Ever wonder where funding for mental health research goes? Or how research evidence informs medicine and practice?

The scientific evidence used in medicine comes from a pool of tens of thousands of published research studies. There are many types of studies, and the design of any given study usually depends on the question that the researchers want answered. Studies can differ considerably in the way they are designed and conducted, and can therefore differ considerably in quality.

Often the scientific community behind mental health research, studies and reports don’t get a lot of attention or gratitude, but without them our knowledge of mental health and mental illness would develop pretty slowly.

Evidence-based medicine is extremely important in the treatment of mental illness in general, and is particularly important in the treatment of mental illness in children and adolescents.

Here are some recent examples of research related to adolescents conducted by the National Institute of Mental Health.

(Our group is not affiliated with any of these studies, their results or NIMH)

Anxious and Depressed Teens and Adults: Same Version of Mood Gene, Different Brain Reactions

An NIMH study using brain imaging shows that some anxious and depressed adolescents react differently from adult patients when looking at frightful faces. This difference occurs even though the adolescent and adult patients have the same version of a mood gene. Researchers in the NIMH Mood and Anxiety Disorders Program and colleagues reported these findings online October 31, 2008, in the journal Biological Psychiatry.

Depression Relapse Less Likely Among Teens Who Receive CBT After Medication Therapy

Adolescents with major depression who received cognitive behavioral therapy (CBT) after responding to an antidepressant were less likely to experience a relapse or recurrence of symptoms compared to teens who did not receive CBT, according to a small, NIMH-funded pilot study published in the December 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Suicidal Thinking May Be Predicted Among Certain Teens with Depression

Certain circumstances may predict suicidal thinking or behavior among teens with treatment-resistant major depression who are undergoing second-step treatment, according to an analysis of data from an NIMH-funded study. The study was published online ahead of print February 17, 2009, in the American Journal of Psychiatry.

Getting Closer to Personalized Treatment for Teens with Treatment-resistant Depression

Some teens with treatment-resistant depression are more likely than others to get well during a second treatment attempt of combination therapy, but various factors can hamper their recovery, according to an NIMH-funded study published online ahead of print February 4, 2009, in the Journal of the American Academy of Child and Adolescent Psychiatry.

Evidence-based medicine (EBM) is a term that has become widely used in health care settings. But, what exactly is EBM and what does it mean for you?

EBM is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. The “best evidence” comes from the more than 20,000 scientific research studies that are published every year, and “patient care” involves everything from diagnosis to treatment.

EBM is not just a recipe for treatment (e.g. every 15 year-old male with depression is not automatically prescribed the same medication). It is a methodical approach to patient care that is comprised of three components: the scientific evidence, the expertise of your health provider(s), and you.

EBM “integrates the best external evidence with individual clinical expertise and patients’ choice” to ensure that patients receive the treatment that best meets their needs. Evidence-based medicine goes beyond treatments. It also applies to how patients are assessed, diagnosed, monitored, and followed over time.

When we are unwell, it is often difficult to tell what has caused the problem and what can best help. Imagine that you are ill for a few days with a sore throat and cough. When your condition improves, you might wonder what made you feel better. Was it the bedrest, the cold medication, the chicken soup, or was it simply giving your body enough time to fight off the illness? And what if your friend gave you a “secret remedy” made from milk, cognac and grass? Is that why you feel better?

Before you spend time and money on a treatment, you might have a lot of questions. You might want the best information about whether the treatment works, how well it works compared to other treatments and what possible problems can result from the treatment. You should be aware of possible problems (such as the types of side effects that might
happen, the cost of the treatment and the difficulties in taking the treatment) that may occur when you and your health care provider are deciding which treatment you should have.

The ultimate goal of EBM is to help patients receive the treatment that is most appropriate for them. This means finding a balance between the scientific evidence, the patient’s values and the experience of their health provider(s).

Remember, people can respond differently to any given treatment, so it is impossible to know exactly how you may respond. However, at least you can know what the chances are that you might be helped or harmed by a given treatment. This can help you, your doctor and other health providers come to a better decision about what treatment is right for you.

To help understand evidence-based medicine the Chair has developed a guide for patients. Feel free to download it from our website and use it to help you make the best decisions about your health care.

A teen version of this guide will be available sometime soon!

~ Dr. Stan Kutcher

The recent Globe and Mail piece on mental health concerns pertaining to children and youth strikes many correct notes, but unfortunately also incorrectly hits a few important “major chords”, particularly pertaining to the use of medications to treat mental disorders in young people.

Contrary to much popular opinion, there is a rich and scientifically sound data set pertaining to the effective use of medications to treat specific mental disorders and also specific symptoms that are found in some mental disorders. Indeed, there has arguably been much more rigorous first order clinical trials research conducted in medications use than in any other treatment modality in this population.

For many mental disorders, the use of medications is an essential (albeit not sufficient intervention) that helps control symptoms and promotes recovery. Unfortunately, public understanding of the medication use issue in the treatment of mental disorders in young people falls far short of the scientific evidence that supports this intervention. It is not uncommon to read reports about the increase in medication prescriptions to treat mental disorders over the last few years, and usually this data is negatively portrayed. Frequently the media issue focuses on the presumed “over-use” of medications.

Now, we know that diagnosis and treatment of mental disorders in young people has been a concern for decades. Fundamental to this concern has been the finding that these disorders have been under-recognized and under treated. This sorry state of affairs has been slowly changing. Today more young people are being appropriately diagnosed and treated for their mental disorder. However, now when we find the statistics increasing for both diagnosis and effective treatment, there is criticism that this increase is somehow alarming and to be feared.

Did you know that the use of medications in young people to treat asthma and diabetes has increased more than the use of medications to treat depression over the last few years? Do we read sensationalized reports of “over-medication” for diabetes? No we do not – quite the opposite. Publicly we are concerned about the increasing rates of diabetes and we want to address this problem effectively and comprehensively. So we advocate for better diet, more exercise and earlier diagnosis and treatment with medicines that help control blood sugar. This is different than what happens when we publicly address the issue of treatment for mental illnesses. In their case we seem to criticize the use of treatments known to be effective. This is quite the difference in approach, so we need to begin to wonder why.

I am not saying that medications are always properly prescribed and properly used in the treatment of children and youths living with mental illnesses. That is clearly not the case. And the proper use of these medicines needs to be improved. There is a great need to provide better education to doctors and all other health providers about how to best and most properly use medications to treat mental disorders in young people. We also need more research to help address some of the issues that we have not yet fully understood and we need to develop more sophisticated research studies that compare and contrast the use of medications with other forms of treatment so that we can get the complexity of care needs better understood.

So, I wonder why. Could it be that we as a society still somehow hold the fantasy that mental disorders really do not affect young people and thus they do not need medical treatments? Could it be that we hold invalidated beliefs about what works in the treatment of mental disorders in young people – a sort of herbs and spices model that we abandoned for such childhood diseases as cancer and diabetes long ago? Could it be that we do not really know the correct information about appropriate or inappropriate medication use and instead of trying to find out are just happy being intellectually lazy? Could it be that our understanding of brain function and brain development is so uninformed that we assume that any kind of medication that affects brain function will have more negative than positive effects but that for some unknown reasons other interventions, which also affect brain function, are somehow uniquely spared such concerns? Or could it be that we still hold a very very very strong stigma against children and young people that are mentally ill – and as a result would deny them access to properly researched and properly provided treatments?

These are serious issues. I will address a number of the important issues around medication use in young people in the next few blogs – starting with this: what does it mean for a medication to be used “off label”? Keep your eye on this space! If you want more info check out our evidence-based medicine guide for patients.

~ Dr. Stan Kutcher