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March 14, 2019 by Lisa Cosgrove, Deborah Erlich and Allen F. Shaughnessy | J Am Board Fam Med

No Magic Pill: A Prescription for Enhanced Shared Decision-Making for Depression Treatment

 Journal of the American Board Family Medicine

Abstract

For over 2 decades, there have been debates, sometimes contentious, about the efficacy and safety of antidepressants. Growing awareness of the difficulty some patients have when discontinuing these medications has intensified these debates. Recently, Cipriani and colleagues published the largest meta-analysis to date that assessed the efficacy and tolerability of antidepressants. They concluded that all were more efficacious than placebo, and they also synthesized the trial results from head-to-head studies in an effort to guide pharmacologic treatment for major depressive disorder in adults. Although the researchers acknowledged many limitations in their analysis, including the fact that effect sizes were modest at best, the media overstated the results of the study. Both the meta-analysis and the news stories reinvigorated the debates about whether or not antidepressants “work.” Unfortunately, however, the key question—how can this meta-analysis help physicians in assisting their patients with a difficult decision about depression treatment options?—was lost in the controversy. In this commentary, we identify the questions and challenges that were not addressed in the current debate and offer specific suggestions for enhancing shared decision making for physicians working in primary care settings.

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March 14, 2019 by Justin Karter | MadInAmerica.com

First-Person Accounts of Madness and Global Mental Health: An Interview with Dr. Gail Hornstein

Dr. Gail Hornstein, author of Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness, discusses the importance of personal narratives and service-user activism in the context of the global mental health movement.

Interview by Justin Karter.

(MadInAmerica.com) – This week, MIA Radio presents the fifth in a series of interviews on the topic of the global “mental health” movement.” This series is being developed through a UMASS Boston initiative supported by a grant from the Open Society Foundation. The interviews are being led by UMASS PhD students who also comprise the Mad in America research news team.

I was fortunate to interview Dr. Gail Hornstein, a Professor of Psychology at Mount Holyoke College in South Hadley, Massachusetts. She is the author of To Redeem One Person is to Redeem the World: The Life of Frieda Fromm-Reichmann and, most recently, Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness. In her work, she chronicles both the personal narratives of people with lived experience of being treated as “mad,” and also the growing movement of survivor and service-user activism. Her Bibliography of First-Person Narratives of Madness in English (now in its 5th edition) lists more than 1,000 books by people who have written about madness from their own experience; it is used by researchers, clinicians, educators, and peer groups around the world.

She is now director of a major research and training project investigating how hearing voices peer-support groups work, supported by a grant from the Foundation for Excellence in Mental Health Care. This project is training dozens of new hearing voices group facilitators across the US and sponsors research to identify the key mechanisms by which this approach works.

What follows is a transcript of our conversation, edited for clarity.

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March 14, 2019 by Prof Miranda Wolpert et al | The Lancet Psychiatry

Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness

Prof Miranda Wolpert, PsychD, Kate Dalzell, MA, Roz Ullman, PhD, Lauren Garland, MA, Melissa Cortina, DPhil, Daniel Hayes, PhD, Praveetha Patalay, PhD, Duncan Law, DClinPsy

Summary

This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals.

The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration.

A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults.

Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches.

Full article

Source: TheLancet.com/journals/lanpsy/article/PIIS2215-0366(18)30465-6/fulltext

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March 13, 2019 by Peter Simons | MadInAmerica.com

Mental Health Concerns Not “Brain Disorders,” Say Researchers

The latest issue of the journal Behavioral and Brain Sciences features several prominent researchers arguing that mental health concerns are not “brain disorders.”

(MadInAmerica.com) – The journal Behavioral and Brain Sciences features several prominent researchers in its latest issue debunking the notion that mental health concerns are “brain disorders.” It begins with a paper by researchers in the Netherlands arguing that neurobiology will never convincingly explain any mental health concerns. The rest of the issue includes dozens of commentaries by influential researchers, some supporting the initial premise, and others attempting to argue against it. In response, the initial study authors point out that none of the responses can provide any convincing evidence that neurobiological reductionism has succeeded in a meaningful way.

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March 9, 2019 by Lewis Mehl-Madrona and Barbara Mainguy

Results of an Integrative Medicine and Psychotherapy Approach to Patients with Psychosis

(Morressier) –

Background and Aims: Some patients with the diagnosis of a psychotic disorder wish to minimize or avoid medications. They are seeking a recovery model with the aim of maximizing independence and healing.

Methods: We report qualitative and quantitative data on a group of 69 motivated adult patients with psychosis as a proof of concept study — that management with minimal or no medication is possible for some.

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March 9, 2019 by James Schroeder | Courier & Press

The inextricable link between nutrition and psychological functioning | Schroeder

EVANSVILLE, Ind. — As the health of U.S. population continues to rise to the forefront of discussion, increasing evidence is finding that paying attention to what we eat is not just important for how our bodies function but also for our minds.

More and more, research is indicating the food we consume affects how we feel, think, pay attention and even regulate our behaviors. This is especially important for youth and young adults, whose brains continue to undergo maturation that affects the rest of their lives.

Given this, I sat down with one of the world’s foremost experts on nutrition and mental health, Dr. Bonnie Kaplan, to discuss this critical topic. Dr. Kaplan is an Emeritus Professor at the University of Calgary and has an appointment at the Alberta Children’s Hospital Research Institute. She has published countless articles on this topic and has spoken to audiences all over the world.

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March 8, 2019 by Lisa Rapaport | Reuters Health

Aerobic Exercise Eases Depression, Even in Chronically Ill

(Reuters Health) – People with chronic health problems who suffer from depression may find their mood improve when they do aerobic exercise, a research review suggests.

Patients with long-term medical issues are two to three times more likely to develop depression than the general population, researchers noted in the British Journal of Sports Medicine, online February 6. When these patients do become depressed, their chronic illnesses often worsen and their risk of dying goes up.

For the current study, researchers examined data from 24 studies with a total of 4,111 patients living with chronic illness and symptoms of depression. All of the smaller studies randomly assigned some patients to do aerobic exercise and others to comparison groups that just got usual medical care.

Patients who exercised at least two to three times a week were more likely to see a reduction in depression symptoms than people who didn’t do aerobic exercise at all, the study found. There was a more pronounced effect when people exercised four to five times a week, but this difference was too small to rule out the possibility that it was due to chance.

“One of the key messages that we see often around aerobic exercise is: something is better than nothing and more is better than less, said senior study author Dr. Simon Bacon of Concordia University in Montreal, Canada.

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March 5, 2019 by Mark Abie Horowitz, PhD & Prof David Taylor, PhD | The Lancet

Tapering of SSRI treatment to mitigate withdrawal symptoms

Summary

All classes of drug that are prescribed to treat depression are associated with withdrawal syndromes. SSRI withdrawal syndrome occurs often and can be severe, and might compel patients to recommence their medication. Although the withdrawal syndrome can be differentiated from recurrence of the underlying disorder, it might also be mistaken for recurrence, leading to long-term unnecessary medication. Guidelines recommend short tapers, of between 2 weeks and 4 weeks, down to therapeutic minimum doses, or half-minimum doses, before complete cessation. Studies have shown that these tapers show minimal benefits over abrupt discontinuation, and are often not tolerated by patients. Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms. Other types of medication associated with withdrawal, such as benzodiazepenes, are tapered to reduce their biological effect at receptors by fixed amounts to minimise withdrawal symptoms. These dose reductions are done with exponential tapering programmes that reach very small doses. This method could have relevance for tapering of SSRIs. We examined the PET imaging data of serotonin transporter occupancy by SSRIs and found that hyperbolically reducing doses of SSRIs reduces their effect on serotonin transporter inhibition in a linear manner. We therefore suggest that SSRIs should be tapered hyperbolically and slowly to doses much lower than those of therapeutic minimums, in line with tapering regimens for other medications associated with withdrawal symptoms. Withdrawal symptoms will then be minimised.

Source: TheLancet.com/journals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext

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March 5, 2019 by Benedict Carey | The New York Times

How to Quit Antidepressants: Very Slowly, Doctors Say

(The New York Times) – Thousands, perhaps millions, of people who try to quit antidepressant drugs experience stinging withdrawal symptoms that last for months to years: insomnia, surges of anxiety, even so-called brain zaps, sensations of electric shock in the brain.

But doctors have dismissed or downplayed such symptoms, often attributing them to the recurrence of underlying mood problems.

The striking contrast between the patients’ experience and their doctors’ judgment has stirred heated debate in Britain, where last year the president of the Royal College of Psychiatrists publicly denied claims of lasting withdrawal in “the vast majority of patients.”

Patient-advocacy groups demanded a public retraction; psychiatrists, in the United States and abroad, came to the defense of the Royal College. Now, a pair of prominent British psychiatric researchers has broken ranks, calling the establishment’s position badly mistaken and the standard advice on withdrawal woefully inadequate.

In a paper published Tuesday in Lancet Psychiatry, the authors argued that any responsible withdrawal regimen should have the patient tapering off medication over months or even years, depending on the individual, and not over four weeks, the boilerplate advice.

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March 4, 2019 by Sara L Johansen et al | The BMJ

Management of perinatal depression with non-drug interventions

(The BMJ)

ABSTRACT

Perinatal depression is a common disorder that has been associated with serious risks to mother and child. Recently, screening for depression in pregnant and postpartum women has increased, as has the development of new psychotherapy and non-drug treatment modalities. Matching patients to treatments can be challenging, and although research into personalized treatment of major depression in the general population has increased, no published guidelines focus on personalized treatment approaches to perinatal depression. In particular, guidelines on non-drug treatments are lacking. This review summarizes the evidence on personalized non-drug treatment of perinatal depression, how to incorporate patients’ preferences, novel treatments under investigation, and the potential role of biomarkers in matching patients to treatment. The review provides recommendations for future research in personalized care of perinatal depression.

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