From the Editor

It’s an annual Reading of the Week tradition. As one year draws to a close and we start the next, we pause, take stock, and consider the best selections of the past 12 months.


We can also think about the Readings, mental health care policy, and what to expect in 2020.

So, let’s start with the not-so-big picture: the Reading of the Week has completed another year. For the first time, in the spring, I did a formal evaluation with the help of Faisal Islam (of CAMH Education). Among the survey results: the Readings enjoy a 97% satisfaction rate. Nice. And many readers had good suggestions, which I’m looking forward to using.

And in the big picture: 2019 was a year when further progress was made in the public discourse on mental illness. More people spoke about their personal experiences. Governments across Canada committed themselves to mental health reforms. But it wasn’t all great: moments also reminded us of the work that must be done, especially around stigma, even among prominent Canadians.

The 2019 selections of the Readings included some sparkling and important research. As I have commented before, I find psychiatric journals to be more interesting and more relevant with each passing year (and, at this point, I’ve seen a few passing years).

Does cannabis help with the treatment of mental illness? How does Ramadan affect the mental health of our Muslim patients? Does VR and other new technologies offer hope in the treatment of anxiety and other mental disorders?

These important questions were asked by researchers, and their papers help inform our work as clinicians.

And so with an eye on the future, let’s look back at the last year. Enjoy.

Please note that there will be no Reading for the next two weeks.


The Best Paper: Clinical Relevance

“Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis”

Nicola Black, Emily Stockings, Gabrielle Campbell, Lucy T. Tran, Dino Zagic, Wayne D. Hall, Michael Farrell, Louisa Degenhardt

The Lancet Psychiatry, 28 October 2019  Online First

Countries are increasingly allowing cannabinoids to be made available for medicinal purposes, including for the treatment of mental disorders.

So begins the Black et al. paper on cannabis that is timely and highly relevant to clinicians.

Our patients routinely ask if cannabis should be part of their treatment. Drawing on the available evidence, the authors write: “There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis.”

In a few years, there will be more data, and this paper may look dated. But right now, it is the Big Paper on the Big Topic.


The Runner-Up Paper: Clinical Relevance

“Association of Antidepressant Use With Adverse Health Outcomes: A Systematic Umbrella Review”

Elena Dragioti, Marco Solmi, Angela Favaro, Paolo Fusar-Poli, Paola Dazzan, Trevor Thompson, Brendon Stubbs, Joseph Firth, Michele Fornaro, Dimitrios Tsartsalis, Andre F. Carvalho, Eduard Vieta, Philip McGuire, MD, Allan H. Young Jae Il Shin, Christoph U. Correll, Evangelos Evangelou

JAMA Psychiatry, 2 October 2019  Online First

Accumulating evidence suggests a sharp growth in antidepressant use worldwide. Up to 8% to 10% of adults in the United States take at least 1 antidepressant drug, which is ranked third among prescribed and fourth among sold medications.

So begins the Dragioti et al. paper on antidepressants.

Essentially, this paper asks a simple question: are the pills safe?

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.


The Paper I Wish Everyone Would Read

“Sister First, Doctor Second”

Saadia Sediqzadah

The New England Journal of Medicine, 11 July 2019

‘I think your brother has schizophrenia,’ she said.

I was entering my third year of medical school when I received a phone call from my brother’s friend.

So begins a NEJM paper by Dr. Saadia Sediqzadah, a senior resident of psychiatry.

It has been hard to watch my brother transform from a healthy, handsome, popular adolescent to a thin, frail man who talks to himself. As a psychiatry resident, I have knowledge about mental health that is both a gift and a curse: I understand my brother’s disease and can support my family in helping him, but I know too much about the shortcomings of our mental health system.

It is a beautiful and moving paper, a reminder that we may be clinicians and knowlegeable, but we are human too, and that illnesses touches us and our families.


The Best Paper: Health Services Improvement

“Effectiveness of Self-guided App-Based Virtual Reality Cognitive Behavior Therapy for Acrophobia: A Randomized Clinical Trial”

Tara Donker, Ilja Cornelisz, Chris van Klaveren, Annemieke van Straten, Per Carlbring, Pim Cuijpers, Jean-Louis van Gelder

The Lancet Psychiatry, April 2019

Virtual reality and other new technologies could offer new options for treatment. But is there any evidence to support the hope? In this study, participants with acrophobia were treated with a VR intervention.

The Donker et al. paper shows us tangible results: the number needed to treat was just 1.7. The intervention, by the way, was an app (cost: $13.99) and cardboard Google glasses (cost: $10).


Best Paper: Special Populations (and Considerations)

“Considerations for clinicians treating Muslim patients with psychiatric disorders during Ramadan”

Zainab Furqan, Rania Awaad, Paul Kurdyak, Muhammad I. Husain, Nusrat Husain, Juveria Zaheer

The Lancet Psychiatry, 2 May 2019  Online First

About 80% of Muslims in North America will fast during Ramadan. Should medication times change? Is sleep disrupted? Are patients on lithium at greater risk of toxicity?

This paper asks basic questions and seeks to answer them. And it’s invaluable.

A better understanding of the effect of fasting on health can allow for more nuanced decisions between clinicians and patients, so that informed decisions can be made about balancing faith-based practices and health.

Well said.


The Person of the Year

In selecting a person of the year, I consider people who have made contributions to scholarship or advocacy. Michael Wilson’s influence seems to stretch beyond these simple descriptions – he helped change our national conversation. As a former minister of finance and a successful Bay Street executive, it would have been easy to focus his energy on other causes. But he sought to raise awareness about those with mental illness – speaking personally about his son’s struggles and his eventual suicide.

I’ll repeat the comments I made before: I attended a speech he gave shortly after his son’s death, and I remember the quiet of the room when Wilson spoke – no one shuffled her papers or chatted with his neighbour. I remember thinking how unusual this presentation was: he spoke about suicide at a time when suicide wasn’t discussed.

Wilson passed in February.

The Honourable Michael H. Wilson was elected 33rd Chancellor of the University of Toronto for a three-year term beginning on July 1, 2012. In 2015 he was re-elected to an additional three-year term, the maximum service length permitted by the University of Toronto Act, 1971.

A past Reading considers Michael Wilson and his contributions.


Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.