Tag: depression

Reading of the Week: More Therapy, More Inequity? The New JAMA Psych Study; Also, Dr. Reimer on Living with Depression and Generative AI & Biases

January 23, 2025 /

From the Editor

What has been the most significant innovation in mental healthcare delivery in recent years? It wasn’t a new medication or therapy, but the widespread adoption of the webcam in 2020. Over the course of a handful of pandemic weeks, psychiatrists and therapists switched to virtual sessions, making it easier for people to receive care, including psychotherapy, unbound by geography, and thus addressing inequity – or, at least, that was the hope. As noted recently in The New York Times: “In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, one that could radically lower barriers to care.”

So, are more people receiving psychotherapy? And has this new era of virtual care resulted in better access for all? Dr. Mark Olfson (of Columbia University) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. Drawing on the data of more than 90 000 Americans, they analyzed trends in outpatient psychotherapy in the US, finding more care than ever before. That said, they note greater inequity: “psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access.” We consider the study and its implications.

As doctors, we often shy away from discussing our health, especially our mental health – even with our own physicians. This is particularly concerning because doctors have a higher suicide rate than the general population, yet fears of vulnerability, judgment, and stigma keep many of us silent. In this episode of Quick Takes, I sit down with Dr. Joss Reimer, president of the Canadian Medical Association, who openly shares her own experiences with depression, as a doctor and as a patient. “We all need help sometimes.”

And in the third selection, Matthew Flathers (of Harvard University) et al. analyze AI depictions of psychiatric diagnoses in a new paper for BMJ Mental Health. They tested two AI image models with different diagnoses and commented on the results. “Generative AI models acquire biases at every stage of their development – from societal prejudice in online training data, to the optimisation metrics and safety guidelines each developer puts in place. These layered biases persist even when their precise origins remain elusive.”

DG

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Reading of the Week: ECT & Maintenance – the New JAMA Psych Paper; Also, Social Contagion & Psychiatry and Dr. Julie Trivedi on Resilience

December 12, 2024 /

From the Editor

He didn’t get better despite several medication trials. Exhausted and feeling suicidal, he chose ECT. The change was incredible. When he returned to the clinic after discharge – bright and energetic – a member of the outpatient team didn’t recognize him. 

But how can we keep people like my patient well and out of hospital? How strong is the evidence supporting maintenance ECT? Dr. Anders Jørgensen (of the University of Copenhagen) and his co-authors attempt to answer these questions in a new JAMA Psychiatry paper. Drawing on a Danish national database and spanning almost two decades of data, they analyzed outcomes for nearly 20 0000 patients who began ECT, including the risk of hospitalizations. “In this cohort study involving patients who had ECT, continuing ECT was associated with a decreased risk of rehospitalization after the acute ECT series and also associated with reduced treatment costs.” We consider the paper and its implications.

Denmark: a land of islands, picturesque cities, and maintenance ECT

In the second selection, Dr. Joel Paris (of McGill University) ponders the societal increase in psychiatric problems, arguing that social contagion may be a factor. In a new BJPsych Bulletin paper, he focuses on non-suicidal self-injurious behaviour. “When clinical symptoms or mental disorders rapidly increase in prevalence, social contagion should be considered as a likely mechanism shaping changes in the form of psychopathology.”

And in the third selection from JAMA, Dr. Julie B. Trivedi (of The University of Texas System) discusses her depression and its treatment. She notes her hospitalization – and her coming to terms with her illness, as a physician, a parent, and a person. “Today, I am focused on bringing light to topics that are stigmatized, talking about topics like mental health and burnout in health care workers that everyone wants to fix but are without an adequate solution, raising awareness of how to recognize mental health challenges among health care professionals, being an advocate for others, and reminding everyone that help is needed.”

DG

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Reading of the Week: Physician Burnout – the New NEJM Review; Also, Depression in India and Dr. Ushna Shamoon on Bias

November 7, 2024 /

From the Editor

I started watching the clock, thinking about how much time is left in my day. That just started getting earlier and earlier. One day, at 8:35 am, I thought: Oh boy, it feels like I’ve been here a while already.

So comments a colleague on his burnout. 

More and more, we are discussing physician burnout. But how has the concept of burnout evolved over time? How is it distinct from depression? What are evidence-based interventions? Drs. Constance Guille (of the University of South Carolina) and Srijan Sen (of the University of Michigan) seek to answer these questions in a new review for The New England Journal of Medicine. Though they note challenges, including with the definition itself, they strike an optimistic tone. “Over the past 15 years, progress has been made in raising awareness about physician well-being and improving well-being in specific populations, including physicians in training. There is a clear pathway for investing in and implementing established interventions and developing new interventions to improve well-being for all physicians.” We consider the review and its implications.

In the second selection, Dr. Felix Teufel (of Emory University) and his co-authors explore the treatment of depression in India. In a new JAMA Psychiatry brief report, they drew on a national survey, finding limited care, particularly among those living in rural areas. “Nationwide, 97% of individuals with depression were undiagnosed, and around half of individuals with diagnosed depression were untreated.”

And, in the third selection from Academic Psychiatry, Dr. Ushna Shamoon (of the University of Texas) writes about her medical school rotation in a county jail. She discusses her biases before stepping into the correctional facility. She then describes her connection to an inmate suffering from mental illness. “Though her mind was riddled with psychosis, she was not just a victim of her illness.”

Note: there will be no Reading next week.

DG

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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: ED Visits & Suicide Attempts – the New AJP Study; Also, Smoking Cessation, and Pappas on Her Genes & Her Olympic Drive

August 8, 2024 /

From the Editor

Are ED visits for suicide attempts becoming more frequent? What are the implications for care?

In the first selection from The American Journal of Psychiatry, Dr. Tanner J. Bommersbach (of the Mayo Clinic) and his co-authors attempt to answer these questions by considering US trends in ED visits for suicide attempts and intentional self-harm. Using national survey data collected over a 10-year period, they estimate that the absolute number of suicide attempts tripled to 5.3 million. “A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita.” We analyze this study.

In the second selection, Drs. Robert A. Kleinman (of the University of Toronto) and Brian S. Barnett (of the Cleveland Clinic) write about smoking cessation and mental illness in a Viewpoint just published in JAMA Psychiatry. They note societal progress – smoking rates are sharply down over the past five decades – yet many with mental illness still use tobacco. They argue that psychiatrists have a significant role to play in addressing this problem. “Patients who stop smoking can limit tobacco-related illness, avoid the distressing effects of nicotine withdrawal and craving, and live longer.”

Later this week, the Olympics conclude in Paris. In the third selection, former Olympian Alexi Pappas discusses her mother’s suicide and her own struggles with depression. In a deeply personal essay from The New York Times, she contemplates genes and destiny and healing. “My future – the universe where my fear lives – was never set in stone, and neither was my mom’s. I’m more than my genes, and I would not reroll the dice if given the option.”

There will be no Readings for the next two weeks.

DG

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Reading of the Week: the CANMAT Depression Update – Seven Takeaways & Commentary; Also, Patient Preferences for Televideo Backgrounds

May 23, 2024 /

From the Editor

Much has changed in the past eight years. In 2016, singer Olivia Rodrigo was starting high school. Quarterback Tom Brady seemed ageless. And none of us were talking about pandemics. 2016 was also the year when the last Canadian Network for Mood and Anxiety Treatments (CANMAT) depression guidelines were released. Well, it’s 2024 and the update has just been published in The Canadian Journal of Psychiatry. 

How has depression management changed over these past eight years, and how should you adjust your clinical practice? In the first selection, we look at seven takeaways and a commentary.

Melancholia (from the Wellcome Library)

In this week’s other selection, Dr. Nathan Houchens (of the University of Michigan) and his co-authors consider telemedicine video backgrounds in a new research letter from JAMA Network Open. They asked patients to rate different backgrounds and in various medical circumstances; they report on survey results of more than 1 200 patients. “In this study, two-thirds of participants preferred a traditional health care setting background for video visits with any physician type, with physician office displaying diplomas rated highest.”

DG

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Reading of the Week: Adolescent Experience with Illness – the World Psych Paper; Also, the CANMAT Depression Update and a Letter to the Editor

May 16, 2024 /

From the Editor

I’m separated from everyone else.

These are the words of a young patient with depression. We often use diagnoses and lists of symptoms to understand patients. But how do patients themselves understand their illness? In the first selection, Dr. Paolo Fusar-Poli (of King’s College London) and his co-authors attempt to answer that question with a “bottom-up” approach. In a new World Psychiatry paper, they describe the experiences of adolescents with mental disorders. “The study was co-designed, co-conducted and co-written by junior experts by experience – representing different genders, ethnic and cultural backgrounds, and continents – and academics, refining an earlier method developed by our group to investigate the lived experience of psychosis and depression.” We examine the paper and its implications.

Childhood depression by Marc-Anthony Macon

Much has changed over the past eight years – who was talking about pandemics in 2016? Last week, the Canadian Network for Mood and Anxiety Treatments (CANMAT) released its first major depression update in eight years. So how has depression management changed? In the second selection, Dr. Raymond Lam (of the University of British Columbia), the co-first author, discusses the update in a Quick Takes podcast interview. “They really are the most widely used guidelines in the world.” 

And in the third selection, in a letter to the editor, Nick Kerman (of the University of Toronto) writes about the recent homelessness paper from JAMA Psychiatry, summarized in a Reading earlier this month. He notes the striking finding: 26% meet the criteria for antisocial personality disorder. “Could it really be 1 in 4 or is there something else that could explain the finding?”

DG

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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: tDCS for Depression – the New JAMA Psych Paper; Also, Psychiatrists & AI and Dr. Daniel Gorman on Charlatan Syndrome

April 11, 2024 /

From the Editor

In her autobiography, psychiatrist Linda Gask writes about her struggles with depression and the moment she realized that she was better: she started to hear the birds chirping again. For many of our patients, the songs of the birds remain elusive. Antidepressants work but some patients don’t respond, and others are cool to the idea of medication management. CBT is effective but difficult to access. What about Transcranial Direct Current Stimulation (tDCS) – an intervention that could be done at home?

Dr. Lucas Borrione (of the University of São Paulo) and his co-authors try to answer that question in a new JAMA Psychiatry paper. They report on a randomized clinical trial including 210 Brazilian adults with a major depressive episode who were offered tDCS and a digital intervention; the study featured two sham interventions. “The findings indicate that unsupervised home use tDCS should not be currently recommended in clinical practice.” We consider the paper and its clinical implications.

Would tDCS have helped?

Artificial intelligence is having a moment. Not surprisingly, many are seeing the possibilities for mental health care, from better therapy to reduced paperwork. In the second selection, from Psychiatry Research, Charlotte Blease (of Uppsala University) and her co-authors report on the findings of a survey of 138 psychiatrists with both qualitative and quantitative data. “The foremost interest was around the potential of these tools to assist psychiatrists with documentation.”

And in the third selection, Dr. Daniel Gorman (of the University of Toronto) writes about the struggles of taking a child to Disney World in JAMA. Any parent – or aunt or cousin or older sib – can relate. But Dr. Gorman notes the particular challenges that he faces: he’s a child psychiatrist. “Sometimes I fantasize about sharing with parents my doubts about parenting strategies, but the risks always seem too great – the risk of discrediting myself and my profession and the risk of robbing parents of agency and hope.”

DG

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Reading of the Week: Do ADHD Meds Reduce Mortality? The New JAMA Psych Study; Also, Dr. Rebecca Lawrence on Her Husband & His Support

April 4, 2024 /

From the Editor

For my patient, ADHD medications transformed his life, helping him focus at school and at work – and even drive better. Many have had similar experiences. Do ADHD medications also reduce mortality? We know that those with ADHD have higher mortality rates and thus it’s reasonable to ask about the possible benefits of methylphenidate and sister drugs.

Lin Li (of the Karolinska Institutet) and her co-authors try to answer that question in a new JAMA Psychiatry paper. Drawing on Swedish databases, they analyzed data from almost 150 000 people with ADHD and looked at two-year mortality, including for those who die by unintentional injuries, suicide, or poisonings, by doing a target trial emulsion – simulating a randomized trial. “Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.” We consider the paper, the editorial that accompanies it, and the clinical implications.

ADHD meds: life saver?

And in the other selection, Dr. Rebecca Lawrence writes about support in a blog for Doctor and Patient. She is personal – besides working as psychiatrist, Dr. Lawrence has been treated for depression, including with ECT. She notes the incredible help her husband has given her over the years. “I look at myself in the mirror and am appalled, but he still smiles at me.

DG

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