Tag: depression

Reading of the Week: Global Burden of Schizophrenia – the new Molecular Psych Study; Also, MedEd’s Evolution & Saxbe on Helping Depressed Teens

November 30, 2023 / / 0 Comments

From the Editor

Is there more mental illness than before? Or is there greater awareness? 

Dr. Marco Solmi (of the University of Ottawa) and his co-authors attempt to answer these questions in a new paper for Molecular Psychiatry that focuses on schizophrenia. Drawing on 30 years of data globally, they consider prevalence (how many have the illness), incidence (the number who develop it each year), and the disability-adjusted life-years (the loss of one healthy year of life) using more than 86 000 points of data. They find: “Globally, we show that, from 1990 to 2019, raw prevalence increased by over 65%, incidence by 37.11%, DALYs by over 65%, but age-adjusted prevalence and incidence estimates showed a slight decrease, and burden did not change.” We consider the paper and its implications.

Textbooks, highlighters, and classrooms? The world of medical education is changing. Today, we have AI, sim, and e-learning. In the second selection, we look at the new Quick Takes podcast with Dr. Ivan Silver (of the University of Toronto), former vice president of education at CAMH who marvels at the potential. “This is the renaissance period for health professional education.” 

And in the third selection, psychologist Darby Saxbe (of the University of Southern California) writes in The New York Times about ways to help depressed adolescents. Drawing on recent studies showing the failure of school-based psychosocial interventions, she argues for a different approach. “It’s critical to keep pace with the evidence and attend to the first principle of all health care providers: First, do no harm.”

DG

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Reading of the Week: Self-stigma & Depression – the new JAD Study; Also, ChatGPT & Mental Health Care, and Dr. Catherine Hickey on the Opioid Crisis

November 2, 2023 /

From the Editor 

Depression is the result of character weakness. So explained my patient who had a major depressive disorder and hesitated to take medications.

Though fading, stigma about mental illness continues to exist, including self-stigma, the negative thoughts and beliefs that patients have about their own disease – as with my patient. How common is self-stigma? How does its prevalence differ around the globe? What are risk factors for it? Nan Du (of the University of Hong Kong) and co-authors attempt to answer these questions in a new Journal of Affective Disorders paper. They do a systematic review and meta-analysis of self-stigma for people with depression, drawing on 56 studies with almost 12 000 participants, and they a focus on international comparisons. “The results showed that the global prevalence of depression self-stigma was 29%. Levels of self-stigma varied across regions, but this difference was not significant.” We consider the paper and its clinical implications.

In this week’s second selection, we look at ChatGPT and mental health care. Dr. John Torous (of Harvard University) joins me for a Quick Takes podcast interview. He sees potential for patients – including making clinical notes more accessible by bridging language and knowledge divides – and for physicians, who may benefit from a more holistic differential diagnosis and treatment plan based on multiple data sets. He acknowledges problems with privacy, accuracy, and ChatGPT’s tendency to “hallucinate,” a term he dislikes. “We want to really be cautious because these are complex pieces of software.” 

And in the third selection, Dr. Catherine Hickey (of Memorial University) writes about the opioid crisis for Academic Psychiatry. The paper opens personally, with Dr. Hickey describing paramedics trying to help a young man who had overdosed. She considers the role of psychiatry and contemplates societal biases. “[I]n a better world, the needless deaths of countless young people would never be tolerated, regardless of their skin color.”

DG

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Reading of the Week: Running vs SSRIs for Depression – the new JAD Paper; Also, Climate Change & Mental Health, and Understanding My Schizophrenia

October 26, 2023 /

From the Editor

“Go for a Run to Beat Depression – It’s Just As Effective As Taking Medication”

– New York Post

“Running could be just as effective at treating depression as medication, scientists find”

– The Independent

Patients often ask what they can do to get better from their depression. Should we be advising them to put on a pair of runners and go for a jog? A new paper published in the Journal of Affective Disorders seems to suggest as much – and it’s caused a bit of media buzz. In the first selection, Josine E. Verhoeven (of Vrije Universiteit Amsterdam) and her co-authors describe this 16-week study that offered 141 people with depression and/or anxiety either a running intervention or medications, and looked at several mental and physical health outcomes. “We showed that while antidepressant medication and running therapy did not statistically significantly differ on mental health outcomes… the interventions had a significantly different and often contrasting impact on several physical health outcomes, with more favorable outcomes for those in the exercise intervention.” We consider the paper and its implications.

In the second selection, Pim Cuijpers (of Vrije Universiteit Amsterdam) and his co-authors discuss climate change and mental health in a new viewpoint for JAMA Psychiatry. Though they note the lack of high-quality research in the area, they argue that it would disproportionately affect low and middle-income nations. They then point a way forward. “There is no doubt that climate change will have a major impact on mental health in the coming decades.”

And in the third selection which is written anonymously, a person with schizophrenia talks about his experiences in a paper for Schizophrenia Bulletin. He tries to empower himself, working to limit side effects and cope with the voices. “My brain disease is incurable, but it is not an excuse for me to be irresponsible or to give up on life.” 

DG

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Reading of the Week: Health Care Workers & Suicide – the new JAMA Paper; Also, Esketamine vs Quetiapine for Treatment-Resistant Depression (NEJM)

October 12, 2023 /

From the Editor

Sure, we are biased – but ours is a different type of job. Working in health care can involve life and death situations and trying to help those who are at their most vulnerable. The stakes can be high. 

But how does such work affect the workers themselves? Dr. Mark Olfson (of Columbia University) and his co-authors try to answer that question in a new paper for JAMA. In it, they analyze suicides among six different types of health care workers, including physicians, by drawing on a US data that offers a nationally representative sample from 2008 to 2019, including 1.84 million people. “Relative to non-health care workers, registered nurses, health technicians, and health care support workers in the US were at increased risk of suicide.” We consider the paper and its implications.

And in the other selection, Dr. Andreas Reif (of the University Hospital Frankfurt) and his co-authors focus on treatment-resistant depression. In this new paper published in The New England Journal of Medicine, they report on the findings from a study where 676 patients were randomized to either esketamine nasal spray or an antipsychotic augmenting agent in addition to an antidepressant. “In patients with treatment-resistant depression, esketamine nasal spray plus an SSRI or SNRI was superior to extended-release quetiapine plus an SSRI or SNRI with respect to remission at week 8.” We also look at the accompanying editorial.

DG

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Reading of the Week: Telepsych vs. In-Person Treatment – the new BJP Paper; Also, Rethinking Palliative Care in Psychiatry and Kemp on His Depression

September 21, 2023 /

From the Editor

When the pandemic started in 2020, the webcam sitting on my desk had barely been used. Of course, over the following days, it became an indispensable part of my outpatient practice as terms like “lockdown” and “Zoom fatigue” entered the common lexicon. 

As we move past the pandemic, questions arise. Who benefits from telepsychiatry? And who is better served with in-person visits? Katsuhiko Hagi (of the Sumitomo Pharma Co.) and co-authors attempt to answer these questions with a new systematic review and meta-analysis, just published in The British Journal of Psychiatry. They analyzed 32 papers, involving 3 600 people, across 11 mental illnesses. “Telepsychiatry achieved a symptom improvement effect for various psychiatric disorders similar to that of face-to-face treatment. However, some superiorities/inferiorities were seen across a few specific psychiatric disorders, suggesting that its efficacy may vary according to disease type.” We consider the paper and its implications.

In the second selection, Kwok Ying Chan (of Grantham Hospital) and his co-authors discuss palliative care. In a Viewpoint paper for JAMA Psychiatry, they note that some patients with severe mental illness could benefit from palliative care – yet such care is less available to those with mental disorders than the general population. They highlight challenges and then outline “a more sustainable model for the collaboration between palliative care and psychiatric teams.”

And in the third selection, health care executive Joe Kemp writes about his struggles with suicidal thoughts and substance misuse. In a deeply personal essay for the New York Post, he talks about turning around his life. “I can’t deny my drug-addled past, or that I’m a survivor of two suicide attempts. But I can proudly show the man I am today as someone who has dignity and self-respect; I’ve acquired the most important things to live a happy life. I just followed a different path to get here.”

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: tDCS vs Sham for Depression – the New Lancet Paper; Also, US Ketamine Seizures and Dr. Lamas on Medical Practice & AI

July 13, 2023 /

From the Editor

He’s tried several medications, but still struggles with his depression. The story is too familiar. Transcranial direct current stimulation (tDCS) is an option, and increasingly the focus of research. With relatively few side effects and the possibility of doing the treatment at home, the advantages of tDCS are clear.

But how do patients taking antidepressants respond? In the first selection, from the pages of The Lancet, Dr. Gerrit Burkhardt (of the University of Munich) and his co-authors report the findings of an impressive study, with a comparison against sham treatment, across eight sites, and involving triple blinding. “Active tDCS was not superior to sham stimulation during a 6-week period. Our trial does not support the efficacy of tDCS as an additional treatment to SSRIs in adults with MDD.” We consider the paper, an accompanying Comment, and the implications.

In the second selection, Joseph J. Palamar (of New York University) and his colleagues analyze data on US ketamine seizures in a Research Letter for JAMA Psychiatry. They view seizures as a measure of recreational and nonmedical use, and conclude: “These data suggest increasing availability of illicit ketamine.”

And in this week’s third selection, Dr. Daniela J. Lamas (of Harvard University), an internist, writes about AI for The New York Times. In thinking about medical practice, she sees artificial intelligence doing more and more, and ultimately helping with diagnosis. She also sees trade-offs. Still, she concludes: “Beyond saving us time, the intelligence in A.I. – if used well – could make us better at our jobs.”

Note that there will be no Reading next week.

DG

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Reading of the Week: Pricing and Alcohol – the New Lancet Paper; Also, Mental Health & the Music Industry and Dr. O’Riordan on Her Depression

July 6, 2023 /

From the Editor

How to reduce alcohol consumption? That question is more relevant than ever, given evidence of increased use in Canada during the pandemic. Recently, Scotland has experimented with minimum unit pricing (MUP) – unlike a tax increase that raises the cost of all alcohol, MUP disproportionally affects low-cost wines and ciders, more likely to be consumed by heavy drinkers. 

In the first selection, Grant M. A. Wyper (of the University of Glasgow) and his co-authors consider the Scottish data. In a new paper for The Lancet, they do an impressive analysis, with a controlled interrupted time series, looking at time before and after the MUP, and contrasting Scottish and (non-MUP) English data. They find: “The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations…” We look at the paper and its implications.

Scotland: a land of hills, lakes, and excessive alcohol consumption

In the second selection, George Musgrave (of the University of London) and his co-authors consider the connection between musicians and mental health. In a Comment for The Lancet Psychiatry, they note: “Great advances have been made in the field of musicians’ mental health.” But they argue that “further dialogue between all major stakeholders is needed if, collectively, we are to shape this emerging intervention landscape to serve the target population effectively, both the musicians themselves and the teams around them.”

And in the third selection, from the pages of the Daily Mail, Dr. Liz O’Riordan describes her career as a surgeon – and her secret battle with depression. In a personal essay, she talks about her decision to speak out. “I’ve got better at asking for help and looking after myself. But I’m not ashamed of depression. It’s part of me, and that’s OK.”

DG


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Reading of the Week: Xylazine – the New NEJM Paper; Also, Probiotics for Depression (JAMA Psych) and the New Drug Crisis (Nat Affairs)

June 29, 2023 /

From the Editor

Is xylazine the new fentanyl?

In the first selection, Dr. Rahul Gupta (of the University of Pennsylvania), who serves as the US Director of National Drug Control Policy, and his co-authors write about xylazine in The New England Journal of Medicine. They describe the emergence of this medication, intended for veterinarian uses, as a substance of abuse. They note its presentation and ask research questions. “Our goal is for the designation of xylazine as an emerging threat and subsequent actions to begin to address this threat before it worsens and undermines efforts to reduce illicit fentanyl use in the United States.” We consider the paper and its implications.

In the second selection, from JAMA Psychiatry, Viktoriya L. Nikolova (of King’s College London) and her co-authors look at probiotics – an area of increasing interest for those with mood and anxiety problems. They report on the findings of a small RCT involving people with depression who took an antidepressant but had an incomplete response. “The acceptability, tolerability, and estimated effect sizes on key clinical outcomes are promising and encourage further investigation of probiotics as add-on treatment for people with MDD in a definitive efficacy trial.”

And in the third selection, Charles Fain Lehman (of the Manhattan Institute) comments on the new drug crisis in a long essay for National Affairs. Lehman notes the rise of the synthetic agents (think fentanyl replacing heroin) and its impact on people, particularly in terms of overdoses. “Today’s drug cycle is different from previous ones, measured not just in the number of people addicted, but the number dead. Reducing the growth of that figure, now more than ever, is a vital task for policymakers to undertake.”

DG

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Reading of the Week: IPT for Depression in Pregnancy – the New JAMA Psych Paper; Also, Treating Opioid Use (JAMA) and Substance Ed for Docs (Wash Post)

June 22, 2023 /

From the Editor

Prenatal depression affects two: the mother and her fetus. But how to effectively address depressive symptoms?

In the first selection, from JAMA Psychiatry, Benjamin L. Hankin (of the University of Illinois at Urbana-Champaign) and his co-authors consider a focused psychotherapy for that population. In a RCT involving 234 participants, they find that IPT was helpful. “Brief IPT significantly reduced prenatal depression symptoms and MDD compared with EUC [enhanced usual care] among pregnant individuals from diverse racial, ethnic, and socioeconomic backgrounds recruited from primary OB/GYN clinics.” We look at the paper and its clinical implications.

In the second selection, Caroline King (of the Oregon Health & Science University) and her co-authors consider buprenorphine for opioid use disorder with a focus on adolescent residential treatment. In a JAMA research letter, they report the findings which included every identified facility in the United States. “In contrast to the standard of care, only 1 in 4 US facilities offered buprenorphine and 1 in 8 offered buprenorphine for ongoing treatment.”

And, in the third selection, former AMA president Dr. Patrice A. Harris (of Columbia University) and her co-authors argue that physicians should know more about addiction treatment. In a Washington Post essay, they argue for more robust training. “Opioid use disorder is treatable, and medicines are readily available. But doctors cannot learn to help patients by taking a weekend course alone.”

DG


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