Tagdepression

Reading of the Week: Substance Problem, Quality of Care Problem? Also, Interventional Psychiatry (CJP) and an Underused Addiction Treatment (NYT)

From the Editor

In terms of depression treatment, do people with substance use problems get worse care than those without?

The answer should be a resounding no. In the first selection, we consider a new paper, just published in The American Journal of Psychiatry, which suggests otherwise. Lara N. Coughlin  (of the University of Michigan) and her co-authors draw on Veterans Affairs data involving more than 53,000 patients. “In this large national sample, we found that patients with comorbid depression and substance use disorders receive lower quality care than those with depression but without substance use disorders.”

syringe_pill_bottle_morphine_small_needle_liquid_capsule-1208971-jpgd

In the second selection, we consider a Canadian Journal of Psychiatry research letter. Dr. Peter Giacobbe (of the University of Toronto) and his co-authors surveyed senior residents, asking about their familiarity and comfort with first line recommendations for the treatment of depression. Spoiler alert: just one in four felt that they had achieved competency in ECT.

Finally, in the third selection, we look at a new essay by journalist Abby Goodnough. With many Americans (and Canadians) struggling with substance problems, she writes about contingency management – that is, rewarding substance users with cash and prizes for sobriety. The concept has evidence in the literature, but lacks political support. She quotes a patient: “Even just to stop at McDonald’s when you have that little bit of extra money, to get a hamburger and a fries when you’re hungry. That was really big to me.”

Note: there will be no Reading next week.

DG

Continue reading

Reading of the Week: Does COVID Affect Outcomes? Also, Depression & Behavioural Economics (JAMA Psych), and Crawford on Virtual Care (Walrus)

From the Editor

As we head into the second wave, are there lessons from the spring?

This week, we have three selections.

In the first, published in The Lancet Psychiatry, Dr. Seung Won Lee (of the Sejong University College of Software Convergence) and co-authors look at mental illness and COVID-19 in South Korea. Doing a cohort study, drawing on national databases, they wonder about diagnosis and clinical outcomes for those with mental illness. “Diagnosis of a mental illness was not associated with increased likelihood of testing positive for SARS-CoV-2.” It’s a big finding – but is it relevant on this side of the Pacific?

wave-1

Can we nudge patients with depression to take medications? In the second selection, we look at a new JAMA Psychiatry research letter. Steven C. Marcus (of the University of Pennsylvania) and his co-authors offer financial incentives for medication compliance. They conclude: “In this pilot study, escalating incentives for daily antidepressant adherence significantly improved adherence compared with a control group during the critical first 6 weeks of treatment.”

Finally, in our third selection, we consider an essay by Dr. Allison Crawford (of the University of Toronto) from The Walrus. She writes about the change in mental health care with COVID-19, as virtual care has become the norm. “I take off my shoes so that I can enter softly and with an open heart. My patients can’t see my bare feet.”

DG

Continue reading

Reading of the Week: Trends in Suicide Mortality in Canada (CJP); also, Suicide Prevention (Quick Takes) and Lawrence on Her Depression (Guardian)

From the Editor

Suicide is often discussed, but what do we know about the overall rate of completions? We hear that there are more suicides in the United States over the past few years – but was does the Canadian data say?

In the first selection, we consider a new paper by Mélanie Varin (of Indigenous Services Canada) and her co-authors. Drawing on a Canadian database, they consider suicide mortality. The good news: the suicide rate in Canada decreased by 24.0% between 1981 and 2017. But, in recent years, there hasn’t been a further decline.So – is the glass half full or half empty?

gettyimages-490475314-1280x640

In the second selection, we look further at suicide, considering a new podcast discussing suicide and suicide prevention. I talk with Dr. Juveria Zaheer (of the University of Toronto) about COVID-19, the literature, and, yes, her suggestions for clinical interviews. “If you have a room of one hundred people, one hundred people in that room have been affected by suicide.”

Dr. Rebecca Lawrence is a UK psychiatrist and we can assume that she has done many suicide risk assessments. In a Guardian essay – our third selection – she tells her story: as a person who struggled with mental illness, then made the decision to become a psychiatrist. “If my story helps anyone unsure of their capacity to take on the job, or worried about the ‘dark secret’ of their own psychological troubles, then I think it’s worth telling.”

DG

Continue reading

Reading of the Week: Apps for the Treatment of Depression (JAMA Psych)? Also, Cannabis & Driving (CJP); Oleynikova on Returning to School (Globe)

From the Editor

The world changed on March 11, the day that the pandemic was declared by the WHO. So did mental health care, with so many of our services becoming virtually delivered. But what’s effective and what should be incorporated into care moving forward?

This week, we have three selections.

The first is a new JAMA Psychiatry paper. With COVID-19, apps are becoming increasingly popular (one therapy app reports a 65% increase in clients over the spring). Can the apps be incorporated into primary care? Andrea K. Graham (of Northwestern University) and her co-authors do a RCT using apps for patients with depression and anxiety. They conclude: “In this trial, a mobile intervention app was effective for depression and anxiety among primary care patients.” But should we be so enthusiastic? And how could apps be used in care?

app-application-application-software-applications

Canada legalized cannabis for non-medical purposes in 2018. In a short research letter – our second selection – medical student Laura A. Rivera and Dr. Scott B. Patten (both of the University of Calgary) consider driving under the influence of cannabis, drawing on national survey data. “Public policy actions toward prevention of DUIC [driving under the influence of cannabis] appear necessary and will have the greatest impact if they are effective in the 15 to 24 age range and in males.”

Finally, in the third selection, we consider an essay from The Globe and Mail. Like many, Vera Oleynikova thinks about the return to school. She writes about her own experiences, noting a complication: she has struggled with depression. “To be sick for a long time and then to feel well again is a magical thing. You feel brand new and capable of anything. You marvel at your own capacity to do the things that for a long time were unavailable to you because of your illness. Which is why going back to school at 31 felt so right.”

DG

Continue reading

Reading of the Week: Perceived Helpfulness of Depression Treatment – the New JAMA Psych Paper; Also, Friedman on Boredom & the Pandemic (NYT)

From the Editor

How helpful do people find treatment for depression?

This question is broad but new work (drawing on WHO surveys) ambitiously attempts to answer it across different countries, including some that are low income.

In the first selection, we consider a paper from JAMA Psychiatry. Meredith G. Harris (of The University of Queensland) and her co-authors report on WHO data. The good news? Many people do find treatment for depression helpful. The bad news? Many providers are needed for people to believe that they had received helpful treatment.

4anvfzqDepression treatment: helpful, like a lift from a friend?

In the second selection, we look at a new essay by Dr. Richard A. Friedman (of Weill Cornell Medical College). Writing in The New York Times, he discusses the pandemic and the possibility of “a mental health epidemic of depression and anxiety.” Dr. Friedman argues that we are seeing mass boredom, not a rise in disorders like depression. While he can’t fully rule out that the pandemic will bring about an increase in mental health problems, he writes: “let’s not medicalize everyday stress.”

DG
Continue reading

Reading of the Week: Depression Outcomes: What Matters to Patients (Lancet Psych)? Also, NYT on Mental Health Apps and Startup Culture

From the Editor

“US Food and Drug Administration accepts only three outcome measures as primary endpoints in phase 3 studies to support an indication for major depressive disorder: the Hamilton Depression Rating Scale, the Montgomery-Åsberg Depression Rating Scale, or the Children’s Depression Rating Scale.”

The editors of The Lancet Psychiatry make this point in in the August issue of that journal. Their concern: the FDA view is very narrow and confined to these three scales.

In the first selection, we look at a new paper from The Lancet Psychiatry. Dr. Astrid Chevance (of the Center for Epidemiology and Statistics Paris Sorbonne) and her co-authors consider depression outcomes. To understand different perspectives, they draw on three groups: providers, patients, and caregivers. For the record, the resulting paper is fascinating and includes outcome measures that aren’t captured by these three scales. We consider the paper and the editorial that runs with it.

depression

In the second selection – also on the topic of depression – Kashmir Hill and Aaron Krolik report for The New York Times on a popular therapy app. They note that Talkspace has good marketing and a growing client base. But should you recommend the app to your patients?

DG

Continue reading

Reading of the Week: Depression – What is the Economic Burden? The New CJP Paper; Also, Zimmerman on Scales (JAMA) and Bernard on her Illness (CMAJ)

From the Editor

For the patient sitting in front of you, depression is a weight around her shoulders, the reason she can’t enjoy her favourite activities or laugh at her partner’s jokes. Such is the patient experience.

This week, we have three selections, and all consider different aspects of this illness. In the first, we look at a paper from The Canadian Journal of Psychiatry. Julie-Anne Tanner (University of Toronto) and her co-authors draw on data to estimate the economic burden of depression in Manitoba. They conclude: “Depression contributes significantly to health burden and per patient costs in Manitoba, Canada. Extrapolation of the results to the entire Canadian health-care system projects an excess of $12 billion annually in health system spending.”

6797008930_0207a99864_b

Manitoba: big prairie & big burden of depression

In the second selection, we review a short JAMA paper by Dr. Mark Zimmerman (Brown University) considering depression management. He recommends the use of the PHQ-9 in screening. As for treatment, he writes: “the PHQ-9 should be administered at each visit to quantitatively measure a patient’s treatment response.”

And in the third selection, returning to the patient experience, Dr. Carrie Bernard (University of Toronto) writes in CMAJ about her journey. “I am a committed family physician, skilled researcher and respected leader at my university. And I suffer from depression. Why is that so difficult to write?”

DG

Continue reading

Reading of the Week: Cuijpers on Depression Treatment (WP); Also, Suicide (NEJM), and Sinyor on DeRozan & Depression (Star)

From the Editor

How to treat depression? How do we approach suicide? Who is the greatest Raptor of all time?

This week, we consider three pieces.

In the first selection, Pim Cuijpers (Vrije Universiteit Amsterdam) and his co-authors do a network meta-analysis of depression treatment, weighing psychotherapy, pharmacotherapy, and the combination of the two. They find: “combined treatment is more effective than psychotherapy or pharmacotherapy alone in the short‐term treatment of moderate depression, and there are no significant differences between psychotherapy and pharmacotherapy.”

In a short New England Journal of Medicine paper, Drs. Seena Fazel (Oxford University) and Bo Runeson (Karolinska Institutet) review a topic of relevance to all clinicians: suicide. “Management of suicidality calls for a comprehensive approach to assessment and treatment.”

TORONTO, ON - SEPTEMBER, 25 DeMar DeRozen poses for photos. It was media day for the Toronto Raptors at their training facility, the BioSteel Centre. Coaches and players met with media, answered questions and had a variety of photographs taken. (Richard Lautens/Toronto Star via Getty Images)Yes, we talk about basketball this week

Finally, in the third selection, the University of Toronto’s Dr. Mark Sinyor writes about basketball and his favourite Raptor – and, yes, stigma.

DG

Continue reading

Reading of the Week: Too Few Psychiatrists? Anderssen on the Gap in Access (Globe); Also, Cuijpers on Success in Depression Treatment (Expert Review)

From the Editor

After a break, the Readings are back. In the coming weeks, we will consider important papers on depression treatment, cannabis, help for the homeless, and more.

This week, there are two selections.

In the first selection, we consider the new Globe and Mail essay by reporter Erin Anderssen on the supply (or the lack of supply) of psychiatrists across Canada. This essay does a sparkling job of pulling together stories and reports, and includes an overview of the literature. It paints a familiar, if unsettling, picture of need unmatched by availability, and includes interviews and original data analysis.

She writes: “The modern psychiatrist can’t be everywhere. So they should be where Canadians need them most.”

We summarize the essay and some of the larger questions raised.

anderssenErin Anderssen

In the second selection, the Vrije Universiteit Amsterdam’s Pim Cuijpers writes about depression and treatment. Thinking about successful care, he asks a simple question: “When patients seek treatment, is a reduction of depressive symptoms really what they want, or do patients have other goals as well?”

DG

Continue reading

Reading of the Week: Cutting-Edge Care – Esketamine for Depression (NEJM), Digital Psychiatry for Suicide Prevention (JAMA Psych), Asylums for All (AJP)

From the Editor

This time of year, many doctors take to social media to offer advice to young colleagues as they start their specialty training (#TipsForNewDocs). Generally, the tweets give solid suggestions on everything from the importance of mentorship to doing regular exercise. For those new grads beginning psychiatry training, I offer: read more, the field is evolving. Since I started my psychiatry residency 19 years ago this month, we have seen new antidepressants placed into the drug cabinets of our patients, mental-health apps populate their smart phones, and clinical guidelines enter our practices, helping us better manage their mental illness.

This week’s Reading focuses on cutting-edge care, and there is plenty to read.

In our first selection, we consider a new paper from The New England Journal of Medicine. Written by Dr. Jean Kim and four other FDA officials, the authors discuss esketamine for depression. “The drug represents an important addition to the treatment options for patients with treatment-resistant depression.”

nasal-spray-sEsketamine: from club drug to depression care

In our second selection, Dr. John Torous (of Harvard Medical School) and Rheeda Walker (of the University of Houston) consider digital psychiatry and suicide prevention, reviewing the field with cautious optimism. The paper opens with a single sentence that puts these efforts in perspective: “Because the rates of suicide attempts and deaths have recently increased to 50-year highs,new solutions are needed.”

And, in our third selection, we look at a not-so-new editorial from The American Journal of Insanity that calls for better treatment of the poor.

Enjoy.

DG

 

Continue reading