT, with Papers from Psychological Medicine

From the Editor

Antidepressants don’t work. Medications fail to address the real cause of depression. ECT is basically a placebo.

These statements are controversial, but they are mentioned often – including by some of our patients. But what does the literature say about depression management? This week, we look at the debate over antidepressants and ECT, drawing on two recent papers from Psychological Medicine.

In the first selection, John Read (of the University of East London) and Dr. Joanna Moncrieff (of University College) argue that our approach to depression is flawed. In a longer paper that draws on more than 120 references, they challenge basic assumptions about mental health care, arguing against antidepressants and ECT. They advocate for an alternative: “Understanding depression and anxiety as emotional reactions to life circumstances, rather than the manifestations of supposed brain pathology, demands a combination of political action and common sense.”

Were Ali and Frazier having a fight over depression management?

In the other selection, Dr. Carmine M. Pariante (of the King’s College London) agrees to disagree. In a Psychological Medicine paper, he responds. “I have written a piece that tries to put together their point of view with the available evidence, while acknowledging the complexity of the debate.” 

DG

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Reading of the Week: Suicide & Physicians – the New CJP Paper; Also, Cannabis and Psychiatry (BJP) and Tom Insel on Mental Health Care (Atlantic)

From the Editor

Despite what we may wish to believe, physicians are mortal. We can develop illnesses – even mental disorders. And some (too many) suicide. Past studies have shown that doctors die by suicide more than the general population. But the data wasn’t Canadian.

In the first selection, Dr. Manish M. Sood (of the University of Ottawa) and his co-authors consider suicide by Canadian physicians. In a new Canadian Journal of Psychiatry paper, they do a population-based, retrospective cohort study drawing on more than a decade and a half of data. They write: “Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians.” We look at the paper.

In the second selection, Dr. Julia Jiyeon Woo (of McMaster University) and her co-authors review cannabis from the perspectives of clinicians and patients. In a new British Journal of Psychiatry paper, they note: “This growing discrepancy between clinicians’ and patients’ perspectives on cannabinoids can be extremely damaging to the therapeutic alliance.” They offer practical suggestions.

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) considers what’s right and what’s wrong with mental health care. As the director of NIMH, he oversaw $20 billion of funding; in his new book, excerpted in the pages of The Atlantic, he calls for mental health reform. He writes: “There are only two kinds of families in America: those who are struggling with mental illness and those who are not struggling with mental illness yet. To ensure that we serve all families well, we don’t necessarily need to know more to do better.”

DG

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