From the Editor
This month, the Reading of the Week – in its present form – turns four.
Today, the Readings are emailed out from sea to sea to sea. It’s a big evolution from the first Readings, started more than six and a half years ago, with me handing out photocopies of papers on the inpatient ward where I worked.
To celebrate our silk anniversary, I’ve picked four major selections from the past four years. I’ve also included some papers that haven’t been discussed – but should have been.
“My Lovely Wife in the Psych Ward”
Pacific Standard, 12 January 2015
Readings have included patient and family essays over the years. This article is particularly moving in part because of its honesty. The author describes his life and relationship as they change with his wife’s mental illness.
It’s worth reading just for this paragraph:
We still have a lot to decide, most of it tremendously complicated. Giulia still wants three kids before she turns 35; I’m interested in avoiding a third hospitalization. When we set aside time to talk about things, we know we’re making calendar space to fight.
“Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters”
Tong Guo, Yu-Tao Xiang, Le Xiao, Chang-Qing Hu, Helen F. K. Chiu, Gabor S. Ungvari, Christoph U. Correll, Kelly Y. C. Lai, Lei Feng, Ying Geng, Yuan Feng, Gang Wang
The American Journal of Psychiatry, 28 August 2015
We have covered many papers over these years but Guo et al.’s paper stands out for its stunning findings: measurement-based care didn’t rival standard care in the management of depression, it produced impressively superior results.
Consider: people in the measurement-based care group responded better than the standard treatment group (86.9% vs. 62.7%); they had a much higher remission rate (73.8% vs. 28.8%); their time to response to treatment was shorter (4.5 weeks vs. 8.1 weeks). Needless to say, this paper has significant implications for the organization of services.
“Major Depression in Canada: What Has Changed over the Past 10 Years?”
Scott B. Patten, Jeanne V. A. Williams, Dina H. Lavorato, Jian Li Wang, Keltie McDonald, and Andrew G. M. Bulloch
The Canadian Journal of Psychiatry, February 2016
How are we doing in the treatment of depression on a national level? In this paper, Canadian Journal of Psychiatry editor Scott Patten and his co-authors draw on census data. They find that while “potentially adequate care” – some type of therapy or medication treatment – is up from 2002 to 2012, many Canadians aren’t getting care (roughly one out of every two Canadians with depression). The paper helps shows the incredible work needed to improve access.
“Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis”
Andrea Cipriani, Toshi A. Furukawa, Georgia Salanti, Anna Chaimani, Lauren Z Atkinson, Yusuke Ogawa, Stefan Leucht, Henricus G. Ruhe, Erick H Turner, Julian P. T. Higgins, Matthias Egger, Nozomi Takeshima, Yu Hayasaka, Hissei Imai, Kiyomi Shinohara, Aran Tajika, John P. A. Ioannidis, John R. Geddes
The Lancet, 21 February 2018 Online First (Open Access)
Do antidepressants work? To answer this question, Dr. Cipriani and his co-authors didn’t simply look at several papers, they attempted to look at everyRCT paper on antidepressants – and then added in unpublished data, pulling in over 500 trials.
They conclude: “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder and the summary effect sizes were mostly modest. Some antidepressants, such as escitalopram, mirtazapine, paroxetine, agomelatine, and sertraline had a relatively higher response and lower dropout rate than the other antidepressants.”
I would estimate that the Readings have covered over 300 papers in these past four years. There are many papers that I wish we discussed, however. Here are a few:
“Improving the Efficiency of Psychotherapy for Depression: Computer-Assisted Versus Standard CBT”
Michael E. Thase, Jesse H. Wright, Tracy D. Eells, Marna S. Barrett, Stephen R. Wisniewski, G.K. Balasubramani, Paul McCrone, Gregory K. Brown
The American Journal of Psychiatry, 3 October 2017 Online First
As we look to improve access, people are increasingly considering e-therapies and other uses of technology. There are many small studies in the area.
Thase et al. wrote a very important paper, comparing computer-assisted CBT to in-person CBT – finding similar results (as measured by the HAM-D). This isn’t just a big finding, it has enormous implications as to how we offer people mental-health services.
“Antipsychotics and mortality in a nationwide cohort of 29,823 patients with schizophrenia”
Heidi Taipale, Ellenor Mittendorfer-Rutz, Kristina Alexanderson, Maila Majak, Juha Mehtälä, Fabian Hotic, Erik Jedenius, Dana Enkussond, Amy Levald, Jan Sermone, Antti Tanskanen, Jari Tiihonen
Schizophrenia Research, 20 December 2017
How do people do with schizophrenia over time? Does medication management make a difference?
In this paper that taps national databases, Taipale et al. compared people with schizophrenia on antipsychotics (depot vs. oral) to those on no medications. “The adjusted risk of death was 56% lower during use of any antipsychotic compared with no use of antipsychotic…” Of course, there are limitations to using big databases; still the conclusion is striking: antipsychotics save lives.
Fads and Fallacies in Psychiatry
RCPsych Publications, 1 November 2013
Fads and Fallacies isn’t actually a paper but a book (albeit a relatively short one, at 128 pages). But it’s worth including in the list because it does such an eloquent job of challenging the overdiagnosis and overtreatment in psychiatry – thoughtfully and carefully. Dr. Joel Paris, the past chair of psychiatry at McGill University, draws on hundreds of papers and his extensive clinical experience to suggest that psychiatry continues to evolve.
What lies ahead? In the coming months, the Readings will change a bit – with a fresher look and stronger partnerships.
But let’s worry about tomorrow, tomorrow.
On our fourth anniversary, I want to thank you, the readers who have joined me week after week, as we explore the ever-changing world of psychiatry.
Your well wishes, thanks, and emails have been appreciated.
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.