Month: June 2023

Reading of the Week: Xylazine – the New NEJM Paper; Also, Probiotics for Depression (JAMA Psych) and the New Drug Crisis (Nat Affairs)

June 29, 2023 /

From the Editor

Is xylazine the new fentanyl?

In the first selection, Dr. Rahul Gupta (of the University of Pennsylvania), who serves as the US Director of National Drug Control Policy, and his co-authors write about xylazine in The New England Journal of Medicine. They describe the emergence of this medication, intended for veterinarian uses, as a substance of abuse. They note its presentation and ask research questions. “Our goal is for the designation of xylazine as an emerging threat and subsequent actions to begin to address this threat before it worsens and undermines efforts to reduce illicit fentanyl use in the United States.” We consider the paper and its implications.

In the second selection, from JAMA Psychiatry, Viktoriya L. Nikolova (of King’s College London) and her co-authors look at probiotics – an area of increasing interest for those with mood and anxiety problems. They report on the findings of a small RCT involving people with depression who took an antidepressant but had an incomplete response. “The acceptability, tolerability, and estimated effect sizes on key clinical outcomes are promising and encourage further investigation of probiotics as add-on treatment for people with MDD in a definitive efficacy trial.”

And in the third selection, Charles Fain Lehman (of the Manhattan Institute) comments on the new drug crisis in a long essay for National Affairs. Lehman notes the rise of the synthetic agents (think fentanyl replacing heroin) and its impact on people, particularly in terms of overdoses. “Today’s drug cycle is different from previous ones, measured not just in the number of people addicted, but the number dead. Reducing the growth of that figure, now more than ever, is a vital task for policymakers to undertake.”

DG

Continue reading

Reading of the Week: IPT for Depression in Pregnancy – the New JAMA Psych Paper; Also, Treating Opioid Use (JAMA) and Substance Ed for Docs (Wash Post)

June 22, 2023 /

From the Editor

Prenatal depression affects two: the mother and her fetus. But how to effectively address depressive symptoms?

In the first selection, from JAMA Psychiatry, Benjamin L. Hankin (of the University of Illinois at Urbana-Champaign) and his co-authors consider a focused psychotherapy for that population. In a RCT involving 234 participants, they find that IPT was helpful. “Brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC [enhanced usual care] among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics.” We look at the paper and its clinical implications.

In the second selection, Caroline King (of the Oregon Health & Science University) and her co-authors consider buprenorphine for opioid use disorder with a focus on adolescent residential treatment. In a JAMA research letter, they report the findings which included every identified facility in the United States. “In contrast to the standard of care, only 1 in 4 US facilities offered buprenorphine and 1 in 8 offered buprenorphine for ongoing treatment.”

And, in the third selection, former AMA president Dr. Patrice A. Harris (of Columbia University) and her co-authors argue that physicians should know more about addiction treatment. In a Washington Post essay, they argue for more robust training. “Opioid use disorder is treatable, and medicines are readily available. But doctors cannot learn to help patients by taking a weekend course alone.”

DG


Continue reading

Reading of the Week: Clozapine Monitoring – the New BJP Paper; Also, Suicide Trends Among Adolescents (CJP) and Van Gogh’s Ear & Iconography (ANZJP)

June 15, 2023 /

From the Editor

“Despite its strong evidence base, clozapine remains grossly under-prescribed in clinical practice. Although reasons for this are multifaceted, a commonly cited influence is the need for mandatory haematological monitoring.” So notes Ebenezer Oloyede (of the University of Oxford) and his co-authors in a new British Journal of Psychiatry paper. Could the requirements be simplified? 

In the first selection, Oloyede et al. look at outcomes of 569 patients on clozapine when, during the pandemic, routine blood monitoring was changed. In this mirror-image cohort study, they find: “[E]xtending the haematological monitoring interval from 4-weekly to 12-weekly did not increase the incidence of life-threatening agranulocytosis in people taking clozapine.” We consider the paper and its implications.

In the second selection, Dr. Rachel H. B. Mitchell (of the University of Toronto) and her co-authors analyze Canadian data on suicide and sex differences. In this Canadian Journal of Psychiatry research article, they find that suicide rates among female adolescents aged 10 to 14 years surpassed similarly aged males in 2011. “The marked and consistent trend of rising suicide rates among adolescent females aged 10 to 14 years in Canada signals increased distress and/or maladaptive coping in this segment of the population.” 

And in the third selection, Alexander Smith (of the University of Bern) and his co-authors write about Vincent van Gogh. In an Editorial for the Australian and New Zealand Journal of Psychiatry, they describe his mental health struggles but also their commercialization. “Vincent van Gogh’s ear has generated an intrinsic cultural currency. Yet, the psychiatric vulnerabilities encompassed by his act of self-harm are not always sensitively considered or acknowledged.”

DG

Continue reading

Reading of the Week: Lithium Prescribing – the New CJP Paper; Also, AI vs. Doctors (JAMA Int Med) and Bergner on Compulsory Mental Health (NYT)

June 8, 2023 /

From the Editor

For patients with bipolar disorder, lithium is an important medication, shown to reduce hospitalizations and suicides better than newer agents. But has it fallen out of fashion? International reports suggest that it has.

In the first selection, Samreen Shafiq (of the University of Calgary) and her co-authors try to answer this question with Canadian data in a new paper for The Canadian Journal of Psychiatry. They draw on a decade of Alberta prescription data with more than 580,000 lithium scripts. “This population-based study suggests that the overall number of new and prevalent lithium users is decreasing in Alberta between the years of 2009 and 2018, but the observed pattern suggests that this decrease may have stopped by the end of our study interval.” We consider the paper and its clinical implications.

In the second selection, John W. Ayers (of University of California San Diego) considers AI-generated responses to health care questions posted on social media, like the need to seek medical attention after a minor head injury with a presentation of a lump and a headache. In a JAMA Internal Medicine paper, they compare ChatGPT answers to those of physicians in terms of quality and empathy. “In this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum.”

The debate over coercive care is hot, with proposals to rebalance patients’ rights actively discussed in New York City, Alberta, and California. In the third selection, author Daniel Bergner writes that we should look for alternatives to medications. In a New York Times essay, he argues that antipsychotics are problematic. “By doubling down on existing methods, we’re only beckoning more failure.”

DG

Continue reading

Reading of the Week: Ketamine vs. ECT – the New NEJM Paper; Also, Burnout & Depression (QT) and Rehab for Schizophrenia (Wash Post)

June 1, 2023 /

From the Editor

“Ketamine Shows Promise for Hard-to-Treat Depression in New Study”

 – The New York Times

The gold standard for treatment-refractory depression has been ECT. Last week, The New England Journal of Medicine published a new study by Dr. Amit Anand (of Harvard University) and his co-authors comparing ketamine with ECT. They did a noninferiority trial, with more than 400 people. The results have been widely reported, including in The New York Times. They write: “This randomized trial evaluating the comparative effectiveness of ketamine and ECT in patients with treatment-resistant depression without psychosis showed noninferiority of ketamine to ECT…” We discuss the paper and the accompanying Editorial.

A recent Canadian Medical Association survey found that the majority of physicians reported experiencing high levels of burnout. In the second selection, Dr. Srijan Sen (of the University of Michigan) discusses this timely topic in a new Quick Takes podcast. He talks about the definition(s) of burnout, and the overlap with depression. “Burnout has become a loose term that means different things to different people.”

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) and his co-authors discuss the life and death of New Yorker Jordan Neely. In an essay for The Washington Post, they argue for better care, in particular with a focus on rehabilitation services for those with schizophrenia. “People with other brain disorders are not abandoned to become homeless or incarcerated rather than receive medical help.”

DG

Continue reading