Saturday, January 21, 2006

Controversies in the treatment of depression; Devices; Self-promotion.

The Lancet has an interesting piece on developments and controversies in the treatment of depression. It initially covers more heavy-duty basic science literature (fMRI, gene studies, etc.), but then enters more familiar territory reviewing psychological therapies, drugs, and non-drug treatments such as electroconvulsive therapies. The concern for increased suicidality with SSRI's is addressed: overall the authors conclude that while it is clear that suicidal thoughts increase early on in SSRI treatment, there's no strong evidence that actual suicides do.

The most interesting part of the piece for me was a brief discussion of SSRI withdrawal symptoms (which are apparently most common with paroxetine and venlafaxine, presumably due to their shorter half lives). Like I blogged previously, there seems to be some unease within the psychiatric community about using the term "withdrawal symptoms," substituting instead "discontinuation symptoms" or "syndrome," to avoid associations with drug "addiction."

And for a hint of what may yet come, brain stimulation therapies (yes with electrodes among other things) are discussed. I am looking forward to these hunks of hardware showing up on my patients. If they haven't already, someone should write an article on up and coming device therapies and implications for end of life care as they are becoming more and more widespread (not only defibrillators but ventricular assist devices, diaphragmmatic "pacemakers," etc.). These are life-saving, but they are going to make end of life decision making even more complicated than it is now. This is fine of course, that's why we do palliative care, but I get a little nervous when I hear about LVADs being used as a "definitive" (or should I say "terminal") therapy for advanced CHF, as opposed to being a "bridge" to transplant....

Some shameless self-promotion: Two Fast Facts that I wrote have now been published on EPERC's website--numbers 147 and 148--on oropharyngeal candidiasis and the lidocaine patch. They are both well-written, insightful, and beyond reproach (ha ha).

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