Tag: Quick Takes

Reading of the Week: Young in Therapy: Need But Not Great Results – the New Lancet Paper; Also, the Wellness Industry & the Rumpelstiltskin Effect

October 2, 2025 /

From the Editor

Therapy can be life changing – especially for young adults who may be at the beginning of illness. The stakes are high but what are the outcomes?

In a new Lancet Psychiatry paper, Rob Saunders (of University College London) and his co-authors attempt to answer this question. They drew on an impressive dataset – from the National Health Service, with more than 1.6 million participants – and compared outcomes (both scales and service specific scores) between young and working age adults. “In a dataset of all individuals receiving psychological therapies for common mental disorders in a national service programme, we found that young adults had poorer outcomes than working age adults.” We discuss the paper and its implications.

With a few clicks of the mouse, our patients can read what we read – including the latest journals. But they also can access a world of half-truths, misleading claims, and falsehoods. In the second selection, a new episode of Quick Takes, I speak with Jonathan Stea, a University of Calgary psychologist and a bestselling author, about his research on the wellness industry. “The beating heart of the wellness industry is pseudoscience.”

And in the third selection from BJPsych Bulletin, Alan Levinovitz (of James Madison University) and Dr. Awais Aftab (of Case Western Reserve University) argue that there is benefit in a diagnosis. In a clever paper, they coin the term Rumpelstiltskin effect (yes, after the Grimm story) – that is, “the therapeutic effect of a clinical diagnosis, independent of any other intervention.” Are they persuasive?

DG


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Reading of the Week: Antidepressant Discontinuation – the New JAMA Psych Study; Also, Obesity Meds and Nazaryan on His Father’s Depression

July 17, 2025 /

From the Editor

“New Research Questions Severity of Withdrawal From Antidepressants”

– The New York Times

“Antidepressant Pullback Symptoms Fewer Than Thought, Study Shows”

–  Bloomberg

Millions of North Americans take antidepressants – about one in seven Canadians – yet these medications remain controversial. A 2019 Lancet Psychiatry study, which drew heavily from online surveys, found that roughly half of patients who quit these meds experienced severe withdrawal symptoms, sparking much debate – and many, many questions from our patients.

How common are discontinuation symptoms? Which one is most commonly experienced? Michail Kalfas (of King’s College London) and his co-authors attempt to answer these questions with a new JAMA Psychiatry paper. They did a systematic review and meta-analysis by analyzing 50 studies involving almost 18 000 people. “This systematic review and meta-analysis indicated that the mean number of discontinuation symptoms at week 1 after stopping antidepressants was below the threshold for clinically significant discontinuation syndrome.” We consider the paper and its implications.

Celebrities use them; politicians discuss them; our patients ask about them. Are semaglutide and sister drugs game changers for those with mental health problems who struggle with obesity? To explore the opportunities and challenges of these new medications, in a new episode of Quick Takes, I speak with Dr. Mahavir Agarwal (of the University of Toronto), Lisa Schaefer (of Obesity Canada), and Dr. Sanjeev Sockalingam (of the University of Toronto). “Imagine a world where you have all the effects of antipsychotics, but none of the side effects.”

Finally, in the third selection, journalist Alexander Nazaryan discusses his father’s mental illness and its impact on his life. In a deeply personal essay for The New York Times, he notes the long shadow of illness. “My father never got to become a famous physicist or see his son go to M.I.T. Worse, he couldn’t ask for help until it was too late.”

DG

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Reading of the Week: Glucagon-Like Peptide 1 Receptor Agonists & Mental Health – the New JAMA Psych Study; Also, Innovation and Lee on His Depression

May 29, 2025 /

From the Editor

These medications are widely discussed – and, yes, our patients ask about them. But how do glucagon-like peptide 1 receptor agonists impact mental health and overall wellness? Should we hesitate before reaching for the prescription pad?

Aureliane C. S. Pierret (of King’s College London) and her co-authors attempt to answer these questions in a new paper just published in JAMA Psychiatry. In their systematic review and meta-analysis, they included more than 107 000 patients, comparing treatment with GLP1-RAs to placebo, looking at psychiatric, cognitive, and quality of life outcomes in those who are overweight, obese, or have diabetes. “Our results provide reassurance regarding the psychiatric safety profile of GLP1-RAs and suggest that GLP1-RA treatment is associated with improved mental well-being, in addition to the known physical health improvements.” We consider the paper and its implications.

When we hear innovations in mental healthcare, we tend to think of apps or wearables. In the second selection from Quick Takes, Daisy Singla (of the University of Toronto) discusses her recent study that expanded access to psychotherapy for perinatal women, reducing symptoms of depression and anxiety by drawing a page from work done in low-income countries. The key concept: training up laypeople to deliver therapy (task sharing). “It’s one of the largest psychotherapy trials in the world.”

And in the third selection, from The Globe and Mail, Joe Lee writes about his realization that he has depression and that it has affected his life for years. In a personal essay, he talks about his illness and the impact on his life. “Depression is weird like that. For some people, it sneaks in. For me, it’s always been there – like blood in my body.”

DG

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Reading of the Week: Task-sharing in Therapy for Perinatal Depression – the New Nature Med Study; Also, Yoga, and Donelle on Grief After Her Daughter’s Suicide

March 27, 2025 /

From the Editor

She was so excited about the pregnancy; in our sessions, she expressed joy. But, as with some women after childbirth, her mood declined. She couldn’t properly care for her son, which she reported with shame and guilt. Perinatal depression is common – and yet many women in Canada and other high-income countries don’t receive care.

What can be done to help them? Could nonspecialist providers – like nurses, midwives, and doulas – be trained up to deliver psychotherapy effectively? Can telemedicine be used? In a new paper for Nature Medicine, Daisy Singla (of the University of Toronto) and her co-authors attempt to answer these questions. In their study, SUMMIT, they conducted a pragmatic, noninferiority trial comparing specialist and nonspecialist providers, delivering care in person or through telemedicine. Participants received eight treatment sessions of behavioural activation. They found noninferiority with both providers and modality of treatment. “This trial suggests compelling evidence for task-sharing and telemedicine to improve access to psychotherapies for perinatal depressive and anxiety symptoms.” We discuss the paper and its implications.

Daisy Singla

Alternative treatments – think mindfulness, acupuncture, yoga – have been historically popular with patients but generally lacking in evidence. Times have changed: mindfulness as a psychotherapy, for instance, is included in the CANMAT depression guidelines. What about yoga? Does depression care include the downward dog? In the second selection, a new episode of Quick Takes, I speak with Dr. Vanika Chawla (of Stanford University) who is part of that university’s lifestyle medicine team and a registered yoga teacher. “I think yoga is a wonderful way to expand providers’ toolbox of existing treatments.”

And in the third selection, Caroline Donelle writes about the suicide of her daughter. In a deeply personal essay for The Globe and Mail, she notes the loss, her decision to move across the country, and her slow healing. “I’m not the person I was when she died and never will be again. I’ve evolved and grown in unexpected ways.”

DG


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Reading of the Week: More Therapy, More Inequity? The New JAMA Psych Study; Also, Dr. Reimer on Living with Depression and Generative AI & Biases

January 23, 2025 /

From the Editor

What has been the most significant innovation in mental healthcare delivery in recent years? It wasn’t a new medication or therapy, but the widespread adoption of the webcam in 2020. Over the course of a handful of pandemic weeks, psychiatrists and therapists switched to virtual sessions, making it easier for people to receive care, including psychotherapy, unbound by geography, and thus addressing inequity – or, at least, that was the hope. As noted recently in The New York Times: “In the 1990s, teletherapy was championed as a way to reach disadvantaged patients living in remote locations where there were few psychiatrists. A decade later, it was presented as a more accessible alternative to face-to-face sessions, one that could radically lower barriers to care.”

So, are more people receiving psychotherapy? And has this new era of virtual care resulted in better access for all? Dr. Mark Olfson (of Columbia University) and his co-authors attempt to answer these questions in a new paper for JAMA Psychiatry. Drawing on the data of more than 90 000 Americans, they analyzed trends in outpatient psychotherapy in the US, finding more care than ever before. That said, they note greater inequity: “psychotherapy use increased significantly faster among several socioeconomically advantaged groups and that inequalities were evident in teletherapy access.” We consider the study and its implications.

As doctors, we often shy away from discussing our health, especially our mental health – even with our own physicians. This is particularly concerning because doctors have a higher suicide rate than the general population, yet fears of vulnerability, judgment, and stigma keep many of us silent. In this episode of Quick Takes, I sit down with Dr. Joss Reimer, president of the Canadian Medical Association, who openly shares her own experiences with depression, as a doctor and as a patient. “We all need help sometimes.”

And in the third selection, Matthew Flathers (of Harvard University) et al. analyze AI depictions of psychiatric diagnoses in a new paper for BMJ Mental Health. They tested two AI image models with different diagnoses and commented on the results. “Generative AI models acquire biases at every stage of their development – from societal prejudice in online training data, to the optimisation metrics and safety guidelines each developer puts in place. These layered biases persist even when their precise origins remain elusive.”

DG

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Reading of the Week: Suicide Barriers & Suicide Prevention – the New CJP Study; Also, the Future of Education and AI & Diagnoses

November 28, 2024 /

From the Editor

The idea is simple: if certain locations attract suicidal individuals, making it harder for suicides to occur at those places can help. After much debate, in 2003, the City of Toronto did exactly that, constructing a suicide barrier for the Bloor Viaduct. Suicides immediately declined. 

What has been the long-term effect? And have the means of suicide deaths simply shifted? In the first selection, Dr. Mark Sinyor (of the University of Toronto) and his co-authors attempt to answer these questions. In a new study published in The Canadian Journal of Psychiatry, they drew on over two decades of data to analyze the impact of this suicide barrier. “Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier.” We consider the study and its implications.

Pretty but lifesaving?

When it comes to medical education, much has changed over the years – including its name. What was once known as Continuing Medical Education (CME) is now referred to as Continuing Professional Development (CPD). But the changes go far beyond a simple rebranding. After all, the sheer volume of journal articles available today is staggering. How can you keep up? How can technology help? In the second selection, a new Quick Takes podcast, I speak with Dr. Sanjeev Sockalingam (of the University of Toronto) to explore the evolving world of CPD. “It took a pandemic to get us to realize that we could do so much online.”

Finally, in the third selection, from JAMA Network Open, Dr. Ethan Goh (of Stanford University) and his colleagues wonder if AI can assist physicians in making diagnoses. In an RCT, physicians were randomized to either conventional resources or those enhanced by access to AI (specifically, LLM). “In this trial, the availability of an LLM to physicians as a diagnostic aid did not significantly improve clinical reasoning compared with conventional resources.”

DG

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Reading of the Week: The Readings at 10; Also, Mentorship and Involuntary Care

September 26, 2024 /

From the Editor

10.

This month, the Reading of the Week celebrates its 10th anniversary. The program has grown and evolved over this past decade but the core idea – timely summaries of the latest in the literature coupled with commentary – hasn’t changed. To mark the anniversary, over the next two weeks, we will look at some important papers that we have covered in the past ten years.

This week: ten papers that I think about often (and helped change my clinical work).

Next week: tens papers that I think about often (and helped change the way I view mental illness).

Of course, the lists of papers are hardly exhaustive. Have a favourite that I missed? Please don’t hesitate to email me.

*      *      *

Many of our colleagues speak enthusiastically about the influence of mentors on their lives – but how can you better incorporate mentorship into your career? What should you look for in a mentor? And what exactly is a mentor? In the second selection, we look at a new Quick Takes podcast interview with Dr. Suzanne Koven (of Harvard University). “Mentorship is especially valuable for people who are aspiring to somewhat unconventional careers, and that was certainly the case with me.”

Finally, in the third selection, a Globe and Mail editorial considers substance misuse and Canadian cities. After an episode of violence in Vancouver, they wonder what could be done and weigh more involuntary care for those with substance problems. “Involuntary care has a role to play in some cases. Getting involuntary care right, however, is difficult.”

DG

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Reading of the Week: Antidepressants & Discontinuation Symptoms – the New Lancet Psych Study; Also, Neuromodulation and Digital Health Technology

June 27, 2024 /

From the Editor

“Once I start taking them, I’m stuck.” When discussing the possible initiation of an antidepressant trial, a patient recently expressed his fear: that he wouldn’t be able to stop the medication because of discontinuation symptoms. These symptoms are debated. Some claim they are very common – though that’s not widely reported in the literature. 

How frequently do these symptoms occur? What percentage of patients experience severe symptoms? Are some antidepressants more associated with this problem than others? Dr. Jonathan Henssler (of the University of Cologne) and his co-authors attempt to answer these questions with an impressive, new systematic review and meta-analysis, published in Lancet Psychiatry. They drew on 79 studies involving more than 21 000 people. “The incidence of antidepressant discontinuation symptoms is approximately 15%, affecting one in six to seven patients who discontinue their medication.” We consider the paper and its clinical implications.

Will the stigma around ECT fade? Will ECT eventually be replaced by ketamine and MST? What’s the future of neuromodulation? We answer these questions and more in the second selection, the latest Quick Takes podcast interview. Dr. Daniel Blumberger, scientific director of CAMH’s Temerty Centre for Therapeutic Brain Intervention and professor at the University of Toronto, notes that ECT still has a unique place. “As far as medical treatments go, ECT is the safest medical procedure in all of medicine.”

And in the third selection, Dr. John Torous (of the Harvard University) and his co-authors focus on digital mental health in a new Viewpoint published in JAMA Psychiatry. They argue that we tend to both overstate and underappreciate the risks and benefits of digital mental health interventions. “Patients and clinicians should not assume wellness digital health technologies are always dangerous, nor should they assume health technologies are always safe.”

DG

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Reading of the Week: Global Burden of Schizophrenia – the new Molecular Psych Study; Also, MedEd’s Evolution & Saxbe on Helping Depressed Teens

November 30, 2023 /

From the Editor

Is there more mental illness than before? Or is there greater awareness? 

Dr. Marco Solmi (of the University of Ottawa) and his co-authors attempt to answer these questions in a new paper for Molecular Psychiatry that focuses on schizophrenia. Drawing on 30 years of data globally, they consider prevalence (how many have the illness), incidence (the number who develop it each year), and the disability-adjusted life-years (the loss of one healthy year of life) using more than 86 000 points of data. They find: “Globally, we show that, from 1990 to 2019, raw prevalence increased by over 65%, incidence by 37.11%, DALYs by over 65%, but age-adjusted prevalence and incidence estimates showed a slight decrease, and burden did not change.” We consider the paper and its implications.

Textbooks, highlighters, and classrooms? The world of medical education is changing. Today, we have AI, sim, and e-learning. In the second selection, we look at the new Quick Takes podcast with Dr. Ivan Silver (of the University of Toronto), former vice president of education at CAMH who marvels at the potential. “This is the renaissance period for health professional education.” 

And in the third selection, psychologist Darby Saxbe (of the University of Southern California) writes in The New York Times about ways to help depressed adolescents. Drawing on recent studies showing the failure of school-based psychosocial interventions, she argues for a different approach. “It’s critical to keep pace with the evidence and attend to the first principle of all health care providers: First, do no harm.”

DG

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Reading of the Week: Self-stigma & Depression – the new JAD Study; Also, ChatGPT & Mental Health Care, and Dr. Catherine Hickey on the Opioid Crisis

November 2, 2023 /

From the Editor 

Depression is the result of character weakness. So explained my patient who had a major depressive disorder and hesitated to take medications.

Though fading, stigma about mental illness continues to exist, including self-stigma, the negative thoughts and beliefs that patients have about their own disease – as with my patient. How common is self-stigma? How does its prevalence differ around the globe? What are risk factors for it? Nan Du (of the University of Hong Kong) and co-authors attempt to answer these questions in a new Journal of Affective Disorders paper. They do a systematic review and meta-analysis of self-stigma for people with depression, drawing on 56 studies with almost 12 000 participants, and they a focus on international comparisons. “The results showed that the global prevalence of depression self-stigma was 29%. Levels of self-stigma varied across regions, but this difference was not significant.” We consider the paper and its clinical implications.

In this week’s second selection, we look at ChatGPT and mental health care. Dr. John Torous (of Harvard University) joins me for a Quick Takes podcast interview. He sees potential for patients – including making clinical notes more accessible by bridging language and knowledge divides – and for physicians, who may benefit from a more holistic differential diagnosis and treatment plan based on multiple data sets. He acknowledges problems with privacy, accuracy, and ChatGPT’s tendency to “hallucinate,” a term he dislikes. “We want to really be cautious because these are complex pieces of software.” 

And in the third selection, Dr. Catherine Hickey (of Memorial University) writes about the opioid crisis for Academic Psychiatry. The paper opens personally, with Dr. Hickey describing paramedics trying to help a young man who had overdosed. She considers the role of psychiatry and contemplates societal biases. “[I]n a better world, the needless deaths of countless young people would never be tolerated, regardless of their skin color.”

DG

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