Tag: antidepressants

Reading of the Week: rTMS vs Meds for Antidepressant Non-responders – the New AJP Study; Also, Stea on the Wellness Industry

September 12, 2024 /

From the Editor

He’s had two antidepressant trials, yet he still can’t get out of bed. What’s the next step for my patient with depression? With so many antidepressant options available, the simplest answer is another med. But what could be an alternative? These questions are highly practical – consider that roughly 700 000 Canadians struggle with treatment-refractory depression. 

Iris Dalhuisen (of Radboud University) and her co-authors attempt to shed light on the issue. In a newly published American Journal of Psychiatry study, they describe a randomized comparison involving 89 people with treatment-refractory depression who received either rTMS or another antidepressant. “In a sample of patients with moderately treatment-resistant depression, rTMS was more effective in reducing depressive symptoms than a switch of antidepressant medication.” We analyze the study, the Editorial that accompanies it, and the implications for practice.

In this week’s other selection, Jonathan N. Stea (of the University of Calgary) writes about the wellness industry in an essay for The Globe and Mail. He bemoans the snake-oil salesmen and their big promises. “As a clinical psychologist, I have encountered many patients who received pseudoscientific assessments and treatments for their mental-health concerns. The tidal wave of pseudoscientific mental-health practices originates both within and outside of the mental-health professions.”

DG

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Reading of the Week: Psychological Interventions for Schizophrenia – the New Lancet Psych Study; Also, Service Dogs for PTSD, and the Latest in the News

July 4, 2024 /

From the Editor

She was distressed by the voices and the paranoid thoughts. Many nights, my patient could barely sleep. She had tried several medications without much improvement. Is there a role for psychological interventions? Would CBT help? What is the evidence for this population?

In the first selection, Nurul Husna Salahuddin (of the Technical University of Munich) and co-authors attempt to answer these questions in a new systematic review and network meta-analysis, just published in Lancet Psychiatry. The analyzed 52 RCTs with 5 034 participants. “We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice.” We consider the paper and its clinical implications.

In the second selection from JAMA Network Open, Sarah C. Leighton (of the University of Arizona) and her co-authors describe a study involving service dogs for those with PTSD. In a nonrandomized controlled trial involving 156 military members and veterans, they examined outcomes after three months. “[C]ompared with usual care alone, partnership with a trained psychiatric service dog was associated with lower PTSD symptom severity and higher psychosocial functioning in veterans.”

Finally, we explore the latest news with recent articles from The Guardian, the Ottawa Citizen, and The New York Times. Among the topics: “honest” obituaries and the opioid crisis, antidepressants and withdrawal, and care for pregnant women with substance problems.

DG

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Reading of the Week: Antidepressants & Discontinuation Symptoms – the New Lancet Psych Study; Also, Neuromodulation and Digital Health Technology

June 27, 2024 /

From the Editor

“Once I start taking them, I’m stuck.” When discussing the possible initiation of an antidepressant trial, a patient recently expressed his fear: that he wouldn’t be able to stop the medication because of discontinuation symptoms. These symptoms are debated. Some claim they are very common – though that’s not widely reported in the literature. 

How frequently do these symptoms occur? What percentage of patients experience severe symptoms? Are some antidepressants more associated with this problem than others? Dr. Jonathan Henssler (of the University of Cologne) and his co-authors attempt to answer these questions with an impressive, new systematic review and meta-analysis, published in Lancet Psychiatry. They drew on 79 studies involving more than 21 000 people. “The incidence of antidepressant discontinuation symptoms is approximately 15%, affecting one in six to seven patients who discontinue their medication.” We consider the paper and its clinical implications.

Will the stigma around ECT fade? Will ECT eventually be replaced by ketamine and MST? What’s the future of neuromodulation? We answer these questions and more in the second selection, the latest Quick Takes podcast interview. Dr. Daniel Blumberger, scientific director of CAMH’s Temerty Centre for Therapeutic Brain Intervention and professor at the University of Toronto, notes that ECT still has a unique place. “As far as medical treatments go, ECT is the safest medical procedure in all of medicine.”

And in the third selection, Dr. John Torous (of the Harvard University) and his co-authors focus on digital mental health in a new Viewpoint published in JAMA Psychiatry. They argue that we tend to both overstate and underappreciate the risks and benefits of digital mental health interventions. “Patients and clinicians should not assume wellness digital health technologies are always dangerous, nor should they assume health technologies are always safe.”

DG

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