Monday, December 8, 2014

Antidepressant Use is No Longer Increasing in Canada

I have just published two papers about major depression in Canada in the Canadian Journal of Psychiatry (abstracts available here). One of these is concerned with the way in which people view their mental health. Everybody seems to feel that life is more stressful now than it was in the past - but when you look at the proportion of people reporting that their lives are very much or extremely stressful in surveys that have been conducted in Canada over the past 20 years there is actually a decline in the proportion reporting this. On the other hand, people are becoming more likely to report that their mental health is only fair or poor. My interpretation of this trend is that it reflects a changing way of looking at mental health - rather than interpreting distressing symptoms as being due to an external cause, people seem increasingly likely to interpret this more internally as a mental health issue. This trend reflects increasing mental health literacy. The second paper is an analysis of trends in antidepressant use over the past 20 years in Canada. After large increases in the 1990s and 2000s, there appears to be no increase over the past 5-10 years. This applies to traditional antidepressant medications. Other sources of data suggest that there has been an increased use of second generation antipsychotic medications for mood disorders including major depression. This trend is consistent with Health Canada's approval of their use as an adjunctive treatment.

Wednesday, November 12, 2014

Global Picture of Depression Summarized in Nature

The current edition of the journal Nature has a focus on depression - with a summary of research progress, and lack thereof. There are some good graphics in it, link to the graphics here. On the global rankings, Canada is slightly below the global mean for depression prevalence. Another thing that is clear - the research funding that goes to depression is out of line (way below) its place as the world's leading cause of disability. It is too bad that all of this came out at the same time that a spacecraft was landing on a comet.

Tuesday, October 21, 2014

Summary of Outcome Data from a Large Anti-stigma Initiative in Canada

Combating stigma has been a major priority of the Mental Health Commission of Canada. They have adopted a targeted approach, working with grassroots organizations to: reduce the impact of stigma on children and youth, reduced stigmatization by health professionals (who are not immune from stigma) and to reduce stigma in workplaces. A major summary of this extensive program of research is now available through the Canadian Journal of Psychiatry and can be accessed here. When it comes to reducing stigma by health professionals, six key ingredients are identified: (1) adopting a recovery emphasis, (2) using multiple forms of social contact (this means real communication between people with illnesses and health professionals outside of the typical professional channels, e.g. "Doctor-Patient"), (3) a personal testimonial, (4) myth-busting, (5) teaching of skills and (6) an enthusiastic leader for the intervention. Among 22 anti-stigma studies evaluated, those that incorporated all six ingredients performed better than those that incorporated only some.

More data on the theme "depression is really hard to treat"

In a recent blog posting, Dr. James Coyne provides a detailed discussion of a large clinical trial evaluating the impact of adding psychotherapy (manual based, high quality cognitive behavioural therapy, CBT) to pharmacotherapy. One of the key results of the trial is that a large proportion of those receiving such state-of-the-art treatment continue to experience depressive symptoms. The addition of CBT did not have a dramatic effect over and above the medication treatment. It is best not to interpret this kind of information as if it were some kind of competition between different modalities of treatment (all of which are supported by evidence). The key message is that depression is a long-term issue for many people. Dr. Coyne's blog may be found here.

Wednesday, July 16, 2014

Mechanisms of Antidepressant Action & Warring Camps in Psychiatry

An interesting plain language summary of a contemporary view (mood regulation network modulation, neuroplasticity) of probable mechanisms of action of antidepressants is available here. Mental health professionals are used to being members of warring theoretical camps - psychotherapy versus medications being one of them. But, this is making less and less sense scientifically as time goes by.

Tuesday, April 29, 2014

Elephant in the Room

The Mood Disorders Society of Canada is gearing up an anti-stigma campaign, called Elephant in the Room. The idea is that organizations can display a blue elephant to signify that their organization is a safe environment to talk about mental health, without stigmatization.

Sunday, April 27, 2014

Mass Hysteria

In a few previous posts, I've discussed the topic of behavioral contagion, which may play a small role in some aspects of depression epidemiology. There is a new slideshow about a related topic - "mass hysteria." You can watch it here.

Wednesday, April 23, 2014

Child Abuse and Depression

In 2012 Statistics Canada conducted the second national mental health survey. For the first time, they included a childhood experiences questionnaire allowing an estimate of the proportion of adult Canadians (age 15+) who report that they were abused as children. A detailed report was published in the Canadian Medical Association Journal, and summarized in a Globe and Mail article. the headline finding is the proportion is large: about 1/3 reporting some kind of abuse during childhood. With respect to the issue of clinical depression, reporting child abuse, depending on the type was associated roughly with a doubling to three-fold increase in the odds of having had an episode of depression at some point in one's life.

Sunday, April 13, 2014

Perceived Needs and Mental Health Care

Perceived needs for mental health care are often unmet. However, as a possible sign that things are getting better, the recent Canadian Community Health survey - Mental Health, reported that 2/3 of those identifying mental health needs reported that they were met. This was a Statistics Canada survey, details are available here.

Friday, February 21, 2014

A Saliva Test for Depression?

A new paper, available on-line and soon to be published in the Proceedings of the National Academy of Sciences has attracted a lot of attention as evidence of a new saliva test for depression. The study is based on two cohorts of secondary school children in the UK. They were followed prospectively and completed depression rating scale scores as well as 0800H saliva cortisol repeatedly during the follow-up (which was 12 months for one of the cohorts and 36 months for the other). As both elevated depressive symptom levels and elevated AM cortisol are well known risk factors, the result is perhaps not surprising: those with persistently elevated symptom levels and persistently elevated AM cortisol had a higher risk for a major depressive episode. The effect was only significant in boys. The idea of a saliva test for depression is intriguing, which may partially explain the media interest. However, statistical prediction does not translate into a clinically meaningful test and certainly not a useful screening test. It has not been shown that this kind of a test is a more effective way to predict depression risk than prediction algorithms using more traditional risk information, or for that matter asking a few questions about important risk factors. The fascination with this kind of result seems to arise from a strong desire for convergence between mental health and physical health disciplines. Physicians base diagnoses on laboratory data quite often, whereas this does not occur to nearly the same extent in mental health. The difference between a measure of depressive symptoms and a depressive episode is that in the latter instance the symptoms are more severe and more persistent. The fact that more severe and more persistent symptoms need to be added to salivary cortisol to create a significant prediction is as much a sign of how difficult it remains to use biological data as it is an indication of an effective diagnostic or predictive tool.

Tuesday, February 4, 2014

Antidepressant Use in Canada

A recent OECD report identified Canada as the worlds third leading consumer of antidepressant medication, the report may be found by following this link. The only countries ahead of Canada were Iceland and Australia. However, a few caveats are in order. First, the study was only based on data from two provinces, Saskatchewan and Manitoba. Second, the report did not have comprehensive coverage of countries. The US, for example, was not included. Available evidence would suggest that the rate of antidepressant use in the US is approximately double that of Canada, approximately 10% (see this CDC databrief from NHANES)versus approximately 5%, see this CJP paper.