2007 was a busy year for people reporting on mental health and psychology stories, with a heavy emphasis on pharmaceutical news and research. No significant breakthroughs in our understanding of any particular mental disorder occurred in 2007, although new techniques, such as functional magnetic resonance imaging (fMRI) and genetic studies continue to be at the forefront of causative research.
We present to you our highlights that we identified as some of the biggest stories in 2007 in mental health. Sorry it’s such a long post, but it was a busy year!
Highlights from Research
A large, randomized, placebo-controlled study from the STEP-BD folks was published in April in the New England Journal of Medicine by Sachs et al. (2007). It found that in people with bipolar disorder, adding an antidepressant to a mood stabilizer doesn’t help to relieve depressive symptoms. It also doesn’t make things worse (e.g., there is no increased likelihood of a manic or hypomanic episode on an antidepressant). However, another study by Goldberg et. al. (2007) found that antidepressants were associated with significantly higher mania symptom severity at a 3 month follow-up.
The most surprising finding, though, was that the placebo outperformed the antidepressants in the study in helping to relieve depressive symptoms. Twenty-seven percent of patients getting a placebo held off depression for at least 8 weeks during the 26-week study while antidepressants only worked in 23.5 percent of patients.
Multiple follow-ups from the CATIE study of 2006 were published. Stroup, et. al. (2007) found there to a pretty big variation amongst the atypical antipsychotics, Seroquel (quetiapine), Zyprexa (olanzapine) and Risperdal (risperidone) when it comes to a person with schizophrenia discontinuing the medication (e.g., basically a measure of how well-tolerated and of the perceived benefits of a medication). Seroquel came out on top at 9.9 months before discontinuation, followed by Zyprexa at 7.1 months, with Risperdal bringing up the rear at a measly 3.6 months. This was with a group of people with chronic schizophrenia who had just discontinued use of an older antipsychotic medication, so your mileage may vary.
Keefe et. al. (2007) found no significant differences amongst cognitive improvement (e.g., thinking) in people with schizophrenia taking any antipsychotic medication – they all experienced slight improvements. After 18 months of treatment, neurocognitive improvement was greater in people who took the older antipsychotic, perphenazine, than in the people who took the newer antipsychotics, olanzapine and risperidone. In another study Keefe et. al. (2007) published, they found modest cognitive gains on all three newer atypical antipsychotics for people with early psychosis.
Bick et. al. (2007) highlighted one of the CATIE study’s main findings, that psychiatrists don’t always do a good job assessing and treating medical problems in people who presented with schizophrenia in the study:
“Some of the results were expensive confirmations of known prior results; of the commonly prescribed drugs, clozapine was the most effective, and olanzapine and ziprasidone caused the most and fewest metabolic side effects, respectively.
The most stunning finding was that psychiatrists tend to ignore life-threatening, treatable medical conditions in patients presenting for treatment with schizophrenia. Of patients entering the study, 45% had untreated diabetes, 89% had untreated hyperlipidemias and 62% had untreated hypertension. […] Psychiatrists should learn to properly treat diabetes, hyperlipidemia and hypertension when detected.”
(See also Manschreck & Boshes (2007) for another good summary of the CATIE findings.)
So what did the CATIE study data have to say about the cost effectiveness of newer atypical antipsychotics compared to the other treatment conditions? Rosenheck et. al. (2007) examined that question and found some unsurprising results – placebo treatment is the most cost-effective treatment available:
“There were no differences in measures of effectiveness between initiation of active treatments or placebo (which represented watchful waiting) but the placebo group had significantly lower health care costs. [Ed. – emphasis added]”
Maybe doctors should be prescribing more sugar pills?