Burnout is a state of emotional exhaustion related to chronic stress from work or personal issues. Madsen and colleagues found that burnout is associated with an increased risk of antidepressant treatment in 2936 Danish human service workers. As noted by the authors, these results suggest that individuals with high levels of burnout are at substantial risk of developing a clinically significant mental health condition that may require antidepressant treatment.
Mental Illness
Is adding an atypical antipsychotic effective in OCD patients not responding to SSRI antidepressants?
In the November 2014 issue of BMC Psychiatry, David Veale and colleagues from King’s College in London conducted a meta-analysis of the clinical effectiveness of adding atypical anti-psychotics (aripiprazole, olanzapine, quetiapine, or risperidone) to Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants (e.g., fluoxetine, fluvoxamine, citalopram) in treatment-resistant patients with Obsessive Compulsive Disorder (OCD) . They found limited evidence for using a low dose of risperidone or aripiprazole and no evidence for using olanzapine or quetiapine. They suggest considering other augmentation strategies such as combining the SSRI antidepressant with cognitive-behavioral therapy or clomipramine.
Low Dose of Quetiapine is Effective in Borderline Personality Disorder
Individuals with borderline personality disorder (BPD) suffer from mood instability, impulsive behavior, and disturbed relationships. Although studies suggest a beneficial effect of psychotherapy in BPD, results of medication studies have been mixed. In the October issue of the American Journal of Psychiatry, Dr. Donald Black and colleagues conducted a 8-week double-blind study comparing quetiapine, a second-generation antipsychotic, with placebo in 95 individuals diagnosed with BPD. They found that a low dose of quetiapine (150 mg daily) reduced the symptom severity of BPD. In their conclusion, the authors urged for longer and additional studies to confirm the effectiveness of quetiapine in this disorder.
Cognitive-Behavioral Therapy and Risperidone in Obsessive-Compulsive Disorder
In a video, Dr. Helen Blair Simpson discusses her study published in JAMA Psychiatry comparing Exposure and Ritual Prevention Cognitive-Behavioral Therapy (CBT), risperidone, and placebo in OCD patients treated with selective serotonin reuptake inhibitor antidepressants (SSRI’s). CBT had better outcomes than risperidone and placebo. Dr. Simpson suggests discontinuing antipsychotic medications in SSRI-treated OCD patients who do not improve after four weeks.
What is the Relationship between Depression and Physical Activity?
In a previous post (10/2/14), I reported a study suggesting that physical activity improves depression. In a new study published in the October 15 issue of JAMA Psychiatry, Drs. Snehal M. Pinto Pereira, Marie-Claude Geoffroy, and Christine Power suggest a bidirectional relationship between depression and physical activity, i.e., physical activity may decrease depressive symptoms and, in turn, depressive symptoms in early adulthood may be an impediment to physical activity.
Risks of Mania with Antidepressants in Bipolar Disorder
In the October issue of the American Journal of Psychiatry, Alexander Viktorin and colleagues identified 3240 subjects with bipolar disorders treated for a depressive episode. There was a marked increase in the risk of treatment-emergent mania in patients who were not treated with a concurrent mood stabilizer. These results confirm previous guidelines about not using antidepressants as monotherapy in the treatment of bipolar disorder. In an editorial, Dr. Eduard Vieta suggests that “Every patient should have the right to receive a detailed summary of reasonable treatment choices, psychoeducation on the illness, and objective information on the benefits and risks of each strategy. For many patients, antidepressants will not be the first-line recommendation, but perhaps those with a depressive-predominant polarity, with bipolar II disorder, or with a previous response to antidepressants may be candidates for an adjunctive antidepressant.” For those who want to know more about bipolar disorder, ‘Crash Course‘ produced a very informative (and entertaining) video on You Tube.
Mental Health Consequences of Childhood Bullying
In this video sponsored by the National Institute of Mental Health, Drs. William Copeland and Christopher Sarampote discuss the mental health consequences of childhood bullying . In the July issue of the American Journal of Psychiatry, Drs. Takizawa, Maughan, and Arsenault report bullying data from the British National Development Study. This is a 50-year prospective cohort of 17,638 individuals born in 1958. Parents reported childhood bullying in 7,771 or 44% of them. The authors found that childhood bullying victims have higher psychological distress, rates of depression, anxiety, and suicide, less social relationships, more economic hardship, and poorer perceived quality of life than individuals who were not bullied. In an editorial, Dr. E. Jane Costello suggests improving mental health outcomes of childhood bullying victims by doing more research on primary prevention (i.e., intervention before bullying) , secondary prevention (i.e., intervention during bullying), and tertiary prevention (i.e., intervention to prevent mental health consequences after bullying). Given the high rates of childhood bullying and its consequences, Dr. Costello emphasizes the importance of asking patients and parents about a history of bullying.
Yoga as a Treatment for Women with Treatment-Resistant Post-Traumatic Stress Disorder
In a study published in the June 2014 issue of Journal of Clinical Psychiatry, van der Kolk and colleagues compare Sixty-four women with chronic, treatment-resistant post traumatic Stress disorder (PTSD) who were randomly assigned to either trauma-informed yoga or supportive women’s health education, each as a weekly 1-hour class for 10 weeks. At the end of the study, 16 of 31 participants (52%) in the yoga group no longer met criteria for PTSD compared to 6 of 29 (21%) in the control group (n = 60, χ²₁ = 6.17, P = .013). Both groups exhibited a significant decrease in PTSD symptoms during the first half of treatment, but these improvements were maintained in the yoga group, while the control group relapsed after its initial improvement. The authors suggest that yoga may improve the functioning of traumatized individuals by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance.
Can Therapists and Neuroscientists work together?
In the July 17th issue of Nature, Emily Holmes, Michelle Craske, and Ann Graybiel suggest involving more clinical psychologists in Neurosciences. Neuroscientists and clinical scientists “rarely work together, read different journals, and know relatively little of each other’s needs and discoveries. Mental-health disorders account for more than 15% of the disease burden in developed countries, more than all forms of cancer. Yet it has been estimated that the proportion of research funds spent on mental health is as low as 7% in North America and 2% in the European Union.” The author suggests three steps to better integrate clinical psychology in neurosciences: first, uncover the neurobiological mechanisms underlying psychological treatments. Second optimize and develop new psychological treatments by applying neuroscience knowledge and technology; and third forge a link between clinical and laboratory researchers through funding and meetings.
The Addition of Cognitive Therapy to Antidepressants Improves Recovery Outcomes in Some Patients with Major Depression
In the October 2014 issue of JAMA Psychiatry, Hollon and collaborators published a randomized, not-blinded, up-to-42 months study in 452 adult outpatients with chronic or recurrent major depressive disorder (MDD). The trial compares antidepressant medications alone (AD) (n=227) with antidepressants medications + cognitive therapy (AD+CT). The authors found no differences between groups for remission rates, median time to remission, and relapse rates. The AD+CT group had higher recovery rates (defined as 26 consecutive weeks without relapse after remission) than the AD group, more specifically in patients with severe (74% vs. 54%) and non-chronic (77% vs. 60%) MDD. There were no differences in recovery rates between groups for patients with comorbid axis II disorder, chronic, or low-severity depression. These results suggest that only MDD patients with more severe, non-chronic, and no comorbid axis II disorders benefit from the addition of CBT to pharmacotherapy.
Serge Sevy, MD 