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Psychiatry Editors' Choice: Top Stories of 2013

Letter to Readers |
December 30, 2013

Psychiatry Editors' Choice: Top Stories of 2013

  1. Peter Roy-Byrne, MD

A perspective on the clinically most important research from the past year

  1. Peter Roy-Byrne, MD

The editors of NEJM Journal Watch Psychiatry are pleased to present the Psychiatry Top Stories of 2013. NEJM Journal Watch Psychiatry covers many different areas of the field, but the editorial board is increasingly seeking studies and reviews that can inform and improve the clinician's practice of psychiatry.

The task of choosing the best stories was difficult. In an initial step, the editors looked at the more than 250 summaries published between mid-November 2012 and mid-November 2013. Each editor chose his or her favorite 20 stories (which were assigned one point) and then, from these, named their top 10 (and each of these was given an extra point). Eight stories received at least 5 points; another 8 stories received 4 points. The Editor-in-Chief then selected the final two stories from the “second-tier” stories.

This year, our stories all have high relevance for improving clinical practice, in keeping with our emphasis on this goal. Seven stories cover pharmacologic interventions, highlighting either concerns about serious adverse events (lithium, citalopram, varenicline, and antipsychotics) or new data on novel treatments (folate, prazosin, and ketamine).

As psychiatrists, we may sometimes forget that our goal is not only to help our patients but also to “do no harm.” On the one hand, stories this year have reassured us that we need to worry less about the initial warnings regarding citalopram's cardiac effects or about the initial concerns that varenicline could cause or aggravate depression in our patients. Similarly, recently publicized concerns about antipsychotic use in older dementia patients, while still warranted, may need to be tempered a bit, given the complexity of separating treatment effects from aspects of the condition prompting treatment. On the other hand, psychiatrists prescribing lithium need to pay attention to its effects on the parathyroid gland which, while already known, may not always be routinely monitored in clinical practice.

Many of our patients have shown interest in diet and nutritional approaches to improve their well-being, but only a few of these have been demonstrated to be beneficial for psychiatric syndromes. One exception is L-methylfolate, and so the editors found noteworthy a randomized, controlled trial demonstrating its benefit in individuals whose depression is resistant to an initial trial of selective serotonin reuptake inhibitors. Possible medications for post-traumatic stress disorder has shown disappointing efficacy, as highlighted in recent evidentiary reviews. Yet, prazosin, originally found to be specifically helpful for PTSD-related nightmares, may have more widespread benefits for PTSD patients. The stunning effects of ketamine in reversing severe treatment-resistant depression, even if transiently, warrant coverage, given the dearth of interventions for this common condition. However, this story has an important message: Ketamine is not yet ready for prime time, even though some psychiatrists in large U.S. cities are already offering it off label.

Three stories highlight important findings in nonpharmacologic treatment. The apparent equivalence of different psychotherapies — while likely not true for the individual patient (who may prefer or respond better to one modality) — is reassuring to clinicians with focused expertise in a smaller number of psychotherapies. New data on the efficacy of acupuncture are refreshing, especially given many patients' growing interest in alternative treatments. Finally, given the near-epidemic growth of difficult-to-treat PTSD, we have welcome news that combining two different psychotherapeutic approaches might yield better results.

Overall, this has been an exciting year for us, as we changed our name to NEJM Journal Watch Psychiatry. We remain devoted to providing clinicians with the information they need to give their patients the best care — and, as part of NEJM Group, we are now poised to do that better than ever.

Here is our list of top ten stories.

Prazosin for PTSD Symptoms and Nightmares in Active-Duty Combat Soldiers

Varenicline: Fewer Adverse Events Than Previously Thought

The Question of Ketamine in Treatment-Resistant Depression

Lithium Is Associated with Hypercalcemia and Hyperparathyroidism

Acupuncture for Depression Really Works!

Adding Emotion Regulation to Trauma-Focused CBT for PTSD

Folate for Treatment-Resistant Depression

Higher-Dose Citalopram and the FDA Warnings: Not Much to Worry About?

All Psychotherapies Equally Effective for Depression

Do Antipsychotics Hasten Poor Outcomes in Patients with Alzheimer Disease?

On behalf of all of the NEJM JW Psychiatry editors, I hope that you enjoy this list and wish you a wonderful 2014.

Happy New Year!

  • Disclosures for Peter Roy-Byrne, MD at time of publication Equity Valant Medical Solutions Grant / research support NIH-NIDA; NIH-NIMH Editorial boards Depression and Anxiety; UpToDate Leadership positions in professional societies Anxiety Disorders Association of America (Ex-Officio Board Member); Washington State Psychiatric Society (Treasurer)

Reader Comments (2)

CARL JACKSON Physician, Psychiatry

NEJM quality is being maintained
Many thanks

RALPH PHILLIPS Medical Student, Psychiatry, College Undergraduate

My interest in the NEJM for the purpose of obtaining a more advanced education through advances in the field of neurology and psychology, as well as psychiatry; the NEJM has a vast symposium of resources in these professions which enhance my interest that is current and pertinent to my medical knowledge which must remain steadfast in the relevant information that constantly flows in the medical science professions.

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