Tag: ketamine

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

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.


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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)

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.”


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Reading of the Week: A Century After Osler, Is He Relevant (NEJM)? Also, AI & Diagnosis (CMAJ) and Ketamine & Safety (JAD)

From the Editor

A century after his death, is Dr. Osler still relevant?

This week, there are three selections. First, we start with a look back with an essay on Dr. William Osler. We then look forward: with papers on AI and ketamine.

In the first selection, Drs. Charles S. Bryan (the University of South Carolina) and Scott H. Podolsky (Harvard University) write in The New England Journal of Medicine about Dr. Osler on the 100th anniversary of his death. Contemplating his life and views, they note that he “gave physicians what certain national historians gave their countries: warm feelings of togetherness, pride, and purpose.”

nlc012022-v6William Osler

In the second selection, we look at a CMAJ paper. Considering AI and health care, University of Strasbourg’s Dr. Thierry Pelaccia and his co-authors write about the reasoning of mind and machine. They see a bright future: “AI can assume its place as a routine tool in medical practice.”

Finally, for the third selection, we consider a new paper on ketamine and safety from the Journal of Affective Disorders. Drawing on several studies, NIMH’s Elia E. Acevedo-Diaz and her co-authors conclude: “The results indicate that a single intravenous subanesthetic-dose ketamine infusion was relatively safe for the treatment of [treatment-resistant depression].”


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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)

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.




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Reading of the Week: A Statin a Day Keeps the Doctor Away? The New Hayes et al. JAMA Psych Paper

From the Editor

Statins can help prevent MIs in people with high cholesterol. Can they also prevent psychiatric admissions for those with schizophrenia?

The question may seem odd, but there is evidence that statins can reduce symptoms in people with schizophrenia – though the evidence is light. That may not be as surprising as it seems: statins are anti-inflammatories, and a growing literature suggests neuro-inflammation is involved in major mental illness.

So should our patients receive medications like statins? The concept of repurposing common medications has gained attention.

This week, we look at a paper just published in JAMA Psychiatry. In their study, University College London’s Joseph F. Hayes and his co-authors consider the effect of statins, calcium channel blockers, and biguanides (such as metformin). Spoiler alert: they find that these medications reduce psychiatric hospital admissions and self-harm in people with serious mental illness.

statins-understandingthehypeStatins for schizophrenia?

In this Reading, we review the new paper about the not-so-new meds. We also take a quick look at another paper (on ketamine).


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Reading of the Week: Suicidal? Get a Postcard. The New JCP Paper on Suicide Prevention. Also, Ketamine & Inpatients

From the Editor

Can we do better at suicide prevention?

In recent years, several studies have tried brief contact interventions – that is, interventions aimed at maintaining a post-discharge connection – reporting success. These interventions have been relatively simple, such as handwritten postcards or phone calls for people post-attempt.

In this week’s selection, we look at a new paper from The Journal of Clinical Psychiatry. Involving 23 emergency departments and crisis centres in France, the authors pulled together different interventions, coming up with an algorithm offering patients care informed by the best evidence. So some patients received calls, but others were given crisis cards.

It’s an ambitious project. Did it work? The results weren’t statistically significant.

p1110389Postcards: colourful and pretty – and life-saving?

We consider this paper, the negative result, and ask: what does this say about suicide prevention? And then, looking at the evolving literature on suicide, we briefly consider a paper written by Sunnybook’s Mark Sinyor that uses IV ketamine for suicidal thoughts.

Please note: there will be no Reading next week.

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