Tag: Humphreys

Reading of the Week: Antidepressants & Bipolar – the New NEJM Paper; Also, AI & Med Ed and Humphreys on Language

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: Mindfulness Self-Help for Depression? The New JAMA Psych Study; Also, Elderly Overdoses (JAMA Psych) and Sanford on Loss (JAMA)

From the Editor

He diagnosed himself. My patient suspected something was wrong, did some reading, and then completed a PHQ-9 survey (which he found on a website). But, like many, he struggled to get care.

The story is too familiar. Access to care is deeply problematic. Not surprisingly, then, low-cost interventions are of interest, with much work focused on CBT. What about mindfulness? In the first selection, Clara Strauss (of the University of Sussex) and her co-authors attempt to answer that question with direct comparison of mindfulness and CBT. In a new JAMA Psychiatry paper, they find: “practitioner-supported [mindfulness] was superior to standard recommended treatment (ie, practitioner-supported CBT) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness.” We consider the paper and its implications.

In the second selection, Keith Humphreys (of Stanford University) and Chelsea L. Shover (of the University of California, Los Angeles) look at overdose deaths in older Americans for JAMA Psychiatry. Drawing on a database, they find a quadrupling between 2002 and 2021. “Even though drug overdose remains an uncommon cause of death among older adults in the US, the quadrupling of fatal overdoses among older adults should be considered in evolving policies focused on the overdose epidemic.” 

And in the third selection, Dr. Ethan L. Sanford (of the University of Texas) writes about the loss of his infant daughter. In a deeply personal essay for JAMA, he describes her illness and death – and his re-evaluation of his career. “I sometimes wish every physician could understand the loss of a child. I wish they could understand how I miss Ceci achingly, how I miss her in my bones.”

DG

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Reading of the Week: Augmentation in the Elderly with Depression – the New NEJM Study; Also, Dr. Simpson on Violence (Globe)

From the Editor

“Approximately 30% of patients treated for depression do not have a response to selective serotonin-reuptake inhibitors (SSRIs).” So notes an Editorial in The New England Journal of Medicine. And for those who don’t respond, what’s the next step? 

Unfortunately, though many elderly struggle with depression, this population is understudied. In a new paper published in the same journal, Dr. Eric J. Lenze (of the Washington University in St. Louis) and his co-authors attempt to answer that question with a two-step intervention. “In older adults with treatment-resistant depression, augmentation of existing antidepressants with aripiprazole improved well-being significantly more over 10 weeks than a switch to bupropion and was associated with a numerically higher incidence of remission. Among patients in whom augmentation or a switch to bupropion failed, changes in well-being and the occurrence of remission with lithium augmentation or a switch to nortriptyline were similar.” We look at the study and its clinical implications, as well as the accompanying Editorial.

And, in the other selection, Dr. Sandy Simpson (of the University of Toronto) considers the violence seen on public transit in Canada’s largest city. In an essay for The Globe and Mail, he mulls several factors and points a way forward, including by advocating a guaranteed basic income. “We are seeing now that we have failed to create a compassionate society, and that security and safety needs to extend to all people. To achieve this, we need a change in heart, and expenditure.”

DG

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Reading of the Week: David Goldbloom on Research & Clinical Practice

 From a Contributing Editor, Colleague, and Friend of the Editor

This week’s selection is a brief paper with long implications. For all of us clinicians who turn to the peer-reviewed literature (either directly or through the filter of Reading of The Week) for guidance on how to help our patients, this paper is worth a read.

It is impossible to stay current on the treatment research results that emerge daily, and we look to those randomized controlled trials published in high-impact peer-reviewed journals for evidence of what works for people with the diagnoses that we find ourselves addressing in the office, the clinic, the ER or the inpatient unit. But who are those patients who sign consent forms to take part in these studies, and how much do they resemble the people sitting across from us?

Great clipboard but relevant to clinical work? 

– David Goldbloom, OC, MD, FRCP(C)
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