AuthorDavid Gratzer

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: Burnout & North American Psychiatrists – the Big AJP Paper; Also, Satel on Kanye West’s Mental Illness (USA Today)

From the Editor

“Burnout is notoriously difficult to characterize.”

So comment the authors of a new American Journal of Psychiatry paper.

In recent years, we have been collectively speaking much more about physician burnout, but we often lack basic data. Using an online survey, Dr. Richard F. Summers (of the University of Pennsylvania) and his co-authors attempt to find out how common it is among North American psychiatrists. While there are many surveys of physicians, this one focuses on our specialty. What do they find? “Psychiatrists, like other physicians, have substantial burnout.”

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In the second selection, we look at a new essay by Dr. Sally Satel (of Yale University). Writing in USA Today, she discusses the presidential campaign of Kanye West and the unusual comments that he has made. “None of this is funny.” She notes that he has a history of mental illness, and wonders how journalists should have covered the story.

Please note that there will be no Reading next week.

DG

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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?

DG

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Reading of the Week: Is Yoga Useful for Depression (CJP)? Also, Women & COVID (JAMA) and Stergiopoulos on Masks & Medicine (UofTMed)

From the Editor

Complementary and alternative medicines are trendy – but are they helpful?

“Depressed patients… often perceive CAMs [complementary and alternative medicines] as safer, accessible, more tolerable, and easily acceptable compared to pharmaceuticals. It has been estimated that 10% to 30% of depressed patients use CAM therapies, often in tandem with conventional treatments and frequently without the knowledge of their physician. This percentage is even higher amongst those with bipolar disorder (up to 50%) and in clinic populations (up to 86%).”

So writes Dr. Arun V. Ravindran (of the University of Toronto) and his co-authors in a new Canadian Journal of Psychiatry paper. That study – our first selection this week –considers the use of one type of CAM: yoga. They find that it “may be helpful as an adjunctive intervention.”

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In the second selection, writing in JAMA, Dr. Linda Brubaker (of the University of California, San Diego) considers gender and roles in medicine. While she is careful not to over-generalize, she notes that: “As a group, women physicians spend proportionately more time on home and family care activities.” With the disruptions of COVID-19, she wonders what must be done to support all physicians. “Women and men physicians should be able to share the joy and the work of their lives equally.”

And, in the third selection, University of Toronto psychiatry resident Dr. Erene Stergiopoulos considers masks – and humility – in a time of COVID-19. In a personal essay that turns on a split-second decision, she notes: “These days it’s hard to remember a time before masks. And some days, it’s just as hard to imagine a future without them.”

DG

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Reading of the Week: Physician Suicide – the New JAMA Psychiatry Paper and Editorial

From the Editor

“‘I Couldn’t Do Anything’: The Virus and an E.R. Doctor’s Suicide.”

So headlines a long article on the life and death of a New York doctor who had excelled at medicine – Dr. Lorna Breen oversaw an ER department, and was studying in a dual degree master’s program at Cornell University – but died during the COVID-19 pandemic. The front-page story ran last weekend in The New York Times.

Physician suicide. It’s a weighty topic, one that typically wasn’t discussed much in the past, in part because of the reluctance of physicians to acknowledge their own problems. But how often does it occur and is there a gender gap?

This week, we consider a new paper by Dr. Dante Duarte (of Harvard Medical School) and his co-authors. While previous papers have been published in this area, Duarte et al. are ambitious: they do a systematic review and meta-analysis of studies published over the last four decades. In the JAMA Psychiatry paper, they find: “suicide standardized morality ratios were high in female physicians and low in male physicians after 1980…”

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The paper runs with an editorial by Drs. Katherine J. Gold (of the University of Michigan) and Thomas L. Schwenk (of the University of Nevada). Putting the paper in a larger context, they write: “Suicide prevention is a moral responsibility of the entire medical profession.”

And a quick word of welcome to PGY1 residents who are joining us this week as part of our continued partnership with 12 Canadian residency programs from coast to coast to coast.

DG

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Reading of the Week: Suicide Prevention in the Acute Care Setting (JAMA Psychiatry); Also, Gottlieb on Racism (Wash Post)

From the Editor

In the year before they suicide, more than 90% of people have had contact with some type of acute care – an ED visit, a trip to the family doctor, or an appointment at an outpatient specialty clinic. So how can we help people better? Given the contact, what can we do to reduce suicides?

This week, we have two selections; the first focuses on this question. In a new JAMA Psychiatry paper, Dr. Stephanie K. Doupnik (of the University of Pennsylvania) and her co-authors do a systematic review and meta-analysis of 14 studies that used brief suicide prevention interventions in acute care settings (think brief contact interventions like a phone call after an ED visit). They find an encouraging result: “In this meta-analysis, brief suicide prevention interventions were associated with reduced subsequent suicide attempts.” We consider the big paper, and the editorial that accompanies it.

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In the other selection, therapist Lori Gottlieb discusses race and therapy in a Washington Post essay. She examines her own biases, and the way they play out in her therapy session. “Here’s what we didn’t talk about [in school]: the racism that might take place inside the supposedly ‘safe space’ of our therapy rooms – our patients’ racism and our own.”

Please note that there will be no Reading next week. Happy Canada Day.

DG

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Reading of the Week: What do Google Searches Tell Us about Suicide & COVID? (CJP) Also, Bullock on Suicide (NEJM)

From the Editor

How will the pandemic impact mental health? Will we see more people with depression and PTSD? What about suicides?

In a recent JAMA Psychiatry paper, Mark A. Reger (of the University of Washington) and his co-authors argued that we may see a “perfect storm” with COVID-19, increasing the risk of suicide. A BMJ blog speculated that we could have a “pandemic after the pandemic,” as mental health problems grow even as the virus fades.

This week, we have two selections; the first focuses on suicide and the pandemic. Using an innovative approach – that is, considering Google searches for suicide and related terms, as a proxy for completions – the authors draw on American and international data. In a new Canadian Journal of Psychiatry paper, Dr. Mark Sinyor (of the University of Toronto) and his co-authors find surprisingly “that the initial stages of the pandemic were accompanied by a substantial reduction in searches related to suicide, anxiety, and hopelessness with no change in searches for depression.”

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In the second selection, Dr. Justin L. Bullock (of the University of California, San Francisco) discusses suicide in The New England Journal of Medicine. The young doctor is very personal, describing his own struggles with mental illness. “‘I’m starting to get depressed,’ I told my sister emotionlessly. She began to cry, probably flashing back to the last time I was severely depressed, attempted suicide, and ended up in the ICU. I told her I was sad that my 2-year-old niece wouldn’t remember me. ‘Do you think I would ever let her forget you?’ she responded. We both cried.”

DG

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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: What Can Past Coronaviruses Teach Us? Also, Sharing Notes (Lancet Psych) & Sediqzadah on Therapy in a Digital World (Globe)

From the Editor

As we consider the psychiatric needs arising from COVID-19, are there lessons to be drawn from past severe coronavirus infections?

The first selection seeks to answer that question.

In The Lancet Psychiatry, Dr. Jonathan P. Rogers (of the University College London) and his co-authors do a systematic review and meta-analysis of severe coronavirus infections with a focus on psychiatric presentations. They included papers covering SARS and MERS. “This review suggests, first, that most people do not suffer from a psychiatric disorder following coronavirus infection, and second, that so far there is little to suggest that common neuropsychiatric complications beyond short-term delirium are a feature.”

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Should mental health notes be shared with patients? In the second selection, we look at paper from The Lancet Psychiatry. Charlotte R. Blease (of Harvard Medical School) and her co-authors champion the idea. “Sharing clinical notes in mental health settings will be more complex than in other clinical specialties; however, for most patients it will be feasible and, if carefully implemented, an empowering tool that could improve care.”

Finally, we consider an essay from The Globe and Mail. Dr. Saadia Sediqzadah (of the University of Toronto), who is graduating from her psychiatry residency this month, discusses her training and the expectation that patients “present to the clinic.” Now practicing in a COVID-19 world, she writes about psychotherapy and her patients. “What would Freud say? I care less about that as we now contend with a very different world than his. The question I ask now is, how will we go back?”

DG

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“Not normal is the new normal”: How does the pandemic impact mental health treatment? We asked a CAMH psychiatrist

I’m grateful for the opportunity to have talked with Liza Agrba of Toronto Life about COVID-19 and mental health.

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The full interview can be found here:

https://torontolife.com/city/life/not-normal-is-the-new-normal-how-does-the-pandemic-impact-mental-health-treatment-we-asked-a-camh-psychiatrist/