Tag: depression

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

September 3, 2020 /

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

August 13, 2020 /

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

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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)

February 20, 2020 /

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.”

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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

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

January 30, 2020 /

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

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

January 23, 2020 /

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

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

July 18, 2019 /

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

 

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Reading of the Week: Dr. Farrell on Her Medical School Days & Her Depression

May 30, 2019 /

From the Editor

It’s been 19 years since I finished medical school. Though almost two decades have passed, medical schools are very similar today – the anatomy lessons, the white coat ceremony, the Hippocratic Oath.

But things appeared different then. No one seemed to have struggled with depression or anxiety. Except, of course, that people did – they struggled quietly, and with shame.

This week’s selection is short and moving, and was just published in JAMA. Dr. Colleen Farrell, a resident of internal medicine at NYU, writes about her depression during her med school days – and the lessons she has learned.

premednav_sinai_white_coat-jpg__750x325_q85_crop_subsampling-2_upscaleA white coat ceremony: 1 in 5 adults has a mental health problem – even here

This week, we consider Dr. Farrell’s essay.

DG

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Reading of the Week: Is Cannabis Helpful? Can We Prevent Depression? What’s It Like to be Depressed & in Medicine?

January 24, 2019 /

From the Editor

In most Readings of the Week, a paper or essay is selected and then discussed. This week, we return to an older format, and look at several selections, offering an overview of a few topics.

The selections ask thought-provoking questions:

Is cannabis helpful?

Can we prevent depression?

What’s it like to be depressed – and in medicine?

cbd-oil-cannabis-leaf-1296x728

Cannabis: Hype or Help?

Enjoy.

DG

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Reading of the Week: How to Improve Depression Treatment? Cuijpers in JAMA. Also, Kurdyak on Access & Goodman on Mental Health Screening for Docs

December 13, 2018 /

From the Editor

This week, we consider three provocative but thoughtful essays.

In the first selection, Vrije Universiteit Amsterdam’s Pim Cuijpers – a highly published researcher in depression – wonders what needs to be done to improve depression outcomes. In this JAMA paper, he notes the importance of the task: “One estimate suggests that approximately 30% of patients with depressive disorders have a chronic course with limited response to treatment.”

ketamine-a-miracle-drug-for-depression-or-not-rm-1440x810Is ketamine a possible breakthrough for depression? Cuijpers ask.

In the second selection, the University of Toronto’s Dr. Paul Kurdyak considers how to address the shortage of psychiatrists – and notes, in this healthydebate.ca essay, that the problem is more complicated than some would suggest; he argues that the supply of psychiatrists across Ontario has little impact on access because of practice styles.

Finally, in the third selection, Columbia University’s Matthew L. Goldman and his co-authors note that doctors are screened for TB. They ask: “Should physicians also be screened for mental health conditions such as depression or burnout?”

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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