Tag: antidepressant

Reading of the Week: Visual Hallucinations & Outcomes – the New Schizophrenia Study; Also, Opioid Deaths in Canada and Dr. Roy Perlis on Antidepressants

April 25, 2024 /

From the Editor

Last week, I met a person who had deeply unsettling auditory hallucinations. I asked him the questions that we all ask: When did the voices start? How many voices do you hear? Do the voices tell you to do things? In contrast, while we know that people with psychotic illnesses can have visual hallucinations, we rarely inquire about them and if we do, it’s in a perfunctory manner, as I did with him. Clinicians aren’t the only ones to gloss over visual hallucinations; they tend to be under-researched, especially with regard to long-term outcomes.

In the first selection, Isabel Kreis (of the University of Oslo) and her co-authors look at outcomes and visual hallucinations in an impressive, new study published in Schizophrenia. They report on 184 people from Norway with first-episode psychosis, followed for ten years, with a focus on visual hallucinations and functionality, suicide attempts, and childhood trauma. “These findings highlight the relevance of assessing visual hallucinations and monitoring their development over time.” We consider the paper and its implications.

In the second selection from CMAJ, Shaleesa Ledlie (of the University of Toronto) and her co-authors report on opioid-related deaths in Canada. They drew from a national database and looked at several years of data, including over the start of the pandemic. “Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults.”

And in the third selection, Dr. Roy Perlis (of Harvard University) argues that the time has come for over-the-counter antidepressants in a STAT essay. He notes that many people with depression are untreated and that increasing the availability of these medications would be helpful. “With part of the solution hiding in plain sight, it’s time to do everything possible to give Americans another way to get treatment.”

DG

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Reading of the Week: Antidepressants & Bipolar – the New NEJM Paper; Also, AI & Med Ed and Humphreys on Language

August 10, 2023 /

From the Editor

What’s the role of antidepressants in the treatment of bipolar disorder? That question is openly debated.

In a New England Journal of Medicine paper that was just published, Dr. Lakshmi N. Yatham (of the University of British Columbia) and his co-authors try to shed light on this issue. In their study, people with bipolar depression who were in remission were given an antidepressant or a placebo and followed for a year. The study involved 209 people from three countries. “[A]djunctive treatment with escitalopram or bupropion XL that continued for 52 weeks did not show a significant benefit as compared with treatment for 8 weeks in preventing relapse of any mood episode.” We consider the paper and its implications.

In the second selection, Drs. Avraham Cooper (of Ohio State University) and Adam Rodman (of Harvard University) consider AI and medical education in The New England Journal of Medicine. They talk about previous technological advancements in history, including the stethoscope. AI, in their view, will change practice and ethics – with clear implications for training and education. “If we don’t shape our own future, powerful technology companies will happily shape it for us.”

And in the third selection, Keith Humphreys (of Stanford University) writes about words and word choices to describe vulnerable populations in an essay for The Atlantic. He notes historic disputes, such as the use of the term patient. “[M]aking these judgments in a rigorous, fact-based way would prevent experts, policy makers, and the general public from being distracted by something easy – arguing about words – when we need to focus on doing something much harder: solving massive social problems.” 

DG

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Reading of the Week: No Better Than Placebo? Debating Antidepressants and ECT, with Papers from Psychological Medicine

June 9, 2022 /

From the Editor

Antidepressants don’t work. Medications fail to address the real cause of depression. ECT is basically a placebo.

These statements are controversial, but they are mentioned often – including by some of our patients. But what does the literature say about depression management? This week, we look at the debate over antidepressants and ECT, drawing on two recent papers from Psychological Medicine.

In the first selection, John Read (of the University of East London) and Dr. Joanna Moncrieff (of University College) argue that our approach to depression is flawed. In a longer paper that draws on more than 120 references, they challenge basic assumptions about mental health care, arguing against antidepressants and ECT. They advocate for an alternative: “Understanding depression and anxiety as emotional reactions to life circumstances, rather than the manifestations of supposed brain pathology, demands a combination of political action and common sense.”

Were Ali and Frazier having a fight over depression management?

In the other selection, Dr. Carmine M. Pariante (of the King’s College London) agrees to disagree. In a Psychological Medicine paper, he responds. “I have written a piece that tries to put together their point of view with the available evidence, while acknowledging the complexity of the debate.” 

DG

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Reading of the Week: Should Patients Quit Antidepressants? The New NEJM Paper; Also, the NYT Obit on Dr. Paula Clayton

October 14, 2021 /

From the Editor

“Can I stop my antidepressants now?”

Patients often ask that question after feeling better. Studies have looked at relapse for people with depression who go off their medications, of course, but overwhelmingly such work has focused on patients recruited from specialty care (who are, perhaps, more ill).

In the first selection, we consider a new paper from The New England Journal of Medicine by Gemma Lewis (of University College) et al. The patients have been recruited from English family practices. The study is well designed and thoughtful, adding nicely to the literature. The chief finding? “Those who were assigned to stop their medication had a higher risk of relapse of depression by 52 weeks than those who were assigned to maintain their current therapy.” We consider the big paper and its clinical implications.

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In the second selection, drawing from the pages of The New York Times, reporter Clay Risen writes about the life of Dr. Paula J. Clayton. This psychiatrist, who passed in September, was an accomplished researcher: “Dr. Clayton was part of a generation of clinical psychiatrists who, in the decades after World War II, revolutionized their field by applying medical rigor to the diagnosis of mental illness.” In later years, she was a strong advocate for those with mental illness.

DG

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Reading of the Week: Are the Pills Safe? JAMA Psychiatry on Antidepressants, NICE on Withdrawal Symptoms

October 31, 2019 /

From the Editor

They are popular, but are they safe?

It’s the question that patients often ask about antidepressants. Though SSRIs have been on the market for decades – and older antidepressants for much longer – people continue to question their overall safety. Online forums relate stories of problems; news articles have linked them to suicidal thoughts in youth and other issues; regulatory agencies have acted on their doubts – the FDA, as an example, issued a black box warning for SSRIs use in adolescents.

This week, in our first selection, we consider a new paper from Linköping University’s Elena Dragioti and her co-authors. In this JAMA Psychiatry paper, the authors use a systematic umbrella review, drawing on meta-analyses of observational studies. “This study’s findings suggest that claimed adverse health outcomes associated with antidepressants may not be supported by strong evidence and may be exaggerated by confounding by indication; no absolute contraindication to the use of antidepressants was found to be currently supported by convincing evidence.”

We discuss the paper and the methodology.

antidepressants

In the second selection, we draw from the recently revised UK NICE guideleines, which provide advice on withdrawal symptoms and tapering strategies. “There is substantial variation in people’s experience…”

DG

 

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Reading of the Week: Antidepressants after Acute Coronary Syndrome and Depression – A Lifesaver? The New JAMA Paper

August 9, 2018 /

From the Editor

State-of-the-art care for acute coronary syndrome includes oxygen and clot-busting drugs. Should it also include a depression screen and an antidepressant if necessary?

In this week’s Reading, we look at a new JAMA paper showing a response to escitalopram for patients post-ACS (Acute Coronary Syndrome) with depression. Though work has been done in this area before, this paper is an important contribution: it’s well designed, and offers a long follow-up period. Chonnam National University Medical School’s Jae-Min Kim and his co-authors conclude: “In this median 8.1-year follow-up of a randomized 24-week clinical trial of treatment for depression in patients with recent ACS, MACE [major adverse cardiac event] incidence was significantly lower in patients receiving escitalopram than those receiving placebo.”

We consider the paper and its implications.

norm_2xGood EKG, good antidepressant?

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

DG
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Reading of the Week: Depression and Its Management — The American Journal of Psychiatry on Exercise and Long-term Use of Medication

May 3, 2018 /

From the Editor

It’s one of the most common and disabling illnesses. But how to treat depression in the long term?

In the first selection, we consider a paper just published by The American Journal of Psychiatry. In it, LaSalle University’s Felipe B. Schuch and his co-authors present a meta-analysis on exercise and depression. Drawing on 49 studies, they find that physical activity can protect against the development of depression, regardless of age and geographical region.

treat-alternative-exercise_an_alternative_adhd_treatment-article-3280a-man_running_sunset-ts_451886305-3Exercise: good for the heart, the lungs, and the prevention of depression?

In the second selection, Harvard University’s Roy H. Perlis writes a commentary for The American Journal of Psychiatry responding to a recent New York Times article that questioned the long-term use of antidepressants. He writes: “The informative analogy might be treatment of type 2 diabetes. While diet and exercise have a substantial impact on disease course (notably, results far more compelling than those in depression), it is hard to envision front-page articles in the New York Times about the dangers of long-term diabetes treatment.”

DG

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Reading of the Week: The Big NYT Article on Antidepressants & Withdrawal – Our Vioxx Moment?

April 12, 2018 /

From the Editor

“Many People Taking Antidepressants Discover They Cannot Quit.”

The New York Times. Front page. Sunday edition.

One of the most read newspapers in the world just ran a story suggesting that antidepressants may be linked to significant withdrawal symptoms. That news article is, well, news. Journalists Benedict Carey and Robert Gebeloff interview a mother of four who says, “Had I been told the risks of trying to come off this drug, I never would have started it.”

istock_000017711523xlargeAntidepressants: small pills but big problem?

This week’s Reading looks at the big article and considers its big implications.

DG

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Reading of the Week: Do Antidepressants Work? The New Cipriani Study

March 1, 2018 /

From the Editor

Last week, I spoke to a patient about antidepressants. “But do they really work?” she asked. While antidepressants are commonly prescribed, many patients wonder about them. That’s not surprising: in popular culture, these medications are often portrayed as risky and unhelpful. Just a few weeks ago, the most popular women’s fitness magazine in the world described fawningly how a woman quit her medications and felt better (“I felt more alive and in control of my emotions with each passing day”). A few years ago, a major study suggested that antidepressants basically match placebo in efficacy; 60 Minutes covered it.

And now there is the new Cipriani et al. paper. “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder…”

Is this the biggest psychiatry paper of the year? Certainly, it may be one of the most impressive. It took six years of effort. Oxford University’s Andrea Cipriani and his co-authors drew from all available data – published and unpublished, and covering more than 500 trials.

The media coverage has been incredible. The Guardian summarized the paper with the first two words of its article: “Antidepressants work.”

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In this Reading, we look at the big study and mull the big implications.

DG

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Reading of the Week: “The Secret to My Success? Antidepressants”

July 6, 2017 /

From the Editor

With the end of the academic year and the start of the new one, I’ll spend the next few days updating the distribution lists for the Reading of the Week series. I’m using this opportunity to make a few technical changes, too. This is the Reading of the Week equivalent of a spring clean-up – though it’s July, and I’m not touching a dustpan.

Spring cleaning, at least before computers

In any clean-up, we can mistakenly throw away something valuable – it’s possible that some of you may stop receiving these emails (if you are getting our emails). If that happens and you would like to continue to get the Readings, simply pop me a message.

This week, I’ve picked an entertaining and yet moving essay from writer Julia Fierro talking about her illness and her recovery. Enjoy.

Oh, and congratulations to our colleagues who have finished their studies. I hope you enjoy your career in medicine as much as I have.

DG

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