Case 7-2022: A 65-Year-Old Woman with Depression, Recurrent Falls, and Inability to Care for HerselfN Engl J Med 2022; 386:977-986
A 65-year-old woman was admitted with depression, recurrent falls, and difficulty caring for herself. She reported weakness on the left side and had a monoplegic gait, but results of strength testing were normal. She was treated for functional neurologic disorder but then had progressive neurologic decline. A diagnostic test was...
- N Engl J Med 2022; 386:667-672
ECT is effective for several disorders, particularly severe or treatment-resistant depression, with a rapid response, but stigma has impeded its use. The mechanism is not known, but a seizure is required for efficacy. Effects on memory are prominent though usually transient.
- N Engl J Med 2021; 385:1257-1267
In a trial in the United Kingdom, patients with depression who were being treated in primary care practices and who felt well enough to discontinue antidepressant therapy were randomly assigned to maintain their current antidepressant therapy or to discontinue such therapy. By 1 year, relapse had occurred in 39% of...
- N Engl J Med 2021; 385:1327-1328
Happiness was articulated as a fundamental right by the founding fathers of the United States. Few illnesses interfere with the pursuit of happiness more than depression, and approximately 6% of the world’s population is depressed at any given time. Depression is commonly encountered in primary care, with up to one...
- N Engl J Med 2021; 385:445-449
Depression in adolescents is increasing at a greater rate than in adults. Change in appetite, loss of energy, and insomnia may be more apparent than mood changes. Pharmacologic treatment and psychotherapy are effective, but stigma and adverse effects of medication impede treatment.
- N Engl J Med 2021; 384:2438-2445
A 54-year-old man was evaluated in the neuropsychology clinic because of irritability, confusion, and odd behaviors. Nine months earlier, he had been treated for cancer, after which chronic pain had developed. Six weeks before the current evaluation, he had been found unresponsive with medication bottles nearby. A diagnostic test was...
- N Engl J Med 2021; 384:1460-1461
In The Doors of Perception , Aldous Huxley described his trial of mescaline as “the most extraordinary and significant experience available to human beings this side of the Beatific Vision.” His exegesis was preceded by the synthesis of the hallucinogen lysergic acid diethylamide (LSD) by Sandoz chemist Albert Hoffman...
- N Engl J Med 2021; 384:1402-1411
In a randomized trial involving 59 selected patients with depression, the change in depression scale scores from baseline to week 6 did not differ significantly between patients who received two doses of psilocybin and those who received daily escitalopram. Secondary outcomes generally favored psilocybin over escitalopram.
- N Engl J Med 2021; 384:1350-1358
A 70-year-old man with bipolar disorder was evaluated because of depressed mood, suicidal ideation, and gait disturbance. One month earlier, he had been voluntarily hospitalized for depression. In the following weeks, he had worsening gait instability and urinary incontinence. Diagnostic tests were performed.
Physician, Heal Thy Double Stigma — Doctors with Mental Illness and Structural Barriers to DisclosureN Engl J Med 2021; 384:888-891
Throughout the medical school admissions process, training, and licensure activities, students and physicians with histories of mental illness face structural barriers that result in discrimination and discourage disclosure and care seeking.
- N Engl J Med 2020; 383:513-515
Just as the country rallied to care for September 11 first responders who suffered long-term health effects, we must take responsibility for the well-being of clinician first responders to Covid-19 — now and in the long run. Five high-priority actions can help to protect health care workers.
- N Engl J Med 2020; 383:510-512
Many aspects of the Covid-19 pandemic and the public health response to it will undoubtedly contribute to widespread emotional distress and increased risk for psychiatric illness. Health care providers have an important role in addressing these emotional outcomes.
- N Engl J Med 2020; 382:2259-2260
In March 2020, as the coronavirus pandemic spread throughout the United States, Americans bought nearly 2 million guns — the second highest monthly total in the decades since such records have been kept. Previous spikes in U.S. firearm sales have followed widely publicized mass shootings and the attendant national calls...
- N Engl J Med 2020; 382:2220-2229
In this analysis of handgun acquisitions and deaths in California, the authors found a strong association between handgun ownership and death by firearm suicide. The increased risk was highest immediately after acquiring a handgun but persisted. About half of firearm suicides among handgun owners occurred after the first year.
- N Engl J Med 2020; 382:1196-1197
As an intern with a mental illness, I approached the starting line knowing that at some point my vulnerabilities would be exposed and that hitting the wall was inevitable. I didn’t know when, but if my history of mental illness was any indicator, my crash would be bad.
- N Engl J Med 2020; 382:306-307
J. needed me to be honest with him — to tell him that I suspected his symptoms were manifestations of depression rather than a primarily gastrointestinal issue, and that help was available — but I hesitated, knowing how often such conversations went poorly.
- N Engl J Med 2019; 381:903-911
Patients with major depression were treated with an oral γ-aminobutyric acid type A–receptor modulator for 14 days. At day 15, patients who received the drug had a greater reduction in depressive symptoms than patients who received placebo. Headache was the most common adverse event.
- N Engl J Med 2019; 381:980-981
Major depressive disorder is a serious mental health condition that affects up to 16% of people in the United States during their lifetimes and about 7% of the U.S. population in a given year.1 In addition, patients with major depressive disorder have an outsized risk of suicidal behavior....
- N Engl J Med 2019; 381:1-4
The FDA has approved esketamine, the first antidepressant in a new class, for treatment-resistant depression. The agency weighed the drug’s rapid onset of effect against its abuse potential, which led to a Risk Evaluation and Mitigation Strategy.