Companies Tout Psychiatric Pharmacogenomic Testing, But Is It Ready for a Store Near You?

Jennifer Abbasi
JAMA Network
Originally posted October 3, 2018

Here is an excerpt:

According to Dan Dowd, PharmD, vice president of medical affairs at Genomind, pharmacists in participating stores can inform customers about the Genecept Assay if they notice a history of psychotropic drug switching or drug-related adverse effects. If the test is administered, a physician’s order is required for the company’s laboratory to process it.

“This certainly is a recipe for selling a whole lot more tests,” Potash said of the approach, adding that patients often feel “desperate” to find a successful treatment. “What percentage of the time selling these tests will result in better patient outcomes remains to be seen.”

Biernacka also had reservations about the in-store model. “Generally, it could be helpful for a pharmacist to tell a patient or their provider that perhaps the patient could benefit from pharmacogenetic testing,” she said. “[B]ut until the tests are more thoroughly assessed, the decision to pursue such an option (and with which test) should be left more to the treating clinician and patient.”

Some physicians said they’ve found pharmacogenomic testing to be useful. Aron Fast, MD, a family physician in Hesston, Kansas, uses GeneSight for patients with depression or anxiety who haven’t improved after trying 2 or 3 antidepressants. Each time, he said, his patients were less depressed or anxious after switching to a new drug based on their genotyping results.

Part of their improvements may stem from expecting the test to help, he acknowledged. The testing “raises confidence in the medication to be prescribed,” Müller explained, which might contribute to a placebo effect. However, Müller emphasized that the placebo effect alone is unlikely to explain lasting improvements in patients with moderate to severe depression. In his psychiatric consulting practice, pharmacogenomic-guided drug changes have led to improvements in patients “sometimes even up to the point where they’re completely remitted,” he said.

The info is here.

Doctors’ mental health at tipping point

Chris Hemmings
BBC.co.uk
Originally posted September 3, 2018

Here is an excerpt:

'Last taboo'

Dr Gerada says the lack of confidentiality is a barrier and wants NHS England to extend the London approach to any doctor who needs support.

She believes acknowledging that doctors also have mental health problems is "the last taboo in the NHS".

Louise Freeman, a consultant in emergency medicine, says she left her job after she felt she could not access appropriate support for her depression.

"On the surface you might think 'Oh, doctors will get great mental health care because they'll know who to go to'.

"But actually we're kind of a hard-to-reach group. We can be quite worried about confidentiality," she said, adding that she believes doctors are afraid of coming forwards in case they lose their jobs.

"I was absolutely desperate to stay at work. I never wavered from that."

One of the biggest issues, according to Dr Gerada, is the effect on doctors of complaints from the public, which she says can "shatter their sense of self".

The info is here.

Why is suicide on the rise in the US – but falling in most of Europe?

Steven Stack
The Conversation
Originally published June 28, 2018

Here is an excerpt:

There is evidence that rising suicide rates are associated with a weakening of the social norms regarding mutual aid and support.

In one study on suicide in the U.S., the rising rates were closely linked with reductions in social welfare spending between 1960 and 1995. Social welfare expenditures include Medicaid, a medical assistance program for low income persons; Temporary Assistance for Needy Families, which replaced Aid to Families with Dependent Children; the Supplemental Security Income program for the blind, disabled and elderly; children’s services including adoption, foster care and day care; shelters; and funding of public hospitals for medical assistance other than Medicaid.

Later studies found a similar relationship between suicide and social welfare for the U.S. in the 1980s and between 1990 and 2000, as well as for nations in the Organization for Economic Cooperation and Economic Development.

When it comes to spending on social welfare, the U.S. is at the low end of the spectrum relative to Western Europe. For example, only 18.8 percent of the U.S. GDP is spent on social welfare, while most of the OECD nations spend at least 25 percent of their GDP. Our rates of suicide are increasing while their rates fall.

The information is here.

Mental health practitioners’ reported barriers to prescription of exercise for mental health consumers

KirstenWay, Lee Kannis-Dymand, Michele Lastella, Geoff P. Lovell
Mental Health and Physical Activity
Volume 14, March 2018, Pages 52-60

Abstract

Exercise is an effective evidenced-based intervention for a range of mental health conditions, however sparse research has investigated the exercise prescription behaviours of mental health practitioners as a collective, and the barriers faced in prescribing exercise for mental health. A self-report survey was completed online by 325 mental health practitioners to identify how often they prescribe exercise for various conditions and explore their perceived barriers to exercise prescription for mental health through thematic analysis. Over 70% of the sample reported prescribing exercise regularly for depression, stress, and anxiety; however infrequent rates of prescription were reported for conditions of schizophrenia, bipolar and related disorders, and substance-related disorders. Using thematic analysis 374 statements on mental health practitioners' perceived barriers to exercise prescription were grouped into 22 initial themes and then six higher-order themes. Reported barriers to exercise prescription mostly revolved around clients' practical barriers and perspectives (41.7%) and the practitioners' knowledge and perspectives (33.2%). Of these two main themes regarding perceived barriers to exercise prescription in mental health, a lack of training (14.7%) and the client's disinclination (12.6%) were initial themes which reoccurred considerably more often than others. General practitioners, mental health nurses, and mental health managers also frequently cited barriers related to a lack of organisational support and resources. Barriers to the prescription of exercise such as lack of training and client's disinclination need to be addressed in order to overcome challenges which restrict the prescription of exercise as a therapeutic intervention.

The research is here.

Why are Americans so sad?

Monica H. Swahn
quartz.com
Originally published June 16, 2018

Suicide rates in the US have increased nearly 30% in less than 20 years, the Centers for Disease Control and Prevention reported June 7. These mind-numbing statistics were released the same week two very famous, successful and beloved people committed suicide—Kate Spade, a tremendous entrepreneur, trendsetter and fashion icon, and Anthony Bourdain, a distinguished chef and world traveler who took us on gastronomic journeys to all corners of the world through his TV shows.

Their tragic deaths, and others like them, have brought new awareness to the rapidly growing public health problem of suicide in the US. These deaths have renewed the country’s conversation about the scope of the problem. The sad truth is that suicide is the 10th leading cause of death among all Americans, and among youth and young adults, suicide is the third leading cause of death.

I believe it’s time for us to pause and to ask the question why? Why are the suicide rates increasing so fast? And, are the increasing suicide rates linked to the seeming increase in demand for drugs such as marijuana, opioids and psychiatric medicine? As a public health researcher and epidemiologist who has studied these issues for a long time, I think there may be deeper issues to explore.

Suicide: more than a mental health issue

Suicide prevention is usually focused on the individual and within the context of mental health illness, which is a very limited approach. Typically, suicide is described as an outcome of depression, anxiety, and other mental health concerns including substance use. And, these should not be trivialized; these conditions can be debilitating and life-threatening and should receive treatment. (If you or someone you know need help, call the National Suicide Prevention Lifeline at 1-800-273-8255).

The info is here.

Can precision medicine do for depression what it’s done for cancer? It won’t be easy

Megan Thielking
Statnews.com
Originally posted May 9, 2018

At a growing number of research centers across the country, scientists are scanning brains of patients with depression, drawing their blood, asking about their symptoms, and then scouring that data for patterns. The goal: pinpoint subtypes of depression, then figure out which treatments have the best chance of success for each particular variant of the disease.

The idea of precision medicine for depression is quickly gaining ground — just last month, Stanford announced it is establishing a Center for Precision Mental Health and Wellness. And depression is one of many diseases targeted by All of Us, the National Institute of Health campaign launched this month to collect DNA and other data from 1 million Americans. Doctors have been treating cancer patients this way for years, but the underlying biology of mental illness is not as well understood.

“There’s not currently a way to match people with treatment,” said Dr. Madhukar Trivedi, a depression researcher at the University of Texas Southwestern Medical Center. “That’s why this is a very exciting field to research.”

The information is here.

Double warning on impact of overworking on academic mental health

Sophie Inge
The Times of Higher Education
Originally published on April 4, 2018

Fresh calls have been made to tackle a crisis of overwork and poor mental health in academia in the wake of two worrying new studies.

US academics who conducted a global survey found that postgraduate students were more than six times more likely to experience depression or anxiety compared with the general population, with female researchers being worst affected.

Meanwhile, a survey of more than 5,500 staff in Norwegian universities found that academics reported higher levels of workaholism than their administrative colleagues and revealed that the group appears to be among the occupations most prone to workaholism in society as a whole. Young and female academics were more likely than their senior colleagues to indicate that this had an impact on their family life.

The information is here.

Many People Taking Antidepressants Discover They Cannot Quit

Benedict Carey & Robert Gebeloff
The New York Times
Originally posted April 7, 2018

Here is an excerpt:

Dr. Peter Kramer, a psychiatrist and author of several books about antidepressants, said that while he generally works to wean patients with mild-to-moderate depression off medication, some report that they do better on it.

“There is a cultural question here, which is how much depression should people have to live with when we have these treatments that give so many a better quality of life,” Dr. Kramer said. “I don’t think that’s a question that should be decided in advance.”

Antidepressants are not harmless; they commonly cause emotional numbing, sexual problems like a lack of desire or erectile dysfunction and weight gain. Long-term users report in interviews a creeping unease that is hard to measure: Daily pill-popping leaves them doubting their own resilience, they say.

“We’ve come to a place, at least in the West, where it seems every other person is depressed and on medication,” said Edward Shorter, a historian of psychiatry at the University of Toronto. “You do have to wonder what that says about our culture.”

Patients who try to stop taking the drugs often say they cannot. In a recent survey of 250 long-term users of psychiatric drugs — most commonly antidepressants — about half who wound down their prescriptions rated the withdrawal as severe. Nearly half who tried to quit could not do so because of these symptoms.

In another study of 180 longtime antidepressant users, withdrawal symptoms were reported by more than 130. Almost half said they felt addicted to antidepressants.

The information is here.

Moral Injury and Religiosity in US Veterans With Posttraumatic Stress Disorder Symptoms

Harold Koenig and others
The Journal of Nervous and Mental Disease: February 28, 2018

Abstract

Moral injury (MI) involves feelings of shame, grief, meaninglessness, and remorse from having violated core moral beliefs related to traumatic experiences. This multisite cross-sectional study examined the association between religious involvement (RI) and MI symptoms, mediators of the relationship, and the modifying effects of posttraumatic stress disorder (PTSD) severity in 373 US veterans with PTSD symptoms who served in a combat theater. Assessed were demographic, military, religious, physical, social, behavioral, and psychological characteristics using standard measures of RI, MI symptoms, PTSD, depression, and anxiety. MI was widespread, with over 90% reporting high levels of at least one MI symptom and the majority reporting at least five symptoms or more. In the overall sample, religiosity was inversely related to MI in bivariate analyses (r = −0.25, p < 0.0001) and multivariate analyses (B = −0.40, p = 0.001); however, this relationship was present only among veterans with severe PTSD (B = −0.65, p = 0.0003). These findings have relevance for the care of veterans with PTSD.

The paper is here.

Mental Health Crisis for Grad Students

Colleen Flaherty
Inside Higher Ed
Originally published March 6, 2018

Several studies suggest that graduate students are at greater risk for mental health issues than those in the general population. This is largely due to social isolation, the often abstract nature of the work and feelings of inadequacy -- not to mention the slim tenure-track job market. But a new study in Nature Biotechnology warns, in no uncertain terms, of a mental health “crisis” in graduate education.

“Our results show that graduate students are more than six times as likely to experience depression and anxiety as compared to the general population,” the study says, urging action on the part of institutions. “It is only with strong and validated interventions that academia will be able to provide help for those who are traveling through the bioscience workforce pipeline.”

The paper is based on a survey including clinically validated scales for anxiety and depression, deployed to students via email and social media. The survey’s 2,279 respondents were mostly Ph.D. candidates (90 percent), representing 26 countries and 234 institutions. Some 56 percent study humanities or social sciences, while 38 percent study the biological and physical sciences. Two percent are engineering students and 4 percent are enrolled in other fields.

Some 39 percent of respondents scored in the moderate-to-severe depression range, as compared to 6 percent of the general population measured previously with the same scale.

The article is here.

More Religious Leaders Challenge Silence, Isolation Surrounding Suicide

Cheryl Platzman Weinstock
npr.org
Originally posted February 11, 2018

Here is an excerpt:

Until recently, many religious leaders were not well-prepared to talk about suicide with their congregants. Now some clergy have become an important part of suicide prevention.

"Where there's faith, there's hope, and where there's hope, there's life," says David Litts, co-leader of the Faith Communities Task Force of the National Action Alliance for Suicide Prevention.

Arnold also leads that task force. "If someone dies from heart disease, for instance, or in an accident, they may wonder where God is, but when someone dies by suicide, a whole lot of other questions get raised," she says. "When you can't talk about this in church, then it feels like God can't talk about it either."

But in her church, she says, there isn't shame surrounding suicide. During the pastoral prayer, for instance, she says she lifts up congregants dealing with cancer, heart disease or mental health issues. "It's a way of signaling to people this is a safe place to talk about such things and be honest about them."

The article is here.

Loneliness Might Be a Killer, but What’s the Best Way to Protect Against It?

Rita Rubin
JAMA. 2017;318(19):1853-1855.

Here is an excerpt:

“I think that it’s clearly a [health] risk factor,” first author Nancy Donovan, MD, said of loneliness. “Various types of psychosocial stress appear to be bad for the human body and brain and are clearly associated with lots of adverse health consequences.”

Though the findings overall are mixed, the best current evidence suggests that loneliness may cause adverse health effects by promoting inflammation, said Donovan, a geriatric psychiatrist at the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital in Boston.

Loneliness might also be an early, relatively easy-to-detect marker for preclinical Alzheimer disease, suggests an article Donovan coauthored. She and her collaborators recently reported in JAMA Psychiatry that loneliness was associated with a higher cortical amyloid burden in 79 cognitively normal elderly adults. Cortical amyloid burden is being investigated as a potential biomarker for identifying asymptomatic adults with the greatest risk of Alzheimer disease. However, large-scale population screening for amyloid burden is unlikely to be practical.

Regardless of whether loneliness turns out to be a marker for preclinical Alzheimer disease, enough is known about its health effects that physicians need to be able to recognize it, Holt-Lunstad says.

“The cumulative evidence points to the benefit of including social factors in medical training and continuing education for health care professionals,” she and Brigham Young colleague Timothy Smith, PhD, wrote in an editorial.

The article is here.

Suicide Is Not The Same As "Physician Aid In Dying"

American Association of Suicidology
Suicide Is Not The Same As "Physician Aid In Dying"
Approved October 30, 2017

Executive summary 

The American Association of Suicidology recognizes that the practice of physician aid in dying, also called physician assisted suicide, Death with Dignity, and medical aid in dying, is distinct from the behavior that has been traditionally and ordinarily described as “suicide,” the tragic event our organization works so hard to prevent. Although there may be overlap between the two categories, legal physician assisted deaths should not be considered to be cases of suicide and are therefore a matter outside the central focus of the AAS.

(cut)

Conclusion 

In general, suicide and physician aid in dying are conceptually, medically, and legally different phenomena, with an undetermined amount of overlap between these two categories. The American Association of Suicidology is dedicated to preventing suicide, but this has no bearing on the reflective, anticipated death a physician may legally help a dying patient facilitate, whether called physician-assisted suicide, Death with Dignity, physician assisted dying, or medical aid in dying. In fact, we believe that the term “physician-assisted suicide” in itself constitutes a critical reason why these distinct death categories are so often conflated, and should be deleted from use. Such deaths should not be considered to be cases of suicide and are therefore a matter outside the central focus of the AAS.

The full document is here.

Rigorous Study Finds Antidepressants Worsen Long-Term Outcomes

Peter Simons
madinamerica.com
Originally posted

Here is an excerpt:

These results add to a body of research that indicates that antidepressants worsen long-term outcomes. In an article published in 1994, the psychiatrist Giovanni Fava wrote that “Psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat.” In a 2003 article, he wrote: “A statistical trend suggested that the longer the drug treatment, the higher the likelihood of relapse.”

Previous research has also found that antidepressants are no more effective than placebo for mild-to-moderate depression, and other studies have questioned whether such medications are effective even for severe depression. Concerns have also been raised about the health risks of taking antidepressants—such as a recent study which found that taking antidepressants increases one’s risk of death by 33% (see MIA report).

In fact, studies have demonstrated that as many as 85% of people recover spontaneously from depression. In a recent example, researchers found that only 35% of people who experienced depression had a second episode within 15 years. That means that 65% of people who have a bout of depression are likely never to experience it again.

Critics of previous findings have argued that it is not fair to compare those receiving antidepressants with those who do not. They argue that initial depression severity confounds the results—those with more severe symptoms may be more likely to be treated with antidepressants. Thus, according to some researchers, even if antidepressants worked as well as psychotherapy or receiving no treatment, those treated with antidepressants would still show worse outcomes—because they had more severe symptoms in the first place.

The article is here.

The target article is here.

Prince Harry: mental health should be at heart of armed forces training

Caroline Davies
The Guardian
Originally posted October 9, 2017

Prince Harry has said mental health strategies for armed forces personnel are crucial to create a “more confident, focused and, ultimately, more combat-ready military”.

In a speech at the Ministry of Defence, the 33-year-old prince, who spent 10 years in the army, said that as the number of active-duty personnel had been reduced there was a premium on “every individual being fighting fit and deployable”.

Announcing a joint initiative between the MoD and the Royal Foundation, created by the prince and the Duke and Duchess of Cambridge to tackle mental health issues, Harry said mental health strategies needed to be at the forefront of armed forces personnel training.

“Quite simply, these men and women are prized assets which need to be continually invested in. We surely have to think of them as high-performance athletes, carrying all their kit, equipment and a rifle,” he said. “Crucially, fighting fitness is not just about physical fitness. It is just as much about mental fitness too.”

The MoD said the move would build upon a recently launched government strategy aimed at improving mental health among military workers, civilian staff, their families and veterans.

The article is here.

Hindsight Bias in Depression

Julia Groß, Hartmut Blank, Ute J. Bayen
Clinical Psychological Science 
First published date: August-07-2017

Abstract

People tend to be biased by outcome knowledge when looking back on events. This phenomenon is known as hindsight bias. Clinical intuition and theoretical accounts of affect-regulatory functions of hindsight bias suggest a link between hindsight bias and depression, but empirical evidence is scarce. In two experiments, participants with varying levels of depressive symptoms imagined themselves in everyday scenarios that ended positively or negatively and completed hindsight and affect measures. Participants with higher levels of depression judged negative outcomes, but not positive outcomes, as more foreseeable and more inevitable in hindsight. For negative outcomes, they also misremembered prior expectations as more negative than they initially were. This memory hindsight bias was accompanied by disappointment, suggesting a relation to affect-regulatory malfunction. We propose that “depressive hindsight bias” indicates a negative schema of the past and that it sustains negative biases in depression.

The research is here.

Google has created a tool that tests for clinical depression

Katherine Ellen Foley
Quartz
Originally posted August 24, 2017

People often delay seeking treatment for mental health conditions like depression. The longer they wait to see their doctors, the worse the condition becomes, making it harder to treat in the future.

In an effort to encourage more patients to seek treatment sooner, Google announced Aug. 23 that it has teamed up with National Alliance on Mental Illness (NAMI), an advocacy group, to create a simple tool for users to assess if they may be depressed. Now, when people in the US search for “clinical depression” on their phones, the typical “knowledge panel”—a container that displays company-vetted information on Google’s search results page—will come with an option to take a quiz that can assess the severity of symptoms. (Google says the quiz results will not be seen by anyone but the quiz-taker.)

Google’s quiz isn’t new. It’s a reskinned version of the 18-year-old PQH-9 (pdf), used by physicians to help diagnose patients with mental illnesses like depression and anxiety. It asks about general interest in activities, eating and sleeping habits, and overall mood. Alone, the PQH-9 won’t give a definitive diagnosis. Doctors use it in conjunction with physical exams to rule out other causes for patients’ symptoms, like a thyroid problem. Google says its incorporation of the PQH-9 test in its search results is not meant as a final diagnosis, but as a tool to inspire people to have conversations with their healthcare providers if they were hesitant before.

The article is here.

Burnout at Work Isn’t Just About Exhaustion. It’s Also About Loneliness

Emma Seppala and Marissa King
Harvard Business Review

First published June 29, 2017

More and more people are feeling tired and lonely at work. In analyzing the General Social Survey of 2016, we found that, compared with roughly 20 years ago, people are twice as likely to report that they are always exhausted. Close to 50% of people say they are often or always exhausted due to work. This is a shockingly high statistic — and it’s a 32% increase from two decades ago. What’s more, there is a significant correlation between feeling lonely and work exhaustion: The more people are exhausted, the lonelier they feel.

This loneliness is not a result of social isolation, as you might think, but rather is due to the emotional exhaustion of workplace burnout. In researching the book The Happiness Track, we found that 50% of people — across professions, from the nonprofit sector to the medical field — are burned out. This isn’t just a problem for busy, overworked executives (though the high rates of loneliness and burnout among this group are well known). Our work suggests that the problem is pervasive across professions and up and down corporate hierarchies.

Loneliness, whether it results from social isolation or exhaustion, has serious consequences for individuals. John Cacioppo, a leading expert on loneliness and coauthor of Loneliness: Human Nature and the Need for Social Connection, emphasizes its tremendous impact on psychological and physical health and longevity. Research by Sarah Pressman, of the University of California, Irvine, corroborates his work and demonstrates that while obesity reduces longevity by 20%, drinking by 30%, and smoking by 50%, loneliness reduces it by a whopping 70%. In fact, one study suggests that loneliness increases your chance of stroke or coronary heart disease — the leading cause of death in developed countries — by 30%. On the other hand, feelings of social connection can strengthen our immune system, lengthen our life, and lower rates of anxiety and depression.

The article is here.

There is something rotten inside the medical profession

Anonymous
kevinmd.com
Originally published January 26, 2017

In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.

Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients — which is often sadly a given, but for the doctors training inside it. Every generation always looks down on the generation training after it — no one ever had it as hard as them, and thus deserve to suffer just as much, if not more. This dubious school of thought has long been acknowledged as standard practice. To be a good doctor, you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing, and if you admit to struggling, the unspoken opinion (or often spoken) is that you simply couldn’t hack it.

In the cutthroat, often brutalizing culture of medical or surgical training many doctors stay stoically mute in the face of daily, soul destroying adversity; at the worst case, their loudest gesture is deafeningly silent — death by their own hand.

The blog post is here.

Middle School Suicides Reach An All-Time High

Elissa Nadworny
npr.com
Originally posted November 4, 2016

There's a perception that children don't kill themselves, but that's just not true. A new report shows that, for the first time, suicide rates for U.S. middle school students have surpassed the rate of death by car crashes.

The suicide rate among youngsters ages 10 to 14 has been steadily rising, and doubled in the U.S. from 2007 to 2014, according to the Centers for Disease Control and Prevention. In 2014, 425 young people 10 to 14 years of age died by suicide.

The article and the video are here.

National Suicide Hotline: 1-800-273-8255