From the Editor
It’s our tradition that we begin the New Year by reviewing the best of the past year; so, this week, we look back at 2022.
But a bit of a break from tradition: this year, we haven’t organized the papers by different categories, instead choosing eight great papers. Some have been published in big journals; others, not so big. They cover a variety of topics, from prevention to cutting-edge treatments. The one common thread: all are clinically relevant. And, yes, there is a Person of the Year. Spoiler alert: he had a big career and likes to mention Groucho Marx.
An observation about this past year: the quality of scholarship was very high. We’ve picked good papers – but could have picked scores of others. It’s a comment we’ve made in past years, and a good reason for optimism as our field grows more sophisticated and relevant.
“Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia: A Randomized Clinical Trial”
Michael R. Irwin, Carmen Carrillo, Nina Sadeghi, et al.
JAMA Psychiatry, January 2022
“[O]lder adults with depression often do not receive diagnosis and treatment, and even with treatment, only approximately one-third achieve remission, with an estimated remaining disease burden of 60%.”
In this study, the authors look to prevent depression in the elderly by addressing… insomnia with a scaleable intervention. What sorcery is this? The intervention was successful, with clear implications for public health.
“Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial”
Elizabeth A. Hoge, Eric Bui, Mihriye Mete, et al.
JAMA Psychiatry, 9 November 2022 Online First
“Mindfulness-based interventions (MBIs) may be seen as a more acceptable option given that mindfulness meditation has recently become more popular. For example, in the US, approximately 15% of the population has tried meditation.”
Mindfulness is becoming increasingly popular, but can it be used in the treatment of anxiety disorders? In this RCT, the authors compare a form of a mindfulness with an antidepressant, finding non-inferior results. Big study, big result.
Indeed, mindfulness matched the antidepressant.
“‘I was Close to Helping him but Couldn’t Quite get There’: Psychiatrists’ Experiences of a Patient’s Death by Suicide”
Zainab Furqan, Rachel Beth Cooper, Andrew Lustig, et al.
The Canadian Journal of Psychiatry, 19 September 2022 Online First
Have you ever lost a patient to suicide? The experience can be crushing. As the authors note: “Survey studies have indicated that psychiatrists experience strong emotional reactions to a patient dying by suicide. Reactions include disbelief, self-doubt, embarrassment, guilt, self-blame, anger, and shock, as well as fear and anxiety over personal or legal repercussions. Many also experience low mood, irritability and poor sleep.”
They do a qualitative analysis, drawing on seventeen interviews with psychiatrists and finding different emotional responses, including grief and sadness. They go on to make practical suggestions, including the creation of safe spaces.
“Effectiveness of medical treatment for bipolar disorder regarding suicide, self-harm and psychiatric hospital admission: between- and within-individual study on Danish national data”
Cecilie Fitzgerald, Rune Haubo Bojesen Christensen, Jerome Simons, et al.
The British Journal of Psychiatry, November 2022
“People with bipolar disorder have been reported as having an 11-fold higher risk of suicide and an 18-fold higher risk of self-harm (intentional non-fatal self-poisoning and self-injury) compared with the general population. In addition, relapse of the disorder frequently necessitates psychiatric hospital admission.”
So note the authors of this new and important paper comparing lithium to other agents in a cohort study involving more than 33,000 people (yes, you read that correctly). The result? Lithium had better outcomes in terms of suicide, self-harm, and admissions.
“TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality”
Anthony Yeung, Enoch Ng, Elia Abi-Jaoude
The Canadian Journal of Psychiatry, December 2022
“Social media platforms are a popular means of sharing medical information online. TikTok in particular is a relatively new social media platform that has seen rapid adoption by adolescents and young adults, becoming the most downloaded social media application in 2020 with more than 1 billion monthly active users. In particular, the popularity of the platform appears to have contributed to increased awareness of attention-deficit/hyperactivity disorder (ADHD), with some individuals seeking a diagnosis after watching videos about ADHD on the platform.”
It’s popular, but what is the quality of medical information on social media? Yeung et al. focus on ADHD information on TikTok. “In this analysis of popular TikTok videos about ADHD, there were over 2.8 million views per video and each video was shared on average 31,000 times. Approximately half of the videos analyzed (52%) were misleading…” Ouch.
“Risk of suicide death following electroconvulsive therapy treatment for depression: a propensity score-weighted, retrospective cohort study in Canada”
Tyler S. Kaster, Daniel M. Blumberger, Tara Gomes, et al.
The Lancet Psychiatry, June 2022
ECT was first used more than eight decades ago, yet the debate continues. Does it really work? This paper adds to the literature, convincingly showing that ECT reduces completed suicides.
“Using modern epidemiological methods to address confounding, our comparative observational study of more than 65 000 admissions found that death by suicide in the year following discharge after hospitalisation for depression was significantly reduced with electroconvulsive therapy.”
ECT has been called many things. Add to that list: lifesaver.
“Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women: A Randomized Clinical Trial”
Eric S. Zhou, Lee M. Ritterband, Traci N. Bethea, et al.
JAMA Psychiatry, June 2022
“Poor sleep has also been shown to disproportionately affect Black individuals. For example, Black adults in the US have shorter total sleep duration, experience lighter and more fragmented sleep, and report worse sleep quality compared with other racial groups.”
How to address this? The authors designed a tailored intervention, drawing on the help of experts and also those with lived experience. The end result? Participants receiving the tailored intervention had higher completion rates than regular CBT-insomnia.
“Single-Dose Psilocybin for a Treatment-Resistant Episode of Major Depression”
Guy M. Goodwin, Scott T. Aaronson, Oscar Alvarez, et al.
The New England Journal of Medicine, 3 November 2022
“Its potential antidepressant efficacy was suggested by preliminary studies involving patients with life-threatening cancer. Amelioration of symptomatic depression in pilot studies of major depressive disorder, including those that compared psilocybin with escitalopram and that investigated its use in treatment-resistant depression, has suggested therapeutic potential for this agent.”
So note the authors of a new NEJM paper where participants with treatment-resistant depression were given a single dose of psilocybin. They find: “participants with treatment-resistant depression, psilocybin at a single dose of 25 mg, but not 10 mg, reduced depression scores significantly more than a 1-mg dose over a period of 3 weeks but was associated with adverse effects.”
Many questions remain unanswered – including around the practicality and scaleability of an intervention requiring 6-8 hour psychotherapy sessions.
The Person of the Year
In selecting a Person of the Year, we consider people who have made contributions to scholarship or advocacy or clinical work. Past selections have included a former Minister of Finance, the CEO of a major hospital, and the former chair of a university department of psychiatry.
This year, we choose Dr. David Goldbloom, who retired in December.
Dr. Goldbloom has had an impactful career, holding some of the biggest jobs in psychiatry, including as the chair of the Mental Health Commission of Canada and the inaugural physician-in-chief at CAMH. But his influence has truly been felt in his other roles: as a mentor, teacher, and advocate.
In a past Reading, we featured a podcast interview in which he reflected on his career.
And we also featured an excerpt from his new book.
Interested in reading more? The Best of 2021 can be found here:
The Best of 2020, here:
The Best of 2019, here:
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.