Tag: ECT

Reading of the Week: MST vs ECT – the new JAMA Psych Study; Also, Dr. Niall Boyce on Frasier and the Latest in the News

December 14, 2023 /

From the Editor

Electroconvulsive therapy, or ECT, is a highly effective treatment for depression. But patients often complain about side effects, including cognitive problems.

Could magnetic seizure therapy, or MST, provide the benefits of ECT without these issues? In a new paper for JAMA Psychiatry, Zhi-De Deng (of Duke University) and co-authors attempt to answer that question. In a study where 73 patients with depression were given ECT or MST, they found similar results. “This randomized clinical trial found that the efficacy of MST was indistinguishable from that of ultrabrief pulse [right unilateral] ECT, the safest form of ECT currently available.” We consider the paper and its implications.

In the second selection, Dr. Niall Boyce (of the Wellcome Trust) mulls the return of Frasier Crane, the “pompous but kind-hearted American psychiatrist.” In a Lancet perspective, he writes about the original TV comedy and the new revival of Frasier – and also notes the change in perception of psychiatry over the years. His assessment of the show: “Is the new Frasier worth watching? On the early evidence, I would say yes.”

And, finally, we explore the latest in the news with consideration of recent articles from The Globe and Mail and other publications. Among the topics: the (over) prescription of antidepressants, safe supply, and hairdressers and psychotherapy in Togo.

DG


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Reading of the Week: Ketamine vs. ECT – the New NEJM Paper; Also, Burnout & Depression (QT) and Rehab for Schizophrenia (Wash Post)

June 1, 2023 /

From the Editor

“Ketamine Shows Promise for Hard-to-Treat Depression in New Study”

 – The New York Times

The gold standard for treatment-refractory depression has been ECT. Last week, The New England Journal of Medicine published a new study by Dr. Amit Anand (of Harvard University) and his co-authors comparing ketamine with ECT. They did a noninferiority trial, with more than 400 people. The results have been widely reported, including in The New York Times. They write: “This randomized trial evaluating the comparative effectiveness of ketamine and ECT in patients with treatment-resistant depression without psychosis showed noninferiority of ketamine to ECT…” We discuss the paper and the accompanying Editorial.

A recent Canadian Medical Association survey found that the majority of physicians reported experiencing high levels of burnout. In the second selection, Dr. Srijan Sen (of the University of Michigan) discusses this timely topic in a new Quick Takes podcast. He talks about the definition(s) of burnout, and the overlap with depression. “Burnout has become a loose term that means different things to different people.”

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) and his co-authors discuss the life and death of New Yorker Jordan Neely. In an essay for The Washington Post, they argue for better care, in particular with a focus on rehabilitation services for those with schizophrenia. “People with other brain disorders are not abandoned to become homeless or incarcerated rather than receive medical help.”

DG

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Reading of the Week: ECT & Suicide – the New Lancet Psych Paper; Also, Violence & Psych Trainees (Acad Psych) and Dr. Murthy on Burnout (NEJM)

July 21, 2022 /

From the Editor

In a recent survey, 20% identified fear of death as a major concern with ECT. One of the oldest treatments in psychiatry is also its most stigmatized and feared.

And is it also underappreciated? Is ECT a lifesaver for those who are suicidal? In the first selection, Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer that question with a propensity score-weighted, retrospective cohort study comparing those who received ECT and those who didn’t, using Ontario data. In The Lancet Psychiatry, they write: “1 year after discharge from a psychiatric hospital, patients with depression who were exposed to electroconvulsive therapy had a nearly 50% reduction in the relative risk of death by suicide when compared with those who had not been exposed.” We consider the paper and its clinical implications.

We aren’t talking about candy

In the second selection, Dr. Victor Pereira-Sanchez (of the New York University) and his co-authors look at violence against European psychiatric trainees. In this Academic Psychiatry paper, drawing on survey data, they conclude: “Violence from patients is reported by many psychiatric trainees across countries in Europe, with very frequent verbal abuse and worrisome figures of physical and sexual assaults.”

Finally, in the third selection, Dr. Vivek H. Murthy (the US Surgeon General) writes about burnout and American health care workers. In The New England Journal of Medicine, he offers a practical plan, with an emphasis on reducing administrative burden, bettering mental health for health care workers, and changing culture to support well-being. He argues that action is needed: “we cannot allow ourselves to fail health workers and the communities they serve.”

DG

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Reading of the Week: No Better Than Placebo? Debating Antidepressants and ECT, with Papers from Psychological Medicine

June 9, 2022 /

From the Editor

Antidepressants don’t work. Medications fail to address the real cause of depression. ECT is basically a placebo.

These statements are controversial, but they are mentioned often – including by some of our patients. But what does the literature say about depression management? This week, we look at the debate over antidepressants and ECT, drawing on two recent papers from Psychological Medicine.

In the first selection, John Read (of the University of East London) and Dr. Joanna Moncrieff (of University College) argue that our approach to depression is flawed. In a longer paper that draws on more than 120 references, they challenge basic assumptions about mental health care, arguing against antidepressants and ECT. They advocate for an alternative: “Understanding depression and anxiety as emotional reactions to life circumstances, rather than the manifestations of supposed brain pathology, demands a combination of political action and common sense.”

Were Ali and Frazier having a fight over depression management?

In the other selection, Dr. Carmine M. Pariante (of the King’s College London) agrees to disagree. In a Psychological Medicine paper, he responds. “I have written a piece that tries to put together their point of view with the available evidence, while acknowledging the complexity of the debate.” 

DG

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Reading of the Week: ECT – the New NEJM Review; Also, Ethnicity & Drug Overdoses (JAMA) and Neil Seeman on His Father (CMAJ)

March 10, 2022 /

From the Editor

He has tried different medications, and yet he continues to struggle. The months have turned into years. When he was last well, he worked two jobs and was physically active, hoping to run the Boston marathon one day. When I saw him, he explained that he has difficulty following the plot of a TV show. Asked if he had ever considered ECT, his eyes widened. “They still do that?”

In the first selection, we look at a new review paper on ECT from The New England Journal of Medicine. Drs. Randall T. Espinoza (of the University of California, Los Angeles) and Charles H. Kellner (of the Medical University of South Carolina) provide a concise summary of the latest evidence. They conclude: “ECT is a valuable treatment for several severe psychiatric illnesses, particularly when a rapid response is critical and when other treatments have failed.” We consider the paper and the ongoing stigma associated with the treatment.

In the second selection, Joseph R. Friedman and Dr. Helena Hansen (both of the University of California, Los Angeles) draw on American data to consider overdose deaths and ethnicity. The JAMA Psychiatry paper concludes: “In this cross-sectional study, we observed that Black individuals had the largest percentage increase in overdose mortality rates in 2020, overtaking the rate among White individuals for the first time since 1999, and American Indian or Alaska Native individuals experienced the highest rate of overdose mortality in 2020 of any group observed.”

And in the third selection, Neil Seeman (of the University of Toronto) considers the life and death of his father, Dr. Philip Seeman, the celebrated scientist who studied schizophrenia. In this CMAJ essay, he comments on dopamine and his father’s life work. And he also writes about his relationship and dying. “It was that giving ice chips to my father will forever remind me of how the sensation of touch can stir love, fetch memories, and offer solace.”

DG

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Reading of the Week: Is ECT Really Safe? The New Lancet Psychiatry Paper; Also, Antrim on His ECT (New Yorker)

August 26, 2021 /

From the Editor

Is it safe?

The first treatment of electroconvulsive therapy (ECT) was administered in 1938. Yet decades later, people still debate the safety of this treatment; a study found that one in five patients reported fear of death as a major concern. (And, yes, so many of our patients have seen that movie.)

In our first selection, we consider a new and important paper on this topic, just published in The Lancet Psychiatry. Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors attempt to answer the safety question by comparing those who received ECT with those who didn’t in the context of depression and inpatient care. “In this population-based study of more than 5000 admissions involving electroconvulsive therapy for inpatients with depression, the rate of serious medical events within 30 days was very low among those exposed to electroconvulsive therapy and a closely matched unexposed group (0.5 events per person-year vs 0.33 events per person-year), with those who received electroconvulsive therapy having a numerically lower risk of medical complications.” We look at the big study, with an eye on clinical implications.

ect-1945ECT machine (cira 1950)

In the other selection, we look at a new essay from The New Yorker. Writer Donald Antrim – an accomplished novelist and a MacArthur fellow – discusses his depression, his suicidal thoughts, and his decision to opt for ECT. He notes that after treatment: “I felt something that seemed brand new in my life, a sense of calm, even happiness.”

DG

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Reading of the Week: ECT at 82

December 3, 2020 /

From the Editor

If you were ill with depression, would you consider electroconvulsive therapy? What if you had a manic episode?

In April 1938, the first treatment of ECT was administered in Rome. Now, 82 years later, ECT continues to be used. But, as Dr. David Goldbloom (of CAMH) notes: “ECT has the unusual status of being one of the most vilified and validated treatments in all of psychiatry and indeed in all of medicine.” The treatment has fallen out of favour, and is not even offered in certain centres.

But would you consider ECT?

In the first selection, we look at a new paper from Psychiatric Services. Dr. Rebecca E. Barchas, a retired psychiatrist, discusses her experiences with ECT – as a patient, not as a physician. She notes the depths of her depression and the decision to receive ECT, which she didn’t know much about despite many years of practice. “If reading these thoughts can help even one more patient who needs ECT accept it or help one more physician to consider recommending it when appropriate, I will have accomplished my goal of helping to destigmatize ECT.”

birthday-cake-1200ECT at 82: Still relevant?

In the second selection, we consider a narrative review from The American Journal of Psychiatry. ECT for patients experiencing manic episodes is used less and less often; in several recent surveys, no patient with mania received ECT. But what’s the evidence? Dr. Alby Elias (of the University of Melbourne) and his co-authors review decades’ worth of literature, from RCTs to retrospective studies, finding the treatment is safe and effective. But is it relevant in an era of pharmacology?

DG

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

November 5, 2020 /

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.”

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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

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Reading of the Week: ECT & Equity (CJP); also, COVID and Mental Health Surveys (Policy Options) and Farrell on Witnessing the Pandemic (Nation)

July 23, 2020 /

From the Editor

Who has better access to care?

This week, we have three selections. The first is a paper about inpatient ECT – an important topic. And the study – just published in The Canadian Journal of Psychiatry – has interesting findings, including that ECT is not particularly commonly performed (for just 1 out of 10 inpatients with depression). But this new paper by Dr. Tyler S. Kaster (of the University of Toronto) and his co-authors also touches on the larger issue of equity. We consider it – and the questions the study raises.

ect-maching

The second selection is an essay from Policy Options. Drs. Scott Patten (of the University of Calgary) and Stan Kutcher (of Dalhousie University) bemoan the state of mental health data during the pandemic. “There has been a disturbing acceptance of trivial and often misrepresented information, delivered from sub-optimal surveys and problematic interpretation of results.”

Finally, we consider an essay by Dr. Colleen M. Farrell (of Cornell University). She discusses COVID-19 – she is working in the ICU of a major New York City hospital during the pandemic – but also ties to the larger issues of public health, advocacy, and the role of medicine. “As I tend to my patients in the Covid ICU, I struggle to process reality. The attending physicians who are my teachers have few answers; this disease is new to all of us.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: Mental Health & the Opinion Pages – Mental Health Reform (Star), ECT (Guardian), and Suicide and “13 Reasons Why” (LA Times)

August 1, 2019 /

From the Editor

“Mental health is out of the closet. Now that we’ve opened the door, time for a closer look at what’s been out of sight for so long.”

This week, we consider three selections. They appeared in newspapers in recent days, and discuss mental health topics. The opening quotation – which is from the first essay – applies to all of them; a closer look: calls for more debate about how mental health services are organized, the care that patients are offered, and the way mental illness is portrayed in our culture.

In our first selection, we consider an op ed from Toronto Star columnist Martin Regg Cohn. He wonders about improving access to mental health care. In a provocative essay, he mulls the mismatch between the supply and demand of services (particularly psychiatric services). He argues: “We might as well accept that our mental health spending will increase significantly over the years. All the more reason to start reallocating funds wisely now.”

newspapersThree Selections, Three Newspapers

In the second selection, we look at an essay by Dr. Mariam Alexander, an NHS psychiatrist, who discusses ECT. She opens simply: “It might come as quite a surprise to learn that, as a psychiatrist, if I ever had the misfortune to develop severe depression, my treatment of choice would be electroconvulsive therapy (ECT).”

And in our third selection, the University of Toronto’s Dr. Mark Sinyor considers the popular show “13 Reasons Why” and offers a cautionary note about the portrayal of suicide. The LA Times op ed notes that Netflix and others have “the potential to do good in the world when handling sensitive mental health issues.”

Enjoy.

DG

 

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