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Hawley LL, Niederkrotenthaler T, Zaheer R, Schaffer A, Redelmeier DA, Levitt AJ, Sareen J, Pirkis J, Sinyor M. Is the narrative the message? The relationship between suicide-related narratives in media reports and subsequent suicides. Aust N Z J Psychiatry 2023; 57:758-766. [PMID: 35999688 PMCID: PMC10126449 DOI: 10.1177/00048674221117072] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES When journalists report on the details of a suicide, the way that they contextualize the meaning of the event (i.e. the 'narrative') can have significant consequences for readers. The 'Werther' and 'Papageno' narrative effects refer to increases and decreases in suicides across populations following media reports on suicidal acts or mastery of crises, respectively. The goal of this study was to investigate the impact of these different narrative constructs on subsequent suicides. METHODS This study examined the change in suicide counts over time in Toronto, Canada. It used latent difference score analysis, examining suicide-related print media reports in the Toronto media market (2011-2014). Articles (N = 6367) were coded as having a potentially harmful narrative if they described suicide in a celebrity or described a suicide death in a non-celebrity and included the suicide method. Articles were coded as having potentially protective narratives if they included at least one element of protective content (e.g. alternatives to suicide) without including any information about suicidal behaviour (i.e. suicide attempts or death). RESULTS Latent difference score longitudinal multigroup analyses identified a dose-response relationship in which the trajectory of suicides following harmful 'Werther' narrative reports increased over time, while protective 'Papageno' narrative reports declined. The latent difference score model demonstrated significant goodness of fit and parameter estimates, with each group demonstrating different trajectories of change in reported suicides over time: (χ2[6], N = 6367) = 13.16; χ2/df = 2.19; Akaike information criterion = 97.16, comparative fit index = 0.96, root mean square error of approximation = 0.03. CONCLUSION Our findings support the notion that the 'narrative' matters when reporting on suicide. Specifically, 'Werther' narratives of suicides in celebrities and suicides in non-celebrities where the methods were described were associated with more subsequent suicides while 'Papageno' narratives of survival and crisis mastery without depictions of suicidal behaviours were associated with fewer subsequent suicides. These results may inform efforts to prevent imitation suicides.
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Affiliation(s)
- Lance L Hawley
- Frederick W. Thompson Anxiety Disorders
Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health
Promotion, Department of Social and Preventive Medicine, Center for Public Health, Medical
University of Vienna, Vienna, Austria
| | - Rabia Zaheer
- Department of Psychiatry, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Donald A Redelmeier
- Department of Medicine, University of
Toronto, Toronto, ON, Canada
- Evaluative Clinical Sciences, Sunnybrook
Research Institute, Toronto, ON, Canada
- Division of General Internal Medicine,
Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences,
Toronto, ON, Canada
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jitender Sareen
- Departments of Psychiatry, Psychology and
Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of
Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health
Sciences Centre, University of Toronto, Toronto, ON, Canada
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Klim-Conforti P, Levitt AJ, Cheung AH, Loureiro R, Fefergrad M, Schaffer A, Niederkrotenthaler T, Sinyor M, Zaheer J. Youth voices and experiences regarding a school-based cognitive behavioral therapy skills intervention: lessons for future engagement and adaptation. BMC Public Health 2022; 22:1709. [PMID: 36076231 PMCID: PMC9461107 DOI: 10.1186/s12889-022-14058-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background The Cognitive Behavioral Therapy Skills Intervention (or CBTSI) aims to build mental health literacy and knowledge, allowing youth to build resilience and improve mental health broadly. In Ontario, Canada, youth voice is scant and European studies have largely reported on youth factors supporting stigma reduction, help-seeking intentions and overall satisfaction with a given intervention. Process evaluations and implementation that underpin what youth require to embrace mental health literacy interventions, particularly those that embed key learning principles in the everyday curriculum, have not been broached. The goal of this study is to understand both barriers and facilitators to engagement with the CBTSI (an intervention novel in itself because of the combined mental health plus cognitive behavior therapy (CBT) skills principles embedded in literacy) and the resources and structures that students report requiring, to fully engage with such an intervention. Methods Student focus groups were conducted utilizing qualitative interviews that were analyzed thematically. Analysis was informed using principles of pragmatism and analyzed inductively using thematic analysis (Braun and Clarke, Qual Res Psychol 3:77–101, 2006), first looking at the whole and then coding for themes, within an interpretivist framework. Youth were in middle school (grade 7 and 8) in Toronto, Canada who had received the CBTSI. Face to face interview guides with iterative questioning were conducted in February of 2020, and these interviews were audio-recorded and professionally transcribed. Teachers randomly chose a subset of youth whose parents consented to the research to ensure ethno-racial similarity to classroom demographics. Results There were eight groups with sixty students who participated. Students were 12 to 14 years of age. Major themes were identified: maximizing the opportunities for involvement and self-determination created an atmosphere where confidence and self-compassion could flourish, signalling to the students that they understood and were able to deploy the strategies they were taught; students expressed that the intervention needs to be adapted to enhance personal dignity, respecting both individual wishes and goals in light of the variability in student reported mental health. A model explains the structures and adaptations required to maximize learning based on youth feedback. Interpretation Mental health literacy incorporating CBT is a promising population-based health promotion intervention. Future adaptations and implementation decisions regarding the CBTSI need to address the wishes and experiences of these youth. Youth voice in this study explored factors that prevent and promote the uptake of the key lessons within the context of existing variability in student mental health that is often found within the context of a regular classroom. The results should be used to adapt the CBTSI as it is disseminated more broadly.
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Affiliation(s)
- Paula Klim-Conforti
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, Ontario, M5S 3H2, Canada. .,Member of the College of Psychologists of Ontario, Toronto, Ontario, Canada. .,Member of the College of Registered Psychotherapists of Ontario, Toronto, Ontario, Canada.
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amy H Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Raisa Loureiro
- Member of the College of Registered Psychotherapists of Ontario, Toronto, Ontario, Canada
| | - Mark Fefergrad
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090, Vienna, Austria.,Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute for Medical Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Karthikeyan S, Dimick MK, Fiksenbaum L, Jeong H, Birmaher B, Kennedy JL, Lanctôt K, Levitt AJ, Miller GE, Schaffer A, Young LT, Youngstrom EA, Andreazza AC, Goldstein BI. Inflammatory markers, brain-derived neurotrophic factor, and the symptomatic course of adolescent bipolar disorder: A prospective repeated-measures study. Brain Behav Immun 2022; 100:278-286. [PMID: 34896179 DOI: 10.1016/j.bbi.2021.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Numerous studies have found elevated pro-inflammatory markers and reduced brain-derived neurotrophic factor (BDNF) during symptomatic episodes of bipolar disorder (BD) in adults. There is a paucity of research examining these markers in youth with BD, or longitudinally in any BD age group. METHODS 79 adolescents, ages 13-19 years, were enrolled, including 43 symptomatic adolescents with BD and 36 age-matched healthy controls (HC). Blood samples were collected from all participants at intake, and repeatedly from BD participants at pre-specified intervals over the course of two years. Serum was assayed for levels of pro-inflammatory markers (c-reactive protein [CRP], interleukin [IL]-6, tumor necrosis factor alpha [TNF-α]), BDNF and the anti-inflammatory marker, IL-10. Week-by-week severity of mood symptoms was assessed using semi-structured interviews. RESULTS Adolescents with BD provided an average of 4.6 blood samples, on average every 5.0 months. During the most severe symptomatic interval (i.e., highest sum of mood symptom scores) among BD adolescents, levels of CRP (p = 0.01) and pro- to anti-inflammatory ratios (CRP/IL-10; p < 0.001 and IL-6/IL-10; p = 0.046) were significantly greater, and IL-10 levels (p = 0.004) were significantly lower, vs. HC. There were no differences between BD and HC in IL-6, TNF-α or BDNF. Within BD participants, higher BDNF (p = 0.01) and IL-10 levels (p = 0.001) significantly predicted greater burden of mood symptoms over the subsequent epoch. Moreover, higher CRP levels (p = 0.009) at intake predicted greater time to recovery from the index symptomatic episode. CONCLUSIONS In the first repeated-measures study on this topic in adolescents with BD, we found evidence that CRP, an inexpensive and ubiquitous blood test, may be useful in predicting the prospective course of BD symptoms. Future larger studies are warranted.
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Affiliation(s)
- Sudhir Karthikeyan
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | | | - Hyunjin Jeong
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James L Kennedy
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Krista Lanctôt
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Gregory E Miller
- Institute for Policy Research & Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - L Trevor Young
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana C Andreazza
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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4
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Li VW, Morton E, Michalak EE, Tam EM, Levitt AJ, Levitan RD, Cheung A, Morehouse R, Ramasubbu R, Yatham LN, Lam RW. Functional outcomes with bright light in monotherapy and combined with fluoxetine in patients with major depressive disorder: Results from the LIFE-D trial. J Affect Disord 2022; 297:396-400. [PMID: 34699857 DOI: 10.1016/j.jad.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/24/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bright light therapy has been shown to improve depressive symptoms in patients with nonseasonal major depressive disorder (MDD) but there are few studies examining functional outcomes. METHODS We examined secondary functional outcomes in the 8-week randomized, placebo-sham-controlled LIFE-D trial comparing light therapy, fluoxetine, and the combination in patients with nonseasonal MDD. Functional assessments included the Sheehan Disability Scale (SDS) and, for employed participants, the Lam Employment Absence and Productivity Scale (LEAPS). Analysis of covariance (ANCOVA) was conducted with SDS and LEAPS change scores from baseline to week 8 as dependent variables, treatment modality (light, fluoxetine) as an independent variable, and baseline SDS and LEAPS scores as covariates. RESULTS Of 122 randomized participants, SDS data were available for 105 and LEAPS data for 70. For the SDS, there were no interaction effects, but there was a significant small- to medium-sized main effect of light treatment on total SDS scores with corresponding significant effects in the Social Life and Family Life domains, but not in the Work/Study domain. There were no significant interaction or main effects with LEAPS scores. CONCLUSION Light therapy significantly improved social and family life functioning in patients with MDD. However, work functioning was not significantly improved despite large effect sizes; these results were limited by low statistical power because of small sample sizes. Future studies should use longer treatment durations and be powered to detect clinically relevant differences in functional outcomes.
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Affiliation(s)
- Victor W Li
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Edwin M Tam
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Amy Cheung
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rachel Morehouse
- Department of Psychiatry, Dalhousie University, Saint John, NB, Canada
| | | | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada.
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5
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Cheung CP, Thiyagarajah MT, Abraha HY, Liu CS, Lanctôt KL, Kiss AJ, Saleem M, Juda A, Levitt AJ, Schaffer A, Cheung AH, Sinyor M. The association between placebo arm inclusion and adverse event rates in antidepressant randomized controlled trials: An examination of the Nocebo Effect. J Affect Disord 2021; 280:140-147. [PMID: 33212405 DOI: 10.1016/j.jad.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 07/27/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Antidepressant efficacy is influenced by patient expectations and, in randomized controlled trials (RCTs), the probability of receiving a placebo. It is unclear whether tolerability demonstrates a similar pattern. This study aimed to determine whether study design influences adverse event (AE) rates in antidepressant trials for subjects receiving active treatment or placebo. METHODS RCTs comparing one antidepressant to another antidepressant, placebo, or both in major depressive disorder (MDD) (1996-2018) were retrieved from Medline and PsycINFO. Clinicaltrials.gov was searched for unpublished trials. Of 1,997 studies screened, 77 trials were included. Studies were classified as drug-drug, drug-drug-placebo, or drug-placebo based on design and overall number of subjects experiencing any AE was recorded. Subgroup meta-analysis of proportions and meta-regression techniques were used to compare AE rates across study designs in patients receiving active antidepressant treatment and placebo. RESULTS Among the actively treated, AE rates were lower in drug-drug trials (58.5%) compared to drug-drug-placebo (75.7%) and drug-placebo (76.4%) (the model reported coefficients for percent differences between AE rates of different study designs were B=17.0, p<0.001 and B=17.8, p<0.001, respectively). AE rates in patients receiving placebo were not different between study designs. LIMITATIONS The present study is limited by the diverse range of study populations, variability in reporting of AEs, and specific antidepressants employed in the included trials. CONCLUSIONS The inclusion of a placebo arm in the study design was unexpectedly associated with higher rates of AEs among patients receiving active medication in antidepressant trials. This observation has important implications for interpretation of trial tolerability findings.
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Affiliation(s)
- Christian P Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mathura T Thiyagarajah
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Haben Y Abraha
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Celina S Liu
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Alex J Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Canada
| | - Mahwesh Saleem
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Ari Juda
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amy H Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
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6
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Conforti P, Zaheer R, Goldstein BI, Levitt AJ, Schaffer A, Fefergrad M, Cheung AH, Sinyor M. The Feasibility of a Harry Potter-based Cognitive Behavioural Therapy Skills Curriculum on Suicidality and Well-being in Middle Schoolers. Can J Psychiatry 2020; 65:811-813. [PMID: 32701402 PMCID: PMC7564693 DOI: 10.1177/0706743720944046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paula Conforti
- College of Psychologists of Ontario, Toronto, Ontario, Canada.,Institute of Medical Science, Faculty of Medicine, 7938University of Toronto, Ontario, Canada
| | - Rabia Zaheer
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,University of Waterloo, Ontario, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Anthony J Levitt
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Mark Fefergrad
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Amy H Cheung
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
| | - Mark Sinyor
- Department of Psychiatry, 71545Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Ontario, Canada
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Sinyor M, Hawes D, Rector NA, Cheung AH, Williams M, Cheung C, Goldstein BI, Fefergrad M, Levitt AJ, Schaffer A. Preliminary Investigation of a Novel Cognitive Behavioural Therapy Curriculum on the Wellbeing of Middle Schoolers. J Can Acad Child Adolesc Psychiatry 2020; 29:66-75. [PMID: 32405309 PMCID: PMC7213921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/19/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A number of school-based interventions for preventing and attenuating symptoms of anxiety and depression in youth have been developed worldwide but evidence of their effectiveness is mixed. None of these curricula stem from existing children's literature, however, the Harry Potter (HP) series has been identified as potentially imparting Cognitive Behavioural Therapy concepts. METHODS This study aimed to broadly capture, at an interim stage, the feasibility of a pilot HP curriculum aimed at imparting CBT skills to middle-schoolers in order to inform full development of the curriculum. The study design further included a non-randomized, Group (HP; Control) by Time (Baseline, Post-Intervention, Follow-up) mixed factorial approach retrospectively examining change in scores on a "Well-Being and Resiliency Survey" (WBRS) which assessed multiple symptomatic and social domains. RESULTS In total, 232 grade seven and eight students participated in the curriculum over two years with no dropouts. Compared to 362 controls, there were no significant differences in WBRS scores between groups at post or one-year follow-up. CONCLUSIONS This pilot study demonstrated the feasibility of rapid and broad implementation of the intervention. Preliminary analyses showed no indication of effectiveness which may be the product of the intervention being in an interim stage during the study period and/or the retrospective design and limitations in data quality. Specifically, these results suggest that the WBRS may be a suboptimal instrument for measuring the effectiveness of this intervention. A prospective trial of the complete, revised curriculum with validated measures is required to provide an adequately assessment of its impact.
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Affiliation(s)
- Mark Sinyor
- Associate Professor, Department of Psychiatry, University of Toronto. Psychiatrist, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Donaleen Hawes
- Psychologist and Superintendent of Education, Catholic District School Board of Eastern Ontario, Kemptville, Ontario
| | - Neil A Rector
- Professor, Departments of Psychiatry and Psychological Clinical Science, University of Toronto, Toronto, Ontario
| | - Amy H Cheung
- Associate Professor, Department of Psychiatry, University of Toronto; Psychiatrist, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Marissa Williams
- Research Coordinator, Sunnybrook Health Sciences Centre, Toronto, Canada; Master of Counselling Psychology Student, Athabasca University, Athabasca, Alberta
| | - Christian Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario
| | - Benjamin I Goldstein
- Professor, Department of Psychiatry, University of Toronto; Psychiatrist, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Mark Fefergrad
- Assistant Professor and Post-Graduate Training Director, Department of Psychiatry, University of Toronto; Psychiatrist, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Anthony J Levitt
- Psychiatrist, Department of Psychiatry, Sunnybrook Health Sciences Centre; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Ayal Schaffer
- Head, Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre; Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
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8
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Sinyor M, Cheung CP, Abraha HY, Lanctôt KL, Saleem M, Liu CS, Li A, Juda A, Levitt AJ, Cheung AH, Schaffer A. Antidepressant-placebo differences for specific adverse events in major depressive disorder: A systematic review. J Affect Disord 2020; 267:185-190. [PMID: 32217218 DOI: 10.1016/j.jad.2020.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adverse events (AEs) are known to occur while patients are treated with placebos, part of the so-called nocebo effect. Yet evidence is limited regarding the likelihood that specific AEs occurring with antidepressant treatment are or are not due to nocebo effects. METHODS This study identified 56 placebo-controlled, randomized controlled trials (RCTs) of antidepressant monotherapy for adults with major depressive disorder that reported AE rates in sufficient detail for comparison. Poisson regression analyses compared rates of AEs according to antidepressant class weighted by study population to determine which separated from placebo. A "nocebo index" was also calculated (with 0 defined as the lowest rate and 1 or higher indicating the same or greater rate of an AE in the placebo group). RESULTS Numerous AEs did not differ statistically between antidepressant classes and placebo including worsening psychiatric symptoms, all forms of pain, weight gain and respiratory symptoms. Nevertheless, a number of AEs were significantly more common in antidepressants than placebos across multiple antidepressant classes. These were predominantly neurological, sexual and anticholinergic effects. Several AEs that separated statistically between antidepressants and placebos nevertheless had moderate nocebo indices (≥0.5). For example, dizziness in SSRIs separated significantly from placebo (OR 1.50, 95%CI 1.13-1.99) but had a nocebo index of 0.67. LIMITATIONS This study relied on multiple RCTs with subtle design differences. CONCLUSIONS This study identified several AEs that are likely the physiological result of antidepressants and many that likely represent nocebo effects. These results should inform clinical decision making and discussions with patients.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Christian P Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Haben Y Abraha
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Krista L Lanctôt
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mahwesh Saleem
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Celina S Liu
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Abby Li
- Neuropsychopharmacology Research Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ari Juda
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Amy H Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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9
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Sinyor M, Schaffer A, Nishikawa Y, Redelmeier DA, Niederkrotenthaler T, Sareen J, Levitt AJ, Kiss A, Pirkis J. The association between suicide deaths and putatively harmful and protective factors in media reports. CMAJ 2019; 190:E900-E907. [PMID: 30061324 DOI: 10.1503/cmaj.170698] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Exposure to media reporting on suicide can lead to suicide contagion and, in some circumstances, may also lead to help-seeking behaviour. There is limited evidence for which specific characteristics of media reports mediate these phenomena. METHODS This observational study examined associations between putatively harmful and protective elements of media reports about suicide in 13 major publications in the Toronto media market and subsequent suicide deaths in Toronto (2011-2014). We used multivariable logistic regression to determine whether specific article characteristics were associated with increases or decreases in suicide deaths in the 7 days after publication, compared with a control window. RESULTS From 2011 to 2014, there were 6367 articles with suicide as the major focus and 947 suicide deaths. Elements most strongly and independently associated with increased suicides were a statement about the inevitability of suicide (odds ratio [OR] 1.97, confidence interval [CI] 1.07-3.62), about asphyxia by a method other than car exhaust (OR 1.72, CI 1.36-2.18), about suicide by jumping from a building (OR 1.70, CI 1.28-2.26) or about suicide pacts (OR 1.63, CI 1.14-2.35), or a headline that included the suicide method (OR 1.41, CI 1.07-1.86). Elements most strongly and independently associated with decreased suicides were unfavourable characteristics (negative judgments about the deceased; OR 1.85, CI 1.20-2.84), or mentions of railway (OR 1.61, CI 1.10-2.36) and cutting or stabbing (OR 1.59, CI 1.19-2.13) deaths, and individual murder-suicide (OR 1.50, CI 1.23-1.84). INTERPRETATION This large study identified significant associations between several specific elements of media reports and suicide deaths. It suggests that reporting on suicide can have a meaningful impact on suicide deaths and that journalists and media outlets and organizations should carefully consider the specific content of reports before publication.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Yasunori Nishikawa
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Donald A Redelmeier
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Thomas Niederkrotenthaler
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Jitender Sareen
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Alex Kiss
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
| | - Jane Pirkis
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Sinyor); Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto (Schaffer); Department of Psychiatry (Nishikawa), Sunnybrook Health Sciences Centre; University of Toronto and Evaluative Clinical Sciences at the Sunnybrook Research Institute, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and Institute for Clinical Evaluative Sciences (Redelmeier), Toronto, Ont.; Public Health, Medical University of Vienna, Center for Public Health, Department of Social and Preventive Medicine, Suicide Research Unit (Niederkrotenthaler), Vienna, Austria; Departments of Psychiatry, Psychology and Community Health Sciences (Sareen), University of Manitoba, Winnipeg, Man.; Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry (Levitt), University of Toronto; Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute and Department of Health Policy, Management and Evaluation, University of Toronto (Kiss), Toronto, Ont.; Centre for Mental Health, Melbourne School of Population and Global Health and University of Melbourne (Pirkis), Melbourne, Australia
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10
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Levitan RD, Levitt AJ, Michalak EE, Morehouse R, Ramasubbu R, Yatham LN, Tam EM, Lam RW. Appetitive Symptoms Differentially Predict Treatment Response to Fluoxetine, Light, and Placebo in Nonseasonal Major Depression. J Clin Psychiatry 2018; 79. [PMID: 30063303 DOI: 10.4088/jcp.17m11856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We previously reported that morning bright light therapy is efficacious in adults with nonseasonal major depressive disorder (MDD), both on its own and in combination with fluoxetine. Given that appetitive symptoms predict response to bright light therapy in seasonal depression, we examined, in this secondary analysis, whether the same held true in these nonseasonal MDD patients. METHODS Data were collected from October 7, 2009, to March 11, 2014. One hundred twenty-two patients who met DSM-IV-TR criteria for MDD without a seasonal pattern were randomly assigned to light monotherapy, fluoxetine, combination light and fluoxetine, or double-placebo (inactivated negative ion generator plus placebo pill). Multiple regression assessed the percentage change in Montgomery-Asberg Depression Rating Scale (MADRS) scores based on treatment condition, appetitive symptom score at baseline (sum of 4 items on the Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders version), and the condition-by-appetitive score interaction. Sex was considered as a possible moderator of these effects. RESULTS The overall regression model predicting treatment response was highly significant (P < .001), and the treatment condition-by-appetitive score interaction was a strong predictor of MADRS change scores (t = 2.65, P = .009). For individuals in the placebo group, more appetitive symptoms at baseline predicted less decrease in MADRS scores at 8 weeks (r = -0.37; large effect size). In contrast, for individuals in the active treatment groups, more appetitive symptoms at baseline predicted more of a decrease in depression scores at 8 weeks (fluoxetine group r = +0.23, medium effect size; light therapy group r = +0.11, small effect size; combination group r = +0.32, medium to large effect size). No moderation effect of sex was found. CONCLUSIONS More severe appetitive symptoms at baseline predicted treatment response differentially across the 4 treatment groups. Contrary to prior findings in seasonal depression, this association was not robust for MDD patients receiving light therapy alone, although it was stronger in patients receiving fluoxetine with or without light. As the group sample sizes were modest, the current findings should be considered as preliminary only. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00958204.
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Affiliation(s)
- Robert D Levitan
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, M6J 1H4 Canada. .,Mood and Anxiety Disorders Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Program, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia; Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Rachel Morehouse
- Department of Psychiatry, Dalhousie University, Saint John, New Brunswick, Canada
| | | | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia; Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Edwin M Tam
- Department of Psychiatry, University of British Columbia; Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia; Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
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11
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Fishman KN, Levitt AJ, Markoulakis R, Weingust S. Satisfaction with Mental Health Navigation Services: Piloting an Evaluation with a New Scale. Community Ment Health J 2018; 54:521-532. [PMID: 29147951 DOI: 10.1007/s10597-017-0201-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
Abstract
As mental health navigation services continue to be implemented, the need for valid and reliable tools to assess the quality of these services increases. While case managers target individuals with severe mental illness and aim to reduce burden and cost, and increase independence, navigation services target all individuals with a range of mental health and/or substance use issues, with the aim of reducing barriers to treatment and coordinating individualized care. The current study evaluated satisfaction with a navigation service using a new 22-item questionnaire, the Navigation Satisfaction Tool (NAVSAT). Forty clients completed a web-based version of the NAVSAT to evaluate satisfaction with a family mental health navigation service in Toronto, Canada. Descriptive statistics on the sample and range of treatments/services are provided. The NAVSAT has excellent reliability (Cronbach's alpha = 0.96) and face validity. Satisfaction with the following navigation-level factors were the best predictors of overall satisfaction with navigation; the navigator's ability to recommend the appropriate treatment (β = 0.116, p = .05), intake procedures (β = 0.364, p = .005), and the principal contact's satisfaction with his/her frequency of contact with the navigator (β = 0.602, p = .001). Satisfaction with the following provider-level factors were the best predictors of overall satisfaction with the referred service; the referred service's ability to improve the youth's well being (β = 0.684, p < .001), and the referred service's ability to listen and understand the family's concerns (β = 0.356, p = .001). The NAVSAT appears to be a reliable tool for measuring satisfaction in the current sample. If these findings are replicated in a larger population serving youth and young adults in transition, the NAVSAT may prove to be a helpful guide for program evaluation and development for navigation and treatment services for this population.
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Affiliation(s)
- Keera N Fishman
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada. .,Department of Psychology, Faculty of Social Sciences, University of Ottawa, 136 Jean Jacques Lussier, VNR 3088, Ottawa, ON, K1N 6N5, Canada.
| | - Anthony J Levitt
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada.,University of Toronto, Toronto, ON, Canada
| | - Roula Markoulakis
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada
| | - Staci Weingust
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue Room FG03, Toronto, ON, M4N 3M5, Canada
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12
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Swardfager W, Hennebelle M, Yu D, Hammock BD, Levitt AJ, Hashimoto K, Taha AY. Metabolic/inflammatory/vascular comorbidity in psychiatric disorders; soluble epoxide hydrolase (sEH) as a possible new target. Neurosci Biobehav Rev 2018; 87:56-66. [PMID: 29407524 DOI: 10.1016/j.neubiorev.2018.01.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/17/2018] [Accepted: 01/21/2018] [Indexed: 02/06/2023]
Abstract
The common and severe psychiatric disorders, including major depressive disorder (MDD) and bipolar disorder (BD), are associated with inflammation, oxidative stress and changes in peripheral and brain lipid metabolism. Those pathways are implicated in the premature development of vascular and metabolic comorbidities, which account for considerable morbidity and mortality, including increased dementia risk. During endoplasmic reticulum stress, the soluble epoxide hydrolase (sEH) enzyme converts anti-inflammatory fatty acid epoxides generated by cytochrome p450 enzymes into their corresponding and generally less anti-inflammatory, or even pro-inflammatory, diols, slowing the resolution of inflammation. The sEH enzyme and its oxylipin products are elevated post-mortem in MDD, BD and schizophrenia. Preliminary clinical data suggest that oxylipins increase with symptoms in seasonal MDD and anorexia nervosa, requiring confirmation in larger studies and other cohorts. In rats, a soluble sEH inhibitor mitigated the development of depressive-like behaviors. We discuss sEH inhibitors under development for cardiovascular diseases, post-ischemic brain injury, neuropathic pain and diabetes, suggesting new possibilities to address the mood and cognitive symptoms of psychiatric disorders, and their most common comorbidities.
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Affiliation(s)
- W Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada; University Health Network Toronto Rehabilitation Institute, Toronto, Canada.
| | - M Hennebelle
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
| | - D Yu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, Canada; Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada
| | - B D Hammock
- Department of Entomology and Nematology and Comprehensive Cancer Center UCDMC, University of California, Davis, CA, USA
| | - A J Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - K Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
| | - A Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA
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13
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Mooney SJ, Nobrega JN, Levitt AJ, Hynynen K. Antidepressant effects of focused ultrasound induced blood-brain-barrier opening. Behav Brain Res 2018; 342:57-61. [PMID: 29326057 DOI: 10.1016/j.bbr.2018.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 01/18/2023]
Abstract
In many cases, hippocampal neurogenesis appears to be a hallmark of antidepressant treatments. One novel technique for inducing this type of neurogenesis is using focused ultrasound waves, in conjunction with circulating microbubbles, to open the blood-brain-barrier. The present experiment aimed to test whether this technique has antidepressant effects in a rodent model. Rats were subjected to 1, 2 or 3 weekly treatments of magnetic resonance-guided focused ultrasound in order to open the blood-brain-barrier in the hippocampal region. Before and after treatments, animals went through modified forced swim tests. 1 week after the final treatment, animals that received 2 weekly treatments showed antidepressant-like effects on behavioural measures in comparison to untreated controls. This was not the case for animals that received 1 or 3 weekly treatments. Effects had disappeared by 5 weeks following the first ultrasound treatment. These results suggest that focused ultrasound may be used for inducing short-term antidepressant effects.
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Affiliation(s)
- Skyler J Mooney
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
| | - José N Nobrega
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Behavioural Neurobiology Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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14
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Sinyor M, Schaffer A, Redelmeier DA, Kiss A, Nishikawa Y, Cheung AH, Levitt AJ, Pirkis J. Did the suicide barrier work after all? Revisiting the Bloor Viaduct natural experiment and its impact on suicide rates in Toronto. BMJ Open 2017; 7:e015299. [PMID: 28634260 PMCID: PMC5734210 DOI: 10.1136/bmjopen-2016-015299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/19/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This research aims to determine the long-term impact of the Bloor Street Viaduct suicide barrier on rates of suicide in Toronto and whether media reporting had any impact on suicide rates. DESIGN Natural experiment. SETTING City of Toronto, Canada; records at the chief coroner's office of Ontario 1993-2003 (11 years before the barrier) and 2004-2014 (11 years after the barrier). PARTICIPANTS 5403 people who died by suicide in the city of Toronto. MAIN OUTCOME MEASURE Changes in yearly rates of suicide by jumping at Bloor Street Viaduct, other bridges including nearest comparison bridge and walking distance bridges, and buildings, and by other means. RESULTS Suicide rates at the Bloor Street Viaduct declined from 9.0 deaths/year before the barrier to 0.1 deaths/year after the barrier (incidence rate ratio (IRR) 0.005, 95% CI 0.0005 to 0.19, p=0.002). Suicide deaths from bridges in Toronto also declined significantly (IRR 0.53, 95% CI 0.40 to 0.71, p<0.0001). Media reports about suicide at the Bloor Street Viaduct were associated with an increase in suicide-by-jumping from bridges the following year. CONCLUSIONS The current study demonstrates that, over the long term, suicide-by-jumping declined in Toronto after the barrier with no associated increase in suicide by other means. That is, the barrier appears to have had its intended impact at preventing suicide despite a short-term rise in deaths at other bridges that was at least partially influenced by a media effect. Research examining barriers at other locations should interpret short-term results with caution.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alex Kiss
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yasunori Nishikawa
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amy H Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
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15
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Hennebelle M, Otoki Y, Yang J, Hammock BD, Levitt AJ, Taha AY, Swardfager W. Altered soluble epoxide hydrolase-derived oxylipins in patients with seasonal major depression: An exploratory study. Psychiatry Res 2017; 252:94-101. [PMID: 28259037 PMCID: PMC5611448 DOI: 10.1016/j.psychres.2017.02.056] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/10/2017] [Accepted: 02/24/2017] [Indexed: 12/19/2022]
Abstract
Many cytochrome p450-derived lipids promote resolution of inflammation, in contrast to their soluble epoxide hydrolase(sEH)-derived oxylipin breakdown products. Here we compare plasma oxylipins and precursor fatty acids between seasons in participants with major depressive disorder with seasonal pattern (MDD-s). Euthymic participants with a history of MDD-s recruited in summer-fall were followed-up in winter. At both visits, a structured clinical interview (DSM-5 criteria) and the Beck Depression Inventory II (BDI-II) were administered. Unesterified and total oxylipin pools were assayed by liquid chromatography tandem mass-spectrometry (LC-MS/MS). Precursor fatty acids were measured by gas chromatography. In nine unmedicated participants euthymic at baseline who met depression criteria in winter, BDI-II scores increased from 4.9±4.4 to 19.9±7.7. Four sEH-derived oxylipins increased in winter compared to summer-fall with moderate to large effect sizes. An auto-oxidation product (unesterified epoxyketooctadecadienoic acid) and lipoxygenase-derived 13-hydroxyoctadecadienoic acid also increased in winter. The cytochrome p450-derived 20-COOH-leukotriene B4 (unesterified) and total 14(15)-epoxyeicosatetraenoic acid, and the sEH-derived 14,15-dihydroxyeicostrienoic acid (unesterified), decreased in winter. We conclude that winter depression was associated with changes in cytochrome p450- and sEH-derived oxylipins, suggesting that seasonal shifts in omega-6 and omega-3 fatty acid metabolism mediated by sEH may underlie inflammatory states in symptomatic MDD-s.
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Affiliation(s)
- Marie Hennebelle
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA.
| | - Yurika Otoki
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA; Food and Biodynamic Chemistry Laboratory, Graduate School of Agricultural Science, Tohoku University, Sendai, Miyagi, Japan.
| | - Jun Yang
- Department of Entomology and Nematology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA.
| | - Bruce D Hammock
- Department of Entomology and Nematology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA.
| | - Anthony J Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.
| | - Ameer Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA.
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON Canada.
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16
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Schaffer A, Weinstock LM, Sinyor M, Reis C, Goldstein BI, Yatham LN, Levitt AJ. Self-poisoning suicide deaths in people with bipolar disorder: characterizing a subgroup and identifying treatment patterns. Int J Bipolar Disord 2017; 5:16. [PMID: 28332123 PMCID: PMC5406320 DOI: 10.1186/s40345-017-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/21/2017] [Indexed: 02/05/2023] Open
Abstract
Objective To characterize self-poisoning suicide deaths in BD compared to other suicide decedents. Methods Extracted coroner data from all suicide deaths (n = 3319) in Toronto, Canada from 1998 to 2012. Analyses of demographics, clinical history, recent stressors, and suicide details were conducted in 5 subgroups of suicide decedents: BD self-poisoning, BD other methods, non-BD self-poisoning, non-BD other methods, and unipolar depression self-poisoning. Toxicology results for lethal and present substances were also compared between BD and non-BD self-poisoning subgroups as well as between BD and unipolar depression self-poisoning subgroups. Results Among BD suicide decedents, self-poisoning was significantly associated with female sex, past suicide attempts, and comorbid substance abuse. In both the BD and non-BD self-poisoning groups, opioids were the most common class of lethal medication. For both groups, benzodiazepines and antidepressants were the most common medications present at time of death, and in 23% of the BD group, an antidepressant was present without a mood stabilizer or antipsychotic. Only 31% of the BD group had any mood stabilizer present, with carbamazepine being most common. No antidepressant, mood stabilizer, or antipsychotic was present in 15.5% of the BD group. Relative to unipolar depression self-poisoning group, the BD self-poisoning group evidenced higher proportion of previous suicide attempt(s) and psychiatry/ER visits in the previous week. Conclusion People with BD who die by suicide via self-poisoning comprise a distinct but understudied group. The predominant absence of guideline-concordant pharmacologic care comprises a crucial target for future policy and knowledge translation efforts.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
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17
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Hatch JK, Scola G, Olowoyeye O, Collins JE, Andreazza AC, Moody A, Levitt AJ, Strauss BH, Lanctot KL, Goldstein BI. Inflammatory Markers and Brain-Derived Neurotrophic Factor as Potential Bridges Linking Bipolar Disorder and Cardiovascular Risk Among Adolescents. J Clin Psychiatry 2017; 78:e286-e293. [PMID: 28199074 DOI: 10.4088/jcp.16m10762] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/28/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with increased rates of cardiovascular disease (CVD). Brain-derived neurotrophic factor (BDNF) and inflammatory markers are leading biomarkers in BD. We examined whether these biomarkers underlie the link between BD and CVD proxies among adolescents with bipolar spectrum disorders. METHODS Subjects were 60 adolescents, 13-19 years old (40 with BD and 20 healthy controls [HCs]). Semistructured interviews determined diagnoses based on DSM-IV. Serum was assayed for BDNF, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Carotid intima media thickness (cIMT) and flow-mediated dilation were assessed using ultrasound. Procedures were conducted at a subspecialty clinic (January 2011-May 2014). RESULTS Adolescents with BD had significantly greater waist circumference (BD: 81.72 cm [11.67 cm], HC: 75.64 cm [8.63 cm]; U = 547.5, P = .021), body mass index (BMI) (BD: 25.50 kg/m²undefined[5.29 kg/m²], HC: 21.76 kg/m² [3.43 kg/m²]; U = 608.5, P < .0001), pulse pressure (BD: 42.31 mm Hg [10.57 mm Hg], HC: 33.84 mm Hg [6.69 mm Hg]; U = 561.5, P < .001), and IL-6 (BD: 8.93 pg/mL [7.71 pg/mL], HC: 4.96 pg/mL [6.38 pg/mL]; U = 516.0, P < .0001) than HC adolescents. Subjects with BD-I (n = 14) and BD-II (n = 16) had greater IL-6 versus HCs (F₃,₅₁ = 5.29, P = .003). Controlling for BMI and age did not alter these findings. IL-6 was higher in symptomatic (n = 19) and asymptomatic BD (n = 21) versus that found in HCs (F₂,₅₂ = 7.96, P = .001). In symptomatic BD, lower BDNF was associated with greater mean cIMT (ρ = -0.507, P = .037). CONCLUSIONS This study found evidence of increased inflammation among adolescents with BD. While present findings suggest a potential interplay between symptomatic status, biomarkers, and atherosclerosis proxies, there were no significant differences in cIMT or flow-mediated dilation in adolescents with BD compared to HCs. This may indicate that there is potential opportunity for CVD prevention strategies in adolescents with BD.
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Affiliation(s)
- Jessica K Hatch
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada
| | - Gustavo Scola
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Omodele Olowoyeye
- Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Jordan E Collins
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ana C Andreazza
- Department of Psychiatry, University of Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alan Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, Schulich Heart Program, Toronto, Ontario, Canada
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bradley H Strauss
- Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, Schulich Heart Program, Toronto, Ontario, Canada
| | - Krista L Lanctot
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, FG-53, 2075 Bayview Ave, Toronto ON, Canada, M4N3M5. .,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Ontario, Canada
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18
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Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, Hasnain M, Jollant F, Levitt AJ, MacQueen GM, McInerney SJ, McIntosh D, Milev RV, Müller DJ, Parikh SV, Pearson NL, Ravindran AV, Uher R. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments. Can J Psychiatry 2016; 61:540-60. [PMID: 27486148 PMCID: PMC4994790 DOI: 10.1177/0706743716659417] [Citation(s) in RCA: 657] [Impact Index Per Article: 82.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Pharmacological Treatments" is the third of six sections of the 2016 guidelines. With little new information on older medications, treatment recommendations focus on second-generation antidepressants. RESULTS Evidence-informed responses are given for 21 questions under 4 broad categories: 1) principles of pharmacological management, including individualized assessment of patient and medication factors for antidepressant selection, regular and frequent monitoring, and assessing clinical and functional outcomes with measurement-based care; 2) comparative aspects of antidepressant medications based on efficacy, tolerability, and safety, including summaries of newly approved drugs since 2009; 3) practical approaches to pharmacological management, including drug-drug interactions and maintenance recommendations; and 4) managing inadequate response and treatment resistance, with a focus on switching antidepressants, applying adjunctive treatments, and new and emerging agents. CONCLUSIONS Evidence-based pharmacological treatments are available for first-line treatment of MDD and for management of inadequate response. However, given the limitations of the evidence base, pharmacological management of MDD still depends on tailoring treatments to the patient.
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Affiliation(s)
- Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario *Co-first authors.
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia *Co-first authors
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Venkat Bhat
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
| | - Mehrul Hasnain
- Department of Psychiatry, Memorial University, St. John's, Newfoundland
| | - Fabrice Jollant
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Daniel J Müller
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
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19
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Lam RW, Levitt AJ, Levitan RD, Michalak EE, Cheung AH, Morehouse R, Ramasubbu R, Yatham LN, Tam EM. Efficacy of Bright Light Treatment, Fluoxetine, and the Combination in Patients With Nonseasonal Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:56-63. [PMID: 26580307 DOI: 10.1001/jamapsychiatry.2015.2235] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Bright light therapy is an evidence-based treatment for seasonal depression, but there is limited evidence for its efficacy in nonseasonal major depressive disorder (MDD). OBJECTIVE To determine the efficacy of light treatment, in monotherapy and in combination with fluoxetine hydrochloride, compared with a sham-placebo condition in adults with nonseasonal MDD. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo- and sham-controlled, 8-week trial in adults (aged 19-60 years) with MDD of at least moderate severity in outpatient psychiatry clinics in academic medical centers. Data were collected from October 7, 2009, to March 11, 2014. Analysis was based on modified intent to treat (randomized patients with ≥1 follow-up rating). INTERVENTIONS Patients were randomly assigned to (1) light monotherapy (active 10,000-lux fluorescent white light box for 30 min/d in the early morning plus placebo pill); (2) antidepressant monotherapy (inactive negative ion generator for 30 min/d plus fluoxetine hydrochloride, 20 mg/d); (3) combination light and antidepressant; or (4) placebo (inactive negative ion generator plus placebo pill). MAIN OUTCOMES AND MEASURES Change score on the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to the 8-week end point. Secondary outcomes included response (≥50% reduction in MADRS score) and remission (MADRS score ≤10 at end point). RESULTS A total of 122 patients were randomized (light monotherapy, 32; fluoxetine monotherapy, 31; combination therapy, 29; placebo, 30). The mean (SD) changes in MADRS score for the light, fluoxetine, combination, and placebo groups were 13.4 (7.5), 8.8 (9.9), 16.9 (9.2), and 6.5 (9.6), respectively. The combination (effect size [d] = 1.11; 95% CI, 0.54 to 1.64) and light monotherapy (d = 0.80; 95% CI, 0.28 to 1.31) were significantly superior to placebo in the MADRS change score, but fluoxetine monotherapy (d = 0.24; 95% CI, -0.27 to 0.74) was not superior to placebo. For the respective placebo, fluoxetine, light, and combination groups at the end point, response was achieved by 10 (33.3%), 9 (29.0%), 16 (50.0%), and 22 (75.9%) and remission was achieved by 9 (30.0%), 6 (19.4%), 14 (43.8%), and 17 (58.6%). Combination therapy was superior to placebo in MADRS response (β = 1.70; df = 1; P = .005) and remission (β = 1.33; df = 1; P = .02), with numbers needed to treat of 2.4 (95% CI, 1.6 to 5.8) and 3.5 (95% CI, 2.0 to 29.9), respectively. All treatments were generally well tolerated, with few significant differences in treatment-emergent adverse events. CONCLUSIONS AND RELEVANCE Bright light treatment, both as monotherapy and in combination with fluoxetine, was efficacious and well tolerated in the treatment of adults with nonseasonal MDD. The combination treatment had the most consistent effects. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00958204.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada2Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Anthony J Levitt
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada4Mood Disorders Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert D Levitan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada5Mood and Anxiety Disorders Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada2Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Amy H Cheung
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada4Mood Disorders Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rachel Morehouse
- Department of Psychiatry, Dalhousie University, Saint John, New Brunswick, Canada
| | | | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada2Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Edwin M Tam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada2Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
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20
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Schaffer A, Isometsä ET, Azorin JM, Cassidy F, Goldstein T, Rihmer Z, Sinyor M, Tondo L, Moreno DH, Turecki G, Reis C, Kessing LV, Ha K, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:1006-20. [PMID: 26175498 PMCID: PMC5858693 DOI: 10.1177/0004867415594428] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors. METHODS A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords 'bipolar disorder' and 'suicide attempts or suicide'. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables. RESULTS We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants. CONCLUSION There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology, and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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21
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Schaffer A, Isometsä ET, Tondo L, Moreno DH, Sinyor M, Kessing LV, Turecki G, Weizman A, Azorin JM, Ha K, Reis C, Cassidy F, Goldstein T, Rihmer Z, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:785-802. [PMID: 26185269 PMCID: PMC5116383 DOI: 10.1177/0004867415594427] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. METHODS Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. RESULTS The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4-14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23-26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. CONCLUSION This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and stronger prospective data on treatment options are required before more decisive conclusions can be made regarding the neurobiology and specific treatment of suicide risk in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Schaffer A, Isometsä ET, Tondo L, Moreno D, Turecki G, Reis C, Cassidy F, Sinyor M, Azorin JM, Kessing LV, Ha K, Goldstein T, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Rihmer Z, Yatham LN. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord 2015; 17:1-16. [PMID: 25329791 PMCID: PMC6296224 DOI: 10.1111/bdi.12271] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/05/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. METHODS Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attempts' or 'suicide', was conducted, and data extracted for analysis from all eligible articles. Demographic and clinical variables for which ≥ 3 studies with usable data were available were meta-analyzed using fixed or random-effects models for association with suicide attempts and suicide deaths. There was considerable heterogeneity in the methods employed by the included studies. RESULTS Variables significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use, comorbid cluster B/borderline personality disorder, and first-degree family history of suicide. Suicide deaths were significantly associated with male gender and first-degree family history of suicide. CONCLUSIONS This paper reports on the presence and magnitude of the correlates of suicide attempts and suicide deaths in bipolar disorder. These findings do not address causation, and the heterogeneity of data sources should limit the direct clinical ranking of correlates. Our results nonetheless support the notion of incorporating diagnosis-specific data in the development of models of understanding suicide in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Erkki T Isometsä
- Institute of Clinical Medicine University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy and Harvard Medical School, McLean Hospital, Boston, MA, USA
| | - Doris Moreno
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Departments of Psychiatry, Human Genetics, and Neurology & Neurosurgery, McGill University, Montreal, QC, Canada
| | - Catherine Reis
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Frederick Cassidy
- Department of Psychiatry and Behavioural Sciences, Duke University, Durham, USA
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-Michel Azorin
- Department of Psychiatry, University of Aix-Marseille II, Marseille, France
| | - Lars Vedel Kessing
- Faculty of Health Sciences, University of Copenhagen, Psychiatric Center Copenhagen Department, Copenhagen, Denmark
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University, Bundang Hospital, Seoul, Republic of Korea
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abraham Weizman
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | | | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Schaffer A, Sinyor M, Reis C, Goldstein BI, Levitt AJ. Suicide in bipolar disorder: characteristics and subgroups. Bipolar Disord 2014; 16:732-40. [PMID: 24890795 DOI: 10.1111/bdi.12219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The development of more sophisticated models for understanding suicide among people with bipolar disorder (BD) requires diagnosis-specific data. The present study aimed to elucidate differences between people who die by suicide with and without BD, and to identify subgroups within those with BD. METHODS Data on all suicide deaths in the city of Toronto from 1998 to 2010 were extracted from the Office of the Chief Coroner of Ontario, including demographics, clinical variables, recent stressors, and details of the suicide. Comparisons of person- and suicide-specific variables between suicide deaths among those with BD (n = 170) and those without (n = 2,716) were conducted, and a cluster analysis was performed among the BD suicide group only. RESULTS Those in the BD suicide group were more likely than those in the non-BD suicide group to be female [odds ratio (OR) = 1.75, 95% confidence interval (CI): 1.27-2.42; p = 0.001], to have made a past suicide attempt (OR = 2.01, 95% CI: 1.45-2.80; p < 0.0001), and to have had recent contact with psychiatric or emergency services (OR = 1.59, 95% CI: 1.00-2.52; p = 0.049). Five clusters were identified within the BD group, with differences between clusters in age; sex; marital status; living circumstances; past suicide attempts; substance abuse; interpersonal, employment/financial, and legal/police stressors; and rates of death by fall/jump or self-poisoning. CONCLUSIONS The present findings identified differences between BD and non-BD suicide groups, providing support to the utilization of an illness-specific approach to better understanding suicide in BD. Subgroups of BD suicide deaths, if replicated, should also be incorporated into the design and analysis of future studies of suicide in BD.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Levitt AJ, Jost JJ, Mergl KA, Hannigan A, Degenova J, Chung SY. Impact of chronically street homeless tenants in congregate supportive housing. Am J Orthopsychiatry 2012; 82:413-20. [PMID: 22880979 DOI: 10.1111/j.1939-0025.2012.01164.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New initiatives to house chronically street homeless (CSH) adults have led to increasing proportions of this population living in congregate supportive housing, but little is known about the impact of this shift on supportive housing programs. The present multisite, mixed-methods study examined service utilization and lease compliance among 52 chronically street homeless and 46 long-term shelter stayer (LTSS) adults during their first 12 months in congregate supportive housing. Quantitative analysis of administrative data revealed that CSH tenants used significantly more service resources than LTSS tenants, including more advocacy, escorting, and psychiatric treatment and more assistance with financial, housing, and mental and physical health issues. The 2 groups did not differ significantly on measures of lease compliance. Qualitative focus groups with CSH tenants, service provider staff, and property management staff all indicated that existing supportive housing services are suitable for this population, although some adjustments, additional resources, or both, may be indicated.
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Affiliation(s)
- A J Levitt
- Center for Urban Community Services, 198 E. 121st St., 5th floor, New York, NY 10035, USA.
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Sinyor M, Schaffer A, Smart KA, Levitt AJ, Lanctôt KL, Grysman NH. Sponsorship, antidepressant dose, and outcome in major depressive disorder: meta-analysis of randomized controlled trials. J Clin Psychiatry 2012; 73:e277-87. [PMID: 22401489 DOI: 10.4088/jcp.11r07204] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/31/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Differences in dosing may influence results of pharmaceutical industry-sponsored medication trials. This study aims to determine the relationship between sponsorship and antidepressant dosing and efficacy in randomized controlled trials for major depressive disorder. DATA SOURCES Trials were identified through English-language searches of MEDLINE and PsycINFO (January 1996-June 2010) using specific drug names and classes and depressive disorder or major depression and double blind or double-blind method. Other limitations included human subjects and treatment study designs using the clinical queries option. Other sources were also searched following a strict set of inclusion and exclusion criteria. STUDY SELECTION Randomized controlled trials were included if they examined antidepressant treatment for major depressive disorder, reported mean final medication dosages, acknowledged an association with industry, and included study arms of medications produced by the associated manufacturer and a competitor ("sponsor" and "nonsponsor" arms) (58 trials involving 15,026 patients from 101 citations identified). DATA EXTRACTION Data on dosing, efficacy, baseline severity, and adverse events were extracted by 2 of the authors. RESULTS Meta-analyses were used to examine dosing and efficacy data. Using consensus guidelines for medication dosing, we determined that sponsor medication was dosed relatively higher than nonsponsor medication, in 37% (22/60) of comparisons as opposed to 5% (3/60) in which the nonsponsor medication was dosed higher (χ²₂ = 25.9, P < .001). Trials in which sponsor drugs were dosed higher than nonsponsor drugs demonstrated higher remission rates for the sponsor drug (OR = 1.28, 95% CI = 1.11-1.47, P < .001). These results were confirmed using regulatory dosing guidelines. There was no significant correlation between dosing or outcome with baseline severity or adverse events. CONCLUSIONS Sponsor drugs are dosed higher than nonsponsor drugs in antidepressant randomized controlled trials, and higher dosing is associated with better sponsor drug outcomes in some cases.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Canada.
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26
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Vigod SN, Levitt AJ. Seasonal severity of depressive symptoms as a predictor of health service use in a community-based sample. J Psychiatr Res 2011; 45:612-8. [PMID: 20980021 DOI: 10.1016/j.jpsychires.2010.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 09/24/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine whether severity of seasonal depressive symptoms is an independent predictor of depression-specific health service use. METHODS Cross-sectional telephone survey evaluating mood-related symptom changes across seasons using a structured interview based on the World Mental Health Composite International Diagnostic Interview, in a community sample representative of the province of Ontario, Canada (N = 1605). This study focuses on the 625 individuals (out of a total of 1605 interviewed) who screened positive for lifetime depressive symptoms. Severity of seasonal symptoms of depression (or "seasonality") was measured using the Seasonal Depression Severity (SDS) score (range 0-36). The primary outcome was lifetime depression-specific use of health services from a physician (family physician or psychiatrist). Lifetime psychotropic medication use, use of health services from a non-physician therapist, and psychiatric hospitalization were secondary outcomes. Other important variables that are known to predict depression-specific health service use were considered in multivariable analysis. RESULTS In our sample of individuals with depressive symptoms, those who had used physician health services had higher SDS scores than non-users (11.5 (SD 7.2) vs. 9.7 (SD 6.4), t(616) = 3.182, P = 0.001). In multivariable analysis, SDS score was independently associated with depression-specific health service use by a physician (OR = 1.04, 95% CI 1.01-1.07, p = 0.004). The relationship between seasonality and use of psychotropic medication use was similar (OR = 1.04, 95% CI 1.01-1.07, p = 0.007). CONCLUSIONS Seasonality was independently associated with depression-specific health service use for individuals with depressive symptoms. The results imply that greater seasonality may independently reflect increased severity and need for treatment of depression.
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Affiliation(s)
- Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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27
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Kozloff N, Cheung AH, Schaffer A, Cairney J, Dewa CS, Veldhuizen S, Kurdyak P, Levitt AJ. Bipolar disorder among adolescents and young adults: results from an epidemiological sample. J Affect Disord 2010; 125:350-4. [PMID: 20226535 DOI: 10.1016/j.jad.2010.02.120] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 12/08/2009] [Accepted: 02/18/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past decade, the clinical recognition and treatment of bipolar disorder (BD) in youth have increased significantly; however, little is known about prevalence of and service use for this disorder at a population level. The objective of this study was to measure the lifetime prevalence of BD, and to describe the socio-demographics, comorbidities, and use of mental health services among 15-24-year-olds with BD. METHODS Data were extracted from the Canadian Community Health Survey: Mental Health and Well-being (CCHS 1.2), a representative population-based survey of 36,984 people age 15 and older. Among subjects age 15-18 and 19-24 (N=5673), we calculated lifetime prevalence rates of BD and report the demographic and clinical characteristics and rates of service use of this sample. RESULTS The weighted lifetime prevalence of BD was 3.0% among 15-24-year-olds (N=191): 2.1% among 15-18-year-olds, and 3.8% among 19-24-year-olds. Rates of psychiatric comorbidity were high, with anxiety disorders, problematic substance use, and suicidality present among nearly half of the sample. Mental health services were accessed in the previous 12 months by 56.1% of youth with BD. LIMITATIONS The questionnaire used in CCHS 1.2 relied on self-report, limiting its applicability to this younger sample. CONCLUSIONS BD is particularly common among young adults and there are specific factors associated with BD in youth. Nearly half of all youth with BD have never used mental health services, suggesting that clinicians should be more vigilant about the signs and symptoms of BD in young people.
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Affiliation(s)
- Nicole Kozloff
- Department of Psychiatry, University of Toronto, Canada.
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Abstract
OBJECTIVE To determine whether rates of suicide changed in Toronto after a barrier was erected at Bloor Street Viaduct, the bridge with the world's second highest annual rate of suicide by jumping after Golden Gate Bridge in San Francisco. DESIGN Natural experiment. SETTING City of Toronto and province of Ontario, Canada; records at the chief coroner's office of Ontario 1993-2001 (nine years before the barrier) and July 2003-June 2007 (four years after the barrier). PARTICIPANTS 14 789 people who completed suicide in the city of Toronto and in Ontario. MAIN OUTCOME MEASURE Changes in yearly rates of suicide by jumping at Bloor Street Viaduct, other bridges, and buildings, and by other means. RESULTS Yearly rates of suicide by jumping in Toronto remained unchanged between the periods before and after the construction of a barrier at Bloor Street Viaduct (56.4 v 56.6, P=0.95). A mean of 9.3 suicides occurred annually at Bloor Street Viaduct before the barrier and none after the barrier (P<0.01). Yearly rates of suicide by jumping from other bridges and buildings were higher in the period after the barrier although only significant for other bridges (other bridges: 8.7 v 14.2, P=0.01; buildings: 38.5 v 42.7, P=0.32). CONCLUSIONS Although the barrier prevented suicides at Bloor Street Viaduct, the rate of suicide by jumping in Toronto remained unchanged. This lack of change might have been due to a reciprocal increase in suicides from other bridges and buildings. This finding suggests that Bloor Street Viaduct may not have been a uniquely attractive location for suicide and that barriers on bridges may not alter absolute rates of suicide by jumping when comparable bridges are nearby.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, University of Toronto, ON, Canada.
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Sinyor M, Levitt AJ, Cheung AH, Schaffer A, Kiss A, Dowlati Y, Lanctôt KL. Does inclusion of a placebo arm influence response to active antidepressant treatment in randomized controlled trials? Results from pooled and meta-analyses. J Clin Psychiatry 2010; 71:270-9. [PMID: 20122371 DOI: 10.4088/jcp.08r04516blu] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 01/02/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine if the inclusion of a placebo arm and/or the number of active comparators in antidepressant trials influences the response rates of the active medication and/or placebo. DATA SOURCES Searches of MEDLINE, PsycINFO, and pharmaceutical Web sites for published trials or trials conducted but unpublished between January 1996 and October 2007. STUDY SELECTION 2,275 citations were reviewed, 285 studies were retrieved, and 90 were included in the analysis. Trials reporting response and/or remission rates in adult subjects treated with an antidepressant monotherapy for unipolar major depression were included. DATA EXTRACTION The primary investigator recorded the number of responders and/or remitters in the intent-to-treat population of each study arm or computed these numbers using the quoted rates. DATA SYNTHESIS Poisson regression analyses demonstrated that mean response rate for the active medication was higher in studies comparing 2 or more active medications without a placebo arm than in studies comparing 2 or more active medications with a placebo arm (65.4% vs 57.7%, P < .0001) or in studies comparing only 1 active medication with placebo (65.4% vs 51.7%, P = .0005). Mean response rate for placebo was significantly lower in studies comparing 1 rather than 2 or more active medications (34.3% vs 44.6%, P = .003). Mean remission rates followed a similar pattern. Meta-analysis confirmed results from the pooled analysis. CONCLUSIONS These data suggest that antidepressant response rates in randomized control trials may be influenced by the presence of a placebo arm and by the number of treatment arms and that placebo response rates may be influenced by the number of active treatment arms in a study.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, University of Toronto, Ontario, Canada
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Abstract
OBJECTIVE There is a current argument in thyroidology about whether the normal range for basal thyrotropin (TSH) is too broad. Some groups suggest that a TSH of less than 2.5 mIU/L is a better cut-off for euthyroidism. Because major depression is associated with changes in thyroid hormone status and thyroid hormones may be an effective treatment for major depression, we examined whether TSH levels above or below 2.5 mIU/L were related to clinical variables or treatment outcome in euthyroid patients with major depression. METHODS Outpatients with major depression (n =166) were assigned to high-normal and low-normal TSH groups based on their basal TSH levels. The 2 groups were compared along clinical variables and treatment outcome. RESULTS The low-normal TSH group was significantly more depressed, as measured by Hamilton Depression Rating Scale scores, and had more anxiety symptoms and suicidal tendencies than the high-normal group. There was no difference in treatment response between the groups. CONCLUSIONS A comparison of low-normal and high-normal basal TSH groups with major depression revealed significant differences in severity and symptoms of depression but no difference in treatment outcome. These data are preliminary and require replication in a larger sample.
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Abstract
OBJECTIVES Uncertainty exists regarding whether comorbid substance use disorders (SUDs) in bipolar I disorder are more prevalent among persons with versus without comorbid anxiety disorders. Moreover, the independent contribution of these comorbidities to the burden of bipolar disorder (BD) is unclear. METHODS The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with lifetime BD (n = 1,411). Illness severity was compared across four groups based on the presence of lifetime anxiety disorders, lifetime SUDs, neither, or both. Variables included lifetime prevalence of mixed mania, prolonged mood episodes, BD-related health service utilization, and forensic history, 12-month prevalence of mania and depression, and current general mental health functioning. Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule, DSM-IV Version. Analyses were computed separately for males and females. RESULTS For females only, the lifetime prevalence of SUDs was significantly greater among those with lifetime anxiety disorders [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.08-1.86]; this was not found among males (OR = 1.15, 95% CI = 0.79-1.68). In multiple logistic regression analyses among both males and females, anxiety disorders were significantly associated with mixed episodes, prolonged depressive episodes, 12-month prevalence of depression, BD-related health service utilization, and poorer current mental health functioning. SUDs were significantly associated with mixed episodes among females, 12-month prevalence of depression among males, and with forensic history among both males and females. CONCLUSIONS Whereas comorbid anxiety disorders appear to confer increased liability towards poor mental health functioning and greater BD-related health service utilization, comorbid SUDs are associated with positive forensic history. Early identification and treatment of these comorbid conditions are of paramount importance. Further representative prospective studies are needed.
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Affiliation(s)
- Benjamin I Goldstein
- Mood Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Goldstein BI, Levitt AJ. Prevalence and correlates of bipolar I disorder among adults with primary youth-onset anxiety disorders. J Affect Disord 2007; 103:187-95. [PMID: 17328960 PMCID: PMC2206538 DOI: 10.1016/j.jad.2007.01.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 01/24/2007] [Accepted: 01/24/2007] [Indexed: 02/08/2023]
Abstract
OBJECTIVES It is of potentially great public health importance to determine whether youth-onset anxiety disorders are associated with the increased prevalence of subsequent bipolar I disorder (BD) among adults, and to identify risk factors for BD in this population. METHODS The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with social phobia, panic disorder, or generalized anxiety disorder that onset in youth (<19 years) and was not preceded by a major depressive, manic, or mixed episode (N=1571; 572 males, 999 females). The prevalence of BD among subjects with, versus without, these youth-onset anxiety disorders was examined. Variables that could be associated with the increased risk of BD among subjects with youth-onset anxiety disorders were examined, including conduct disorder, youth-onset substance use disorders (SUD), and family history of depression and/or alcoholism. Analyses were computed separately for males and females. RESULTS The prevalence of BD was significantly greater among adults with, versus without, primary youth-onset anxiety disorders for both males (15.9% vs 2.7%; chi2=318.4, df=1, p<0.001) and females (13.8% vs 2.9%; chi2=346.2, df=1, p<0.001). Youth-onset anxiety disorders remained significantly associated with BD after controlling for interceding major depression, and this was true for each of the specific anxiety disorders examined. Among males with youth-onset primary anxiety disorders, conduct disorder and loaded family history of depression were associated with significantly increased risk of BD. Among females, conduct disorder and loaded family history of alcoholism were associated with significantly increased risk of BD. CONCLUSIONS The prevalence of BD was elevated among subjects with youth-onset primary anxiety disorders, particularly if comorbid conduct disorder was present. Future studies are needed to confirm these findings prospectively, and to develop preventive strategies for populations at risk.
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Affiliation(s)
- Benjamin I Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, United States.
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Joffe RT, Brimacombe M, Levitt AJ, Stagnaro-Green A. Treatment of Clinical Hypothyroidism With Thyroxine and Triiodothyronine: A Literature Review and Metaanalysis. Psychosomatics 2007; 48:379-84. [PMID: 17878495 DOI: 10.1176/appi.psy.48.5.379] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Thyroxine is the standard replacement therapy for patients with clinical hypothyroidism. However, there has been recent interest in examining the potential advantages of combined thyroxine and triiodothyronine treatment for the treatment of hypothyroidism. The authors review the nine studies to-date and conclude that the variability and limitations in study design make definitive and clinically useful recommendations difficult. They therefore conducted a metaanalysis of the nine controlled studies examining the impact of combined thyroxine-plus-triiodothyronine versus thyroxine alone, with measures of psychiatric symptoms as the primary outcome. Their analysis reveals no significant difference in treatment effect on psychiatric symptoms in the nine controlled studies to date.
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Affiliation(s)
- Russell T Joffe
- Department of Psychiatry, UMDNJ-New Jersey Medical School, Newark, NJ, USA, and Sunnybrook Hospital, Toronto, Ontario, Canada.
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Korczak DJ, Goldstein BI, Levitt AJ. Panic disorder, cardiac diagnosis and emergency department utilization in an epidemiologic community sample. Gen Hosp Psychiatry 2007; 29:335-9. [PMID: 17591510 DOI: 10.1016/j.genhosppsych.2007.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 03/20/2007] [Accepted: 03/22/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We examined the association between panic disorder (PD), physician-diagnosed cardiac disease (CD), and the interaction of these variables in relation to health care utilization, as measured by emergency department (ED) visitations, in an epidemiologic sample. METHODS Subjects were identified from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of 43,093 adult respondents from the United States who completed face-to-face computer-assisted structured clinical interviews. RESULTS Among patients with CD, the 12-month prevalence of PD (6.0%; 613/10,239) was significantly higher than that among non-CD subjects (3.4%; 1106/32,854; adjusted odds ratio=2.4; 95% confidence interval=2.2-2.7). CD patients with PD had a significantly greater prevalence of angina, tachycardia and alcohol use disorders as compared with PD-negative patients. PD-positive patients reported significantly greater mean 12-month ED visits (1.2) as compared with the PD-negative patients (0.6; P<.001). PD and tachycardia were found to have a significant interaction effect on ED visits for males (F=25.1; df=1,7; P<.001) but not for females (F=1.2; df=1,7; P=.28), with age, income, race and alcohol use included as covariates. CONCLUSIONS Epidemiological data support a relationship between PD and CD that impacts ED utilization. These findings have potential implications for medical, psychiatric and ED-based screening and interventions.
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Affiliation(s)
- Daphne J Korczak
- Department of Psychiatry, The University of Toronto, Toronto, Ontario, Canada M5S 1A1.
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Michalak EE, Murray G, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Tam EM, Cheung A, Lam RW. Quality of life as an outcome indicator in patients with seasonal affective disorder: results from the Can-SAD study. Psychol Med 2007; 37:727-736. [PMID: 17112403 DOI: 10.1017/s0033291706009378] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although a host of studies have now examined the relationship between quality of life (QoL) and non-seasonal depression, few have measured QoL in seasonal affective disorder (SAD). We report here on results from the Can-SAD trial, which assessed the impact of treatment with either antidepressant medication or light therapy upon QoL in patients diagnosed with SAD. METHOD This Canadian double-blind, multicentre, randomized controlled trial included 96 patients who met strict diagnostic criteria for SAD. Eligible patients were randomized to 8 weeks of treatment with either: (1) 10000 lux light treatment and a placebo capsule or (2) 100 lux light treatment (placebo light) and 20 mg fluoxetine. QoL was measured with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Medical Outcomes Study (MOS) Short-Form General Health Survey (SF-20) at baseline and 8 weeks. RESULTS Both intervention groups showed significant improvement in QoL over time with no significant differences being detected by treatment condition. Q-LES-Q scores increased significantly in seven of eight domains, with the average scores rising from 48 x 0 (S.D.=10 x 7) at baseline to 69 x 1 (S.D.=15 x 6) at week 8. Treatment-related improvement in QoL was strongly associated with improvement in depression symptoms. DISCUSSION Patients with SAD report markedly impaired QoL during the winter months. Treatment with light therapy or antidepressant medication is associated with equivalent marked improvement in perceived QoL. Studies of treatment interventions for SAD should routinely include broader indices of patient outcome, such as the assessment of psychosocial functioning or life quality.
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Affiliation(s)
- Erin E Michalak
- Division of Clinical Neuroscience, Department of Psychiatry, University of British Columbia, Vancouver, Canada.
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Abstract
OBJECTIVE To evaluate the relative benefits of the combination of lithium and triiodothyronine (T3) in augmentation of antidepressants, compared with either lithium or T3 alone. METHODS We performed a 2-week, randomized, double-blind, placebo-controlled pilot study of the addition of lithium compared with T3 compared with the combination of both in subjects with major depressive disorder who had not responded to an antidepressant. RESULTS All groups improved significantly over the 2 weeks of treatment, but there were no significant between-group differences. CONCLUSION There may be no advantage to a combination of these augmenting agents, although we failed to show separation between active treatments and placebo.
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Affiliation(s)
- Russell T Joffe
- Department of Psychiatry, New Jersey Medical School, Newark, New Jersey, USA.
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Goldstein BI, Levitt AJ. Is current alcohol consumption associated with increased lifetime prevalence of major depression and suicidality? Results from a pilot community survey. Compr Psychiatry 2006; 47:330-3. [PMID: 16905393 DOI: 10.1016/j.comppsych.2006.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 12/30/2005] [Accepted: 01/27/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Alcohol use disorders are associated with increased illness severity and suicidality in major depressive disorder (MDD). However, little is known about how alcohol use across the continuum relates to MDD. METHOD Subjects were 496 adults (201 men, 295 women) who completed a community-based telephone survey that incorporated a validated structured diagnostic interview for depression and a validated alcohol questionnaire. Subjects were divided into 3 alcohol consumption groups based on Canadian low-risk drinking guidelines: minimal (MIN), moderate (MOD), and heavy (HVY) alcohol consumption. RESULTS Among subjects with MDD, drinking group was not associated with measures of disability, health service use, or life satisfaction. Among all women, the prevalence of depression increased significantly across drinking groups (MIN, 24.6%; MOD, 30.3%; HVY, 44.0% [linear-by-linear association chi(2) = 4.1, df = 1, P < .05]), as did the prevalence of suicidality among women with MDD (MIN, 16.3%; MOD, 29.6%; HVY, 45.5% [chi(2) = 4.5, df = 1, P < .05]). CONCLUSION A range of alcohol consumption, not just heavy drinking, may be associated with major depression and suicidality.
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Affiliation(s)
- Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook and Women's Health Sciences Centre, University of Toronto, Toronto, ON, Canada M4N 3M5.
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Goldstein BI, Levitt AJ. Further evidence for a developmental subtype of bipolar disorder defined by age at onset: results from the national epidemiologic survey on alcohol and related conditions. Am J Psychiatry 2006; 163:1633-6. [PMID: 16946191 DOI: 10.1176/ajp.2006.163.9.1633] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examines the relationship between age at onset of bipolar I disorder and illness characteristics among adults in a community sample. METHOD The National Epidemiologic Survey on Alcohol and Related Conditions identified 1,411 adults with bipolar disorder. For analyses, bipolar disorder subjects were divided into three age at onset groups: childhood (less than 13 years old, N=113), adolescence (13-18 years old, N=339), and adulthood (19 years or older, N=959). RESULTS Nonremitting bipolar disorder was most prevalent among childhood-onset subjects, and childhood-onset subjects were most likely to experience prolonged episodes. Antisocial personality disorder was most prevalent among childhood-onset subjects. Drug use disorders were more prevalent among childhood-onset and adolescent-onset, as compared with adult-onset, subjects. Prevalence of mixed episodes or irritability did not differ significantly between groups. CONCLUSIONS Findings corroborate clinical studies: illness characteristics among adults with childhood-onset bipolar disorder are similar to those described in children with bipolar disorder.
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Affiliation(s)
- Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook and Women's Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario, Canada M4N 3M5
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Enns MW, Cox BJ, Levitt AJ, Levitan RD, Morehouse R, Michalak EE, Lam RW. Personality and seasonal affective disorder: results from the CAN-SAD study. J Affect Disord 2006; 93:35-42. [PMID: 16647139 DOI: 10.1016/j.jad.2006.01.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 01/05/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Personality factors have been implicated in seasonal affective disorder (SAD). The present study investigated the relationship between the five-factor model of personality (neuroticism, extraversion, openness, agreeableness, conscientiousness) and SAD. METHODS Ninety-five patients with SAD completed personality measures before and after treatment in a clinical trial and during the summer months. The personality scores of the SAD patients were compared with a matched group of non-seasonal depressed patients and published normative data. Stability and change in personality scores with changes in mood state were assessed. Personality dimensions were evaluated as possible predictors of treatment outcome. RESULTS SAD patients showed elevated openness scores relative to both non-seasonal depressed patients and norms. Their neuroticism scores were lower than non-seasonal depressed patients, but higher than norms. All personality dimensions showed large and highly significant test-retest correlations but several personality dimensions, particularly neuroticism and extraversion, also showed considerable change with changing mood state. None of the personality dimensions were significantly associated with treatment outcome. LIMITATIONS Personality assessment relied on self-report. CONCLUSIONS The personality profile of SAD patients differs from both non-seasonal depressed patients and norms. Elevated openness scores appear to be a unique feature of patients with SAD. Since mood state has a significant impact on personality scores, assessment of personality in SAD patients should ideally be conducted when they are in remission. Further investigation of the relationship between personality and SAD, especially the potential significance of elevated openness scores, is warranted.
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Affiliation(s)
- Murray W Enns
- Department of Psychiatry, University of Manitoba, Canada.
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Goldstein BI, Levitt AJ. A gender-focused perspective on health service utilization in comorbid bipolar I disorder and alcohol use disorders: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2006; 67:925-32. [PMID: 16848652 DOI: 10.4088/jcp.v67n0609] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study compares health service utilization by individuals with comorbid lifetime bipolar I disorder and lifetime alcohol use disorders (AUD) to that of individuals with either diagnosis alone, using nationally representative data. METHOD The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to identify respondents with bipolar I disorder only (BD-only; N = 636), AUD only (N = 11,068), and comorbid bipolar I disorder and AUD (BD-AUD; N = 775). Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The 3 groups were compared with respect to self-reported health service utilization. RESULTS For both men and women, respondents in the BD-AUD group were significantly more likely than AUD-only respondents to report any alcohol-related service utilization (p < .001). BD-AUD respondents were significantly more likely to report bipolar disorder-related hospital admissions as compared with BD-only respondents among males only (p = .009). Within the BD-AUD group, males reported significantly greater utilization of AUD treatment only (p < .001), and females reported significantly greater utilization of bipolar disorder treatment only (p < .001) and significantly greater likelihood of utilizing mental health services overall (p < .001). There was no gender difference in the proportion of respondents who utilized both AUD and bipolar disorder services. CONCLUSIONS As expected, individuals with comorbid bipolar I disorder and AUD utilize significantly more mental health services than individuals with either disorder alone. The primary original finding is that among those with comorbid bipolar I disorder and AUD, bipolar I disorder is more likely to go untreated among males and AUD is more likely to go untreated among females. Gender may be an important factor to consider in future health service planning for comorbid bipolar I disorder and AUD.
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Affiliation(s)
- Benjamin I Goldstein
- Mood Disorders Program, Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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42
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Lam RW, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Michalak EE, Tam EM. The Can-SAD study: a randomized controlled trial of the effectiveness of light therapy and fluoxetine in patients with winter seasonal affective disorder. Am J Psychiatry 2006; 163:805-12. [PMID: 16648320 DOI: 10.1176/ajp.2006.163.5.805] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Light therapy and antidepressants have shown comparable efficacy in separate studies of seasonal affective disorder treatment, but few studies have directly compared the two treatments. This study compared the effectiveness of light therapy and an antidepressant within a single trial. METHOD This double-blind, randomized, controlled trial was conducted in four Canadian centers over three winter seasons. Patients met DSM-IV criteria for major depressive disorder with a seasonal (winter) pattern and had scores > or = 23 on the 24-item Hamilton Depression Rating Scale. After a baseline observation week, eligible patients were randomly assigned to 8 weeks of double-blind treatment with either 1) 10,000-lux light treatment and a placebo capsule, or 2) 100-lux light treatment (placebo light) and fluoxetine, 20 mg/day. Light treatment was applied for 30 minutes/day in the morning with a fluorescent white-light box; placebo light boxes used neutral density filters. RESULTS A total of 96 patients were randomly assigned to a treatment condition. Intent-to-treat analysis showed overall improvement with time, with no differences between treatments. There were also no differences between the light and fluoxetine treatment groups in clinical response rates (67% for each group) or remission rates (50% and 54%, respectively). Post hoc testing found that light-treated patients had greater improvement at 1 week but not at other time points. Fluoxetine was associated with greater treatment-emergent adverse events (agitation, sleep disturbance, palpitations), but both treatments were generally well-tolerated with no differences in overall number of adverse effects. CONCLUSIONS Light treatment showed earlier response onset and lower rate of some adverse events relative to fluoxetine, but there were no other significant differences in outcome between light therapy and antidepressant medication. Although limited by lack of a double-placebo condition, this study supports the effectiveness and tolerability of both treatments for seasonal affective disorder and suggests that other clinical factors, including patient preference, should guide selection of first-line treatment.
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Affiliation(s)
- Raymond W Lam
- Mood Disorders Centre, UBC Hospital, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1.
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43
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Goldstein BI, Levitt AJ. Factors associated with temporal priority in comorbid bipolar I disorder and alcohol use disorders: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2006; 67:643-9. [PMID: 16669730 DOI: 10.4088/jcp.v67n0416] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare illness characteristics, comorbidities, treatment utilization, and family history among individuals with comorbid bipolar I disorder and alcohol use disorders (AUD) based on temporal priority of onset. METHOD The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions identified respondents with lifetime comorbid bipolar I disorder and AUD for whom AUD were antecedent (Alcohol First; N = 311), the onset of the 2 conditions occurred in the same year (Same Year; N = 113), or bipolar I disorder was antecedent (Bipolar First; N = 233). Diagnoses were generated using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. This study examined between-group differences in bipolar I- and AUD-related variables. RESULTS Bipolar First respondents were most likely to experience prolonged manic episodes. There were no differences in the 12-month prevalence of bipolar I disorder among respondents with prior history of bipolar I disorder. The 12-month prevalence of AUD among respondents with prior history of AUD was lower among Alcohol First respondents compared to Same Year or Bipolar First respondents. Same Year respondents were most likely to seek AUD treatment and reported comparatively short latency between onset and treatment of both bipolar I disorder and AUD. The prevalence of family history of comorbid depression and AUD was greatest among Same Year respondents. Same Year respondents also showed the lowest prevalence of anxiety disorders. Overall psychosocial functioning was similar across groups. CONCLUSION Temporal priority in comorbid bipolar I disorder and AUD is associated with several significant between-group differences in features of bipolar I disorder and AUD severity, treatment utilization, other comorbidities, and family history. Same-year onset of bipolar I disorder and AUD may be a marker of a specific subtype of bipolar I-AUD comorbidity. Potential implications of these findings are discussed.
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Affiliation(s)
- Benjamin I Goldstein
- Mood Disorders Program, Department of Psychiatry, Sunnybrook and Women's Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Schaffer A, Cairney J, Cheung AH, Veldhuizen S, Levitt AJ. Use of treatment services and pharmacotherapy for bipolar disorder in a general population-based mental health survey. J Clin Psychiatry 2006; 67:386-93. [PMID: 16649824 DOI: 10.4088/jcp.v67n0308] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study examined characteristics of treatment utilization in a large general population-based sample of bipolar subjects. METHOD Data source was the Canadian Community Health Survey-Mental Health and Well-Being, a nationally representative, community mental health survey of over 36,000 individuals conducted from May to December 2002. Subjects who met study criteria for a current or past manic episode were classified as having bipolar disorder. Sociodemographic and illness-related factors influencing likelihood of accessing treatment, delay to contact with treatment services, and use of pharmacotherapy among bipolar subjects were determined. RESULTS Among the 852 bipolar subjects, 45.2% had never accessed treatment services. Male gender (p = .001), lower level of education (p = .003), and immigrant status (p < .001) were each significantly negatively correlated with use of treatment services. Mean delay from illness onset to contact with any treatment services was 3.1 years. Sixty-six percent of bipolar subjects had not taken a mood stabilizer or antidepressant medication in the past year, and 22% used antidepressants without a mood stabilizer. Female bipolar subjects were significantly more likely than male subjects to be prescribed an antidepressant medication (OR = 1.99, p = .01), even in the absence of higher frequency of recent depressions. CONCLUSION Many individuals with bipolar disorder never receive any form of mental health treatment, and, among those that do, use of pharmacotherapy is not consistent with guideline-based recommendations. These findings reinforce the importance of continued efforts to better identify bipolar individuals early in their course of illness, and the need for further educational focus on bipolar disorder for all mental health treatment providers.
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Affiliation(s)
- Ayal Schaffer
- Department of Psychiatry, Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Canada.
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Murray G, Michalak EE, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Lam RW. O sweet spot where art thou? Light treatment of Seasonal Affective Disorder and the circadian time of sleep. J Affect Disord 2006; 90:227-31. [PMID: 16337687 DOI: 10.1016/j.jad.2005.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2005] [Revised: 10/17/2005] [Accepted: 10/17/2005] [Indexed: 10/25/2022]
Abstract
This study investigated Lewy's Phase Shift Hypothesis (PSH) for winter Seasonal Affective Disorder, which asserts that the phase angle difference (PAD) between circadian and sleep rhythms is critical in the mechanism of light's therapeutic action. Specifically, we sought to test whether a euthymic "sweet spot" could be identified at a PAD (between temperature minimum and wake time) of circa 3 h. After a baseline week, symptomatic SAD patients (N = 43) received 8 weeks of morning light treatment. Analyses were based on SIGH-SAD ratings made at baseline and posttreatment. Also estimated pre- and posttreatment were T(min) (calculated from an algorithm based on Morningness-Eveningness self-report scores), and the phase of the sleep-wake rhythm (as assessed by daily sleep logs). It was predicted that a quadratic relationship would exist between PAD and depression ratings at baseline and posttreatment, with lowest levels around PAD = 3 h. It was further predicted that shift towards PAD = 3 h with treatment would be associated with decreases in depression with treatment. Although trends were in the expected direction, none of the three predictions were supported. Findings are discussed in terms of the study's limitations and the experimental challenge of parsing independent and interacting contributions of sleep and circadian phase.
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Affiliation(s)
- Greg Murray
- Faculty of Life and Social Sciences, Swinburne University of Technology, PO Box 218 John St., Hawthorn 3122 Melbourne, Victoria, Australia.
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Murray G, Michalak EE, Levitt AJ, Levitan RD, Enns MW, Morehouse R, Lam RW. Therapeutic mechanism in seasonal affective disorder: do fluoxetine and light operate through advancing circadian phase? Chronobiol Int 2006; 22:937-43. [PMID: 16298778 DOI: 10.1080/07420520500263292] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the context of Lewy's phase delay hypothesis, the present study tested whether effective treatment of winter Seasonal Affective Disorder (SAD) is mediated by advancing of circadian phase. Following a baseline week, 78 outpatients with SAD were randomized into 8 weeks of treatment with either fluoxetine and placebo light treatment or light treatment and placebo pill. Depression levels were measured on the Ham17+7 and the BDI-II, and circadian phase was estimated on the basis of daily sleep logs and self-reported morningness-eveningness. Among the 61 outpatients with complete data, both treatments were associated with significant antidepressant effect and phase advance. However, pre- and post-treatment comparisons found that the degree of symptom change did not correlate with the degree of phase change associated with treatment. The study therefore provides no evidence that circadian phase advance mediates the therapeutic mechanism in patients with SAD. Findings are discussed in terms of the limitations of the circadian measures employed.
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Affiliation(s)
- Greg Murray
- Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia.
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Cheung AH, Dewa CS, Levitt AJ. Clinical review of mania, hostility and suicide-related events in children and adolescents treated with antidepressants. Paediatr Child Health 2005; 10:457-63. [PMID: 19668657 PMCID: PMC2722596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Recent controversy surrounding the use of non-tricyclic antidepressants and the emergence of suicide-related events, hostility/behavioural activation and mania in youth with depression warrants an exploration of the results from randomized controlled trials (RCTs) and published case reports for the emergence of these adverse events. OBJECTIVE To provide a clinical review of the available evidence from RCTs and case reports regarding the safety of nontricyclic anti-depressants in youth with depression. METHODS Seven RCTs of antidepressant use in youth with depression, four case reports of suicide-related adverse events, three case reports of hostility/behavioural activation, and 12 case reports of precipitation of mania were reviewed. RESULTS The majority of patients with suicide-related adverse events from both RCTs and published case reports were suicidal before the start of antidepressant treatment. Hostility/behavioural activation generally developed within days to weeks after the start of antidepressant treatment; in the majority of cases, symptoms resolved within four weeks of dosage lowering or discontinuation of the medication alone. Rates for precipitation of mania from RCTs ranged from 0% to 6%. In approximately 60% of published case reports, manic symptoms resolved with the discontinuation or lowering of the dosage of medication alone. CONCLUSIONS Several trends were observed in the association between adverse events and the use of nontricyclic antidepressants in youth. When prescribing antidepressants to youth, clinicians should closely monitor patients and fully inform them and their families of the risks and benefits of treatment with antidepressants.
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Affiliation(s)
- Amy H Cheung
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto
| | - Carolyn S Dewa
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto
| | - Anthony J Levitt
- Sunnybrook and Women’s College Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, Ontario
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49
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Shin K, Schaffer A, Levitt AJ, Boyle MH. Seasonality in a community sample of bipolar, unipolar and control subjects. J Affect Disord 2005; 86:19-25. [PMID: 15820267 DOI: 10.1016/j.jad.2004.11.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 11/30/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examined seasonality in a community sample of five diagnostic groups: normal subjects, those with non-seasonal depression (NSD), seasonal depression (SD), non-seasonal bipolar disorder (NSBD) and seasonal bipolar disorder (SBD). METHODS Telephone interviews were conducted across the Province of Ontario. Seasonal changes in mood and behaviour were determined using the Seasonal Pattern Assessment Questionnaire (SPAQ). Five additional seasonality items consisting of depressive symptoms were included in the interview. The mean global severity of seasonality (GSS) scores were obtained and the entire inventory of 11 seasonality items were compared across the identified groups. RESULTS The mean GSS score for the controls was 5.2 (S.D. = 4.0), 8.0 (S.D. = 4.9) for NSD, 10.5 (S.D. = 3.9) for SD, 10.5 (S.D. = 5.4) for NSBD and 13.4 (S.D. = 5.4) for SBD. These scores differed significantly (F = 61.68, df = 4, p < 0.001). For the majority of the individual items, the SBD group rated the highest degree of seasonal fluctuation, while the NSBD and SD groups had nearly identical item scores. LIMITATIONS Limitations in this study include the relatively small number of subjects in the NSBD and SBD groups, and the inherent limitations in a telephone interview. CONCLUSIONS Individuals with bipolar disorder experience greater seasonality than those with depression or healthy controls. Even the non-seasonal bipolar group had as much seasonal fluctuation as the seasonal depression group, which has important implications for the management of bipolar illness.
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Affiliation(s)
- Karen Shin
- Department of Psychiatry, University of Toronto, Canada
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50
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Michalak EE, Tam EM, Manjunath CV, Levitt AJ, Levitan RD, Lam RW. Quality of life in patients with seasonal affective disorder: summer vs winter scores. Can J Psychiatry 2005; 50:292-5. [PMID: 15968846 DOI: 10.1177/070674370505000510] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare perceived quality of life (QoL) in patients diagnosed with seasonal affective disorder (SAD) during the winter and summer months. METHODS Twenty-six patients who were enrolled in an ongoing multicentre study in Canada completed 2 measures of QoL (the 20-item Medical Outcomes Study Short-Form General Health Survey [SF-20] and the Quality of Life Enjoyment and Satisfaction Questionnaire, [Q-LES-Q]) during the winter, when suffering from depression, and again during the summer months. RESULTS Both general and health-related QoL scores were significantly improved in patients with SAD during the summer months, with scores for the most part falling within normal range. CONCLUSIONS Perceived QoL in patients with SAD is markedly impaired during the winter months but shows a substantial rebound during the summer months. The findings of this study provide further evidence that SAD is a distinct diagnostic entity.
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Affiliation(s)
- Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver.
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