Tag: The Lancet

Reading of the Week: MST vs ECT – the new JAMA Psych Study; Also, Dr. Niall Boyce on Frasier and the Latest in the News

December 14, 2023 /

From the Editor

Electroconvulsive therapy, or ECT, is a highly effective treatment for depression. But patients often complain about side effects, including cognitive problems.

Could magnetic seizure therapy, or MST, provide the benefits of ECT without these issues? In a new paper for JAMA Psychiatry, Zhi-De Deng (of Duke University) and co-authors attempt to answer that question. In a study where 73 patients with depression were given ECT or MST, they found similar results. “This randomized clinical trial found that the efficacy of MST was indistinguishable from that of ultrabrief pulse [right unilateral] ECT, the safest form of ECT currently available.” We consider the paper and its implications.

In the second selection, Dr. Niall Boyce (of the Wellcome Trust) mulls the return of Frasier Crane, the “pompous but kind-hearted American psychiatrist.” In a Lancet perspective, he writes about the original TV comedy and the new revival of Frasier – and also notes the change in perception of psychiatry over the years. His assessment of the show: “Is the new Frasier worth watching? On the early evidence, I would say yes.”

And, finally, we explore the latest in the news with consideration of recent articles from The Globe and Mail and other publications. Among the topics: the (over) prescription of antidepressants, safe supply, and hairdressers and psychotherapy in Togo.

DG


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

July 13, 2023 /

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.

DG

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Reading of the Week: Pricing and Alcohol – the New Lancet Paper; Also, Mental Health & the Music Industry and Dr. O’Riordan on Her Depression

July 6, 2023 /

From the Editor

How to reduce alcohol consumption? That question is more relevant than ever, given evidence of increased use in Canada during the pandemic. Recently, Scotland has experimented with minimum unit pricing (MUP) – unlike a tax increase that raises the cost of all alcohol, MUP disproportionally affects low-cost wines and ciders, more likely to be consumed by heavy drinkers. 

In the first selection, Grant M. A. Wyper (of the University of Glasgow) and his co-authors consider the Scottish data. In a new paper for The Lancet, they do an impressive analysis, with a controlled interrupted time series, looking at time before and after the MUP, and contrasting Scottish and (non-MUP) English data. They find: “The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations…” We look at the paper and its implications.

Scotland: a land of hills, lakes, and excessive alcohol consumption

In the second selection, George Musgrave (of the University of London) and his co-authors consider the connection between musicians and mental health. In a Comment for The Lancet Psychiatry, they note: “Great advances have been made in the field of musicians’ mental health.” But they argue that “further dialogue between all major stakeholders is needed if, collectively, we are to shape this emerging intervention landscape to serve the target population effectively, both the musicians themselves and the teams around them.”

And in the third selection, from the pages of the Daily Mail, Dr. Liz O’Riordan describes her career as a surgeon – and her secret battle with depression. In a personal essay, she talks about her decision to speak out. “I’ve got better at asking for help and looking after myself. But I’m not ashamed of depression. It’s part of me, and that’s OK.”

DG


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Reading of the Week: Are Benzodiazepines Misunderstood? Also, Lizotte on Mental Health Support, and The Lancet on Those Doctors Lost to COVID

December 10, 2020 /

From the Editor

In a recent conversation with a resident, we discussed benzodiazepines. “I’ve never prescribed one,” he explained.

This class of medications is very much out of fashion. But, after decades of overuse, have we swung to the other extreme, and forgotten an important tool in our pharmacologic toolkit? In the first selection, we consider a British Journal of Psychiatry editorial. Dr. Edward Silberman (of Tufts University School of Medicine) and his co-authors argue that benzodiazepines are underappreciated. The selection ties well into a commentary that recently appeared in The American Journal of Psychiatry. Dr. Jerrold F. Rosenbaum (of Harvard Medical School) writes: “My own son, a first-year resident in psychiatry, looks at me as if I served on the wrong side in the Spanish Civil War when I speak of benzodiazepines.” Is there a clinical takeaway here?

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In the second selection, writer and comedian Andrew Lizotte discusses the challenges of being a patient in our mental health system. He shares some jokes – but, ultimately, notes ongoing stigma and power imbalances. “We see how mental illness is portrayed in the media. We are scared of being shot by police during a ‘routine health check.’ We see the lack of empathy. Then people wonder why we don’t ask for help.”

Finally, with an eye on COVID-19, we look at a short paper in The Lancet about those doctors who have lost their lives in the pandemic. “These lives are also a reminder of the ongoing dedication and service of those who continue to care for patients at a time when COVID-19 cases and deaths are increasing in many countries.”

DG

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Reading of the Week: Exposure to COVID & Mental Health (JAMA Netw Open); Also, the Psych Impact of Quarantine (Lancet) and Inspiring Docs (NYT)

April 2, 2020 /

From the Editor

We read often about the physical health effects of COVID. But how does this pandemic affect mental health?

This week’s Reading has three selections, with two focused on this question.

In the first selection, we consider the psychological effects of COVID on health care workers. In a new JAMA Network Open paper, Jianbo Lai (of Zhejiang University School of Medicine) and co-authors look at mental health outcomes and the factors associated with them in China. “Among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.”

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During this pandemic, many Canadians are self-isolating; in the coming weeks, many could be quarantined. In the second selection, we consider a new Lancet paper on quarantine and its psychological impact. Samantha K. Brooks (of King’s College London) and her co-authors write: “Given the developing situation with coronavirus, policy makers urgently need evidence synthesis to produce guidance for the public. In circumstances such as these, rapid reviews are recommended by WHO.”

Finally, in the third selection, we look at a NYT essay by Dr. Donald Berwick (of Harvard Medical School). He discusses the way health care providers have risen to the challenge of COVID. “We are witnessing professionalism in its highest form, skilled people putting the interests of those they serve above their own interests.”

DG

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Reading of the Week: On D-Day, Three Papers on Shell Shock, One by Dr. Charles Myers

June 6, 2019 /

From the Editor

Today is the 75th anniversary of D-Day.

Ceremonies are planned across the country, and across Europe; Prime Minister Justin Trudeau is in France. During these anniversaries, people comment on the importance of the moment. US President Barack Obama noted: “much of the progress that would define the 20th century, on both sides of the Atlantic, came down to the battle for a slice of beach only six miles long and two miles wide.” And people speak of the loss of life. US President Ronald Reagan, on a past anniversary, talked about “the boys of Pointe du Hoc” who had tried to take “these cliffs” off the beaches, noting that the majority were killed.

But the damage of war is not only in the loss of life.

In this week’s Reading, we consider shell shock and PTSD starting with the first paper on the topic, written by Dr. Charles S. Myers for The Lancet, published just over a century ago. Dr. Myers writes about three cases of shell shock, noting the similarities in their presentations.

La pointe du Hoc en Normandie (Calvados, Basse-Normandie, France)

We also consider a recent paper, published in JAMA Internal Medicine, discussing a more modern presentation – but perhaps not a profoundly different presentation. Finally, we consider a summary of recent published guidelines.

DG

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Reading of the Week: Do Antidepressants Work? The New Cipriani Study

March 1, 2018 /

From the Editor

Last week, I spoke to a patient about antidepressants. “But do they really work?” she asked. While antidepressants are commonly prescribed, many patients wonder about them. That’s not surprising: in popular culture, these medications are often portrayed as risky and unhelpful. Just a few weeks ago, the most popular women’s fitness magazine in the world described fawningly how a woman quit her medications and felt better (“I felt more alive and in control of my emotions with each passing day”). A few years ago, a major study suggested that antidepressants basically match placebo in efficacy; 60 Minutes covered it.

And now there is the new Cipriani et al. paper. “We found that all antidepressants included in the meta-analysis were more efficacious than placebo in adults with major depressive disorder…”

Is this the biggest psychiatry paper of the year? Certainly, it may be one of the most impressive. It took six years of effort. Oxford University’s Andrea Cipriani and his co-authors drew from all available data – published and unpublished, and covering more than 500 trials.

The media coverage has been incredible. The Guardian summarized the paper with the first two words of its article: “Antidepressants work.”

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In this Reading, we look at the big study and mull the big implications.

DG

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