Tag: JAMA Psychiatry

Reading of the Week: Can We Prevent Depression For Those At Risk?

November 26, 2015 /

Depression is the leading cause of disability worldwide and commonly begins in adolescence. Prevention is one viable strategy for reducing the population burden of depression because most depressed adolescents do not receive specialty mental health treatment and because untreated depression is associated with enduring deleterious effects on interpersonal relationships, educational attainment, and occupational status.

Single-site studies have demonstrated the efficacy of an adaptation of the Coping with Depression for Adolescents intervention in preventing the onset of depression relative to usual care in adolescents with subsyndromal depressive symptoms and in those with a parental history of depression. These results were replicated in our 4-site randomized clinical trial of 316 high-risk adolescents randomly assigned to either an adaptation of the Coping with Depression for Adolescents (cognitive-behavioral prevention [CBP]) plus usual care or usual care alone, which found a lower incidence of depressive episodes at 9 and 33 months after enrollment in those who received CBP.

So begins a new paper that seeks a lofty goal: using a psychological intervention to prevent depression before it starts.

This week’s Reading: “Effect of a Cognitive-Behavioral Prevention Program on Depression 6 Years After Implementation Among At-Risk Adolescents: A Randomized Clinical Trial” by Dr. David A. Brent et al., which was published in the November JAMA Psychiatry.

In this paper, Brent et al. attempt something we often dream about in psychiatry – but are so rarely able to achieve: prevention. That alone would make this paper worth considering. But there’s more: the study features an incredible follow up period (a full six years) and a consideration of the parent, not just the at-risk adolescent. Pulling it together: this is a big paper in a big journal with a big result.

Dr. David Brent

So, can we take an at risk population and, with therapy, prevent them from developing a major mental illness? This is what the study authors seek to find out. As they note early in the paper: “We hypothesized that those who received CBP would have a lower hazard of depression onsets and better developmental competence during emerging adulthood.” Continue reading

Reading of the Week: Marijuana Use and Misuse

October 29, 2015 /

In the United States, laws and attitudes toward the use of marijuana are changing. Twenty-three states now have medical marijuana laws, and marijuana use is higher in states with such laws than in other states. Four of these states have also legalized marijuana for recreational use. More Americans now favor legalization of marijuana use than in previous years. Further, fewer Americans view marijuana use as risky, although studies have shown that use or early use of marijuana is associated with increased risk for many outcomes, including cognitive decline, psychosocial impairments, vehicle crashes, emergency department visits, psychiatric symptoms, poor quality of life, use of other drugs, a cannabis-withdrawal syndrome, and addiction risk. Further, marijuana use disorders (abuse or dependence) are associated with substantial comorbidity and disability and are consequently of substantial public health concern.

So begins a new paper looking at an old question: how does drug legalization affect use and misuse?

This week’s Reading: “Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013” by Deborah S. Hasin et al., just published online (and ahead of print) by JAMA Psychiatry.

You can find the paper here:

http://archpsyc.jamanetwork.com/article.aspx?articleid=2464591

Columbia University’s Hasin and her co-authors have picked a timely topic. Here’s a quick summary: as laws and public attitude have shifted, looking at U.S. survey data, they conclude that marijuana use has sharply increased. Continue reading

Reading of the Week: Of Pills and Placebo – The Pecina et al. paper

October 15, 2015 /

High rates of placebo responses are consistently reported across medical conditions, notably mood disorders, Parkinson disease, and pain, but also schizophrenia, substance use disorders, and surgical procedures. Placebo response rates in antidepressant trials average 31% to 45% compared with approximately 50% responses to antidepressants, and they have increased over the last 30 years. The failure of antidepressant responses to separate from placebo has contributed to the reduction or discontinuation of research on new treatments for depression and other neuropsychiatric illnesses, hindering the development of novel neuropsychiatric treatments.

So begins a new paper considering the relationship between placebo and depression treatment.

This week’s Reading: “Association Between Placebo-Activated Neural Systems and Antidepressant Responses Neurochemistry of Placebo Effects in Major Depression” by Dr. Marta Peciña et al., which was just published “online first” by JAMA Psychiatry.

Dr. Marta Peciña

Here’s a quick summary: this is a big paper in a big journal that seeks to better understand the placebo effect and antidepressants, and taps neuroimaging to do so. There is, however, a catch: the number of patients involved is small. Continue reading