Monday, December 8, 2008

Is depression contagious?

A recent study that has been getting a lot of press coverage asserted that happiness may be contagious. This raises the question about whether depression may have a contagious element. The authors used social network theory to show that the probability of being happy was greater when other around you are happy - and found weaker effects for unhappiness. The idea of emotional contagion is a very old one, but its relevance to depressive disorders has not been confirmed. The outbreak of sports riots is another circumstance in which emotional contagion may play an important role, see here.

Thursday, November 13, 2008

Stepped Care

A trend in how people are understanding optimal treatment for depression is seen in the UK NICE guidelines on depression management, which adopt a "stepped care" approach. This means that an intervention should start with a basic approach and move systematically towards more intensive treatments if the basic interventions are not successful. This fits, in theory, with the idea that many (perhaps most) episodes of depression and mild and self-limited, but that at the other end of the spectrum, many episodes are highly persistent and recurrent (link to a paper on the topic) and need long-term proactive care. This is an idea that is gaining wider acceptance in Canada, see article in the Sudbury Star.

Friday, October 17, 2008

IHE Consensus Development Conference

The Institute of Health Economics consensus development conference on depression is complete. The process for consensus development involved a variety of presentations from leading Canadian and International researchers in the field. These presentations were made to a Jury, which was then sequestered to produce a consensus statement on how to improve diagnosis, prevention and treatment of depression. I have added a link for the statement to the Blog along.


Sunday, September 7, 2008

Upcoming Consensus Conference

A consensus conference on depression will be taking place in Calgary in October.
Registration is still open. More information and the program can be found by following this link.

Saturday, July 26, 2008

On Line Resources

The policy paper emphasizes a public health perspective.
There are also a lot of resources available on the Web that can support clinical care in major depression.
Materials for self-management have been developed by Dr. Dan Bilsker at Simon Fraser University and are freely available here.
An on-line version of CBT is freely available here, from the Australian National University. This version of computerized CBT was evaluated in a randomized controlled trial published in the British Medical Journal, link here.
Wikepedia has alot of information too, including definitions and history, here.
It includes a picture painted by Van Gogh in the year of his suicide.

Monday, July 7, 2008

The issue of depression as a cause of workplace difficulties was, until recently, a neglected topic. This is no longer the case, probably as a result of some major international (e.g. the World Health Organization's Global Burden of Disease Project) and national (e.g. the Kirby Report) initiatives.

The concern is filtering down, as seen in the recent series in the Globe and Mail (see below). This week, there was also some coverage by the Edmonton Journal, see here.


Tuesday, June 24, 2008

Mental Health in Canada: Globe & Mail

This week the Globe and Mail have been running an excellent series on mental health, with articles covering topics including stigma, the impact on people, and today, on peoples' careers. Link to article in on-line edition. Later in the week, there will be an article on the topic of Stigma by Senator Michael Kirby, whose report on mental illness in Canada has had a huge impact. Link to the report here. Canada has some leading researchers in the stigma field, including Dr. Julio Arboleda-Florez (Queen's University). Here is a link to a related newspiece. Another is Dr. Heather Stuart, also at Queen's University, she has made some of her work available on the WWW, see here.

Thursday, May 15, 2008

Profil de la dépression clinique au Canada

Le rapport est maintenant disponible en français.Vous pouvez y accéder à l'aide des rubriques à gauche de l'écran, ou en suivant celien :Vous êtes invités a faire vos commentaires en français ou en anglais.

Profil de la dépression clinique au Canada

Monday, May 5, 2008

Migraine and Mood Disorders

Depression is associated with many physical conditions.
The most commonly implicated conditions are those that involve either inflammation or chronic pain. In a recent analysis of data from the CCHS 1.2, Dr. Nathalie Jette has demonstrated the strong link between migraine and major depression. She has also shown that the association is not specific for major depression. An association was observed also for bipolar disorder, panic disorder and social phobia.

More information here.

Tuesday, April 22, 2008

Link to Relevant Papers in CMAJ

The paper by Katz et al. mentioned in the previous post can be found in the Canadian Medical Association Journal, April 8th Issue. There are also a couple of commentaries on the issue of depression there. The same issue also has a systematic review of screening instruments for depression.

Wednesday, April 9, 2008

More About the Antidepressant Effectiveness Debate

Recent media attention to the idea that antidepressants are less effective than claimed derived from studies re-analyzing data submitted to regulatory agencies. The methodological issue involved is publication bias - the extent of antidepressant effectiveness may have been exaggerated because the most favourable results were the ones that were eventually published, whereas less favourable results were not.

However, the discussion appears to have gone "over the top" and these studies have been mentioned many times in the past few months in the media as providing evidence that the medications are completely ineffective.

The reaction has resulted in some new voices emerging: One is a communication to physicians from Dr. Patrick White, who is the current head of the Canadian Psychiatric Association:

Another is a cautionary note regarding suicide in youth - not a directly related issue has also appeared in the news media. The study, by Katz et al. has apparently not yet been published in the peer reviewed literature, but suggests a possible increased suicide rate in Manitoba youth in conjunction with reduced physician visits and antidepressant prescribing after a Health Canada warning about the medications. The possibility that reduced use of antidepressants in response to a Health Canada warning about their safety may have led to an increase in youth suicides in Manitoba cautions against overstated and rather sweeping criticism of medications such as these - as these can have negative effects.

It would be best if the debate about the proper role of these medications were guided by scientific evidence - and this is one of the goals of the policy paper that is the purpose of this blog. Incidentally, it was featured in the Statistics Canada "Daily" on April 9, 2008.

Tuesday, March 4, 2008

Is it true that antidepressants don't work?

Lately, it has become popular to assert that antidepressants don't work, for example see this newspaper article.

It is true that in many antidepressant trials the observed effects have been modest, and the "placebo response" rates have been very high. However, the recovery rate from depression in people who are untreated is not always indicative of a placebo response. A placebo response implies that the recovery was due to the non-specific benefits of treatment (hope etc.).

The high rate of spontaneous recovery reflects the episodic nature of clinical depression. Many episodes of depression are brief (ie. they recover spontaneously and do not need treatment), but as they become more chronic the recovery rate diminishes. Many clinical trials actively recruit people with mild episodes and no comorbidity - exactly the group that is likely to recover rapidly.

So, despite the popularity of asserting that antidepressants don't work for depression, the reality is simpler: not all episodes of depression (especially mild ones) benefit from antidepressants.

A New Policy Paper on Clinical Depression in the Canadian Context

Researchers across Canada are studying different aspects of major depression using Statistics Canada health survey data accessed primarily in Research Data Centres across Canada. A Profile of Clinical Depression in Canada is the first paper in a "Synthesis Series" designed to bring together research findings on socio-economic and health issues and make them known to policy makers and the public at large.

A Profile of Clinical Depression in Canada