TagLam

Reading of the Week: Suicide and Schizophrenia – Across Life Span; Also, Transgender-Inclusive Care (QT), and the NYT on Chatbots

From the Editor

This week, we have three selections.

In the first, we consider suicide and schizophrenia. In a new JAMA Psychiatry paper, Dr. Mark Olfson (of Columbia University) and his co-authors do a cohort study across life-span, tapping a massive database. They find: “the risk of suicide was higher compared with the general US population and was highest among those aged 18 to 34 years and lowest among those 65 years and older.” The authors see clear clinical implications: “These findings suggest that suicide prevention efforts for individuals with schizophrenia should include a focus on younger adults with suicidal symptoms and substance use disorders.”

In the second selection, we consider transgender-inclusive care, looking at a new Quick Takes podcast. Drs. June Lam and Alex Abramovich (both of the University of Toronto) comment on caring for members of this population. “Trans individuals are medically underserved and experience, poor mental health outcomes, high rates of disease burden – compared to cisgender individuals.”

img_9356

Finally, in our third selection from The New York Times, reporter Karen Brown writes about chatbots for psychotherapy, focusing on Woebot. The writer quotes psychologist Alison Darcy about the potential of these conversational agents: “If we can deliver some of the things that the human can deliver, then we actually can create something that’s truly scalable, that has the capability to reduce the incidence of suffering in the population.”

DG

Continue reading

Reading of the Week: Can Light Therapy Help with Bipolar Depression? Also, the Racism of COVID (BJP) & Gottlieb on the Toilet as the New Couch (NYT)

From the Editor

After his manic episode, the first patient I treated with bipolar disorder was low in mood for months, able to get out of bed, but not able to work. I remember him sitting in my office talking about feeling overwhelmed. For many people with bipolar disorder, the depressive episodes are long and debilitating. And for us clinicians, these episodes are difficult to treat. (I remember feeling overwhelmed, too.)

Can light therapy help?

The first selection seeks to answer that question. Light therapy, after all, has shown its utility in depression, including for those with a seasonal pattern to their lows. But bipolar depression? In a new Canadian Journal of Psychiatry paper, Dr. Raymond W. Lam (of UBC) and his co-authors do a systematic review and meta-analysis. They included seven papers. “This meta-analysis of RCTs found positive but nonconclusive evidence that light therapy is efficacious and well tolerated as adjunctive treatment for depressive episodes in patients with BD.”

phototherapy_1170336

Is the virus racist? In the second selection, we look at a provocative paper from The British Journal of Psychiatry written by Drs. Anuj Kapilashrami and Kamaldeep Bhui (both of Queen Mary University of London). Considering how COVID-19 affects certain groups more than others, they also note that mental illness is more common among minorities, and they argue that: “societal structures and disadvantage generate and can escalate inequalities in crises.” They offer a word of caution: “What is surprising is it takes a crisis to highlight these inequalities and for us to take note, only to revert to the status quo once the crisis is over. ”

Finally, we consider an essay from The New York Times. Lori Gottlieb, a psychotherapist, discusses her practice in a world of pandemic. “Suddenly, her sobs were drowned out by a loud whooshing sound.” She wonders if the toilet is the new couch.

DG

Continue reading

Reading of the Week: The New CANMAT Guidelines for Depression

From the Editor

What’s new in depression treatment?

The new guidelines

This week, we look at the new CANMAT guidelines. Published in September in The Canadian Journal of Psychiatry, the papers – six in all – speak to the latest in depression management.

What should you think about the new antidepressants? What alternatives are there to CBT? What to do when everything else fails? Spoiler alert: this week’s Reading answers all these questions and more.

DG Continue reading

Reading of the Week: Let There Be Light

Major depressive disorder (MDD) affects at least 5% of the population, with a lifetime prevalence estimated at 14%. It is the second-ranked cause of disability worldwide and is associated with impairment in quality of life, increased risk of mortality, and societal burden. Treatments for MDD include psychotherapies and antidepressants, but remission rates remain low despite adequate treatment and more therapeutic options are needed.

Light therapy, an effective treatment for seasonal affective disorder (SAD), may also be appropriate for MDD. Bright light is a safe, well-tolerated, nonpharmacological treatment that can be used alone or combined with medications. Light can correct disturbed circadian rhythms, which have been implicated in the pathophysiology of MDD. Previous metaanalyses of light therapy for nonseasonal MDD, however, have yielded only equivocal and conflicting evidence for efficacy. Two more recent systematic reviews both concluded that the quality and methods of the identified studies were too heterogeneous to conduct a meta-analysis. They each found insufficient evidence for efficacy of bright light monotherapy, although 1 review found low-quality evidence for bright light as adjuvant treatment to antidepressants.

In summary, these systematic reviews indicate that the evidence for benefits of bright light therapy for nonseasonal MDD is inconclusive and well-designed studies are required to resolve this issue.

So begins a new paper on depression. I like these opening paragraphs and, in particular, the first paragraph (and its bluntness). For the clinicians among us, the final phrase is hauntingly true: “more therapeutic options are needed.”

This week’s Reading: “Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial” by Dr. Raymond W. Lam et al., which was just published online (ahead of print) in JAMA Psychiatry.

image001

This is a big paper in a big journal with big clinical implications. It’s also very Canadian – every co-author lives north of the 49th parallel; the first author hails from Vancouver.

We know that light therapy works for those with a seasonal pattern to their depression. But could we use the light therapy for other people suffering from depression? The authors attempt to answer this question. Continue reading