Category: health care

Intranasal Esketamine for Major Depression Available at University of Hospitals & Clinics Department of Psychiatry

Learn about the use of intranasal Esketamine for Major Depressive Disorder at the University of Iowa Hospitals and Clinics here.

Here We Go Again About Antidepressants

Back in August, my colleagues, Drs. George Dawson, MD and Ronald Pies, MD wrote a rejoinder in Psychiatric Times to a review article published in Molecular Psychiatry by J. Moncrieff, Mark Horowitz and others (Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. 2022 Jul 20. doi: 10.1038/s41380-022-01661-0. Epub ahead of print. PMID: 35854107.)

The idea that most psychiatrists subscribe to the so-called “chemical imbalance” theory of depression has arisen again in an article by Mark Horowitz on October 7, 2022. Sena alerted me to the article which is getting a lot of attention. There were well over 600 comments and counting about it when we read it on October 7th.

I would like to refer readers to the Dawson and Pies article, “The Serotonin Fixation: Much Ado About Nothing New,” published August 3, 2022. Since the issue about emotional blunting from SSRIs resurfaced again on October 7th, it wouldn’t hurt to review their September 26, 2022, Psychiatric Times article, “Antidepressants Do Not Work by Numbing Emotions.”

Psychiatrists Cast Doubt on Idea that Antidepressants Work by Causing Apathy

Out of 60 hits on page one of a Google search using terms “emotional blunting from SSRI,” only one cast doubt on the assumption that SSRI antidepressants exert their treatment effect by causing apathy. The rest endorsed the connection.

The one article I found on this quick search which contradicted this widely held and arguably incorrect assumption is “Antidepressants Do Not Work by Numbing Emotions,” published in Psychiatric Times, Sept. 26, 2022, which was written by George Dawson, MD and Ronald W. Pies, MD.

The authors wrote a convincing rebuttal of the assumption that the SSRI mechanism of action for treating depression is by causing apathy. Based on their review, the problem is more likely due to residual depressive symptoms. It’s a good thing it turns up on the first page of a web search.

Maybe We Need a Dose of Humor

Sena and I were listening to the Mike Waters morning radio show (KOKZ 105.7) this morning and his invitation to listeners was to call in and quote their favorite dumb question. One of the callers recited something which was actually a George Carlin joke. Neither one of us thought we heard it right, but it’s the same framework as the joke I found on the web (only the numbers were changed):

“If you’ve got 24 odds and ends on the table and 23 of them fall off, what’ve you got? An odd or an end?”

This is an example of his wordplay humor.

Carlin’s humor was also marked by satire on American culture and politics, the latter of which has gotten pretty rough. You’ll also find references on the web to Carlin’s past history of substance use, which reportedly included psychedelics.

That reminds me of an opinion piece published in the September issue of Current Psychiatry, by the journal’s editor, Henry A. Nasrallah, MD (From neuroplasticity to psychoplasticity: Psilocybin may reverse personality disorders and political fanaticism. Current Psychiatry. 2022 September, 21(9): 4-6 | doi: 10.12788/cp.0283).

I was a little surprised at Dr. Nasrallah’s enthusiastic endorsement of psilocybin for treatment of personality disorders and political extremism. He acknowledges the lack of any studies on the issue. In the last paragraph of his essay is a sweeping endorsement:

In the current political zeitgeist, could psychedelics such as psilocybin reduce or even eliminate political extremism and visceral hatred on all sides? It would be remarkable research to carry out to heal a politically divided populace. The dogma of untreatable personality disorders or hopelessly entrenched political extremism is on the chopping block, and psychedelics offer hope to splinter those beliefs by concurrently remodeling brain tissue (neuroplasticity) and rectifying the mindset (psychoplasticity).

While I’m not so sure about how effective psilocybin would be for this, I’m all for trying something to reduce the “visceral hatred on all sides.”

Maybe humor could be part of the solution. It doesn’t have to be exactly like that of George Carlin. Both parody and satire have been used by many writers for this.

I like the distinction between parody and satire in one article I found on the web. One recent example of satire (or parody; the distinction is sometimes hard to make since the story was listed as “Iowa Parodies”) was in the news and it apparently fooled at least a few people. It was about the Iowa football coaching staff. The title was “Brian Ferentz Promoted to University President To Avoid Having to Fire Him (Satire): The move was deemed ‘a way easier conversation than having him fired’ by the athletic director. It was written by Creighton M, posted September 5, 2022.

I think the story was originally printed without the word “Satire” in the title. I can’t recall seeing the heading “Iowa Parodies” either. A later version of the story added the word “Satire.”

The story might have been about nepotism in the hiring of Brian Ferentz (he’s the son of head coach Kirk Ferentz) as offensive coach. On the other hand, under Iowa law, it was not illegal to hire Brian Ferentz, who in any case reports to athletic director Gary Barta, not Kirk Ferentz.

I suspect the joke had more to do with negative public attitudes about the performance of the Iowa football offense early in the season.

Is it funny? I guess it depends on your perspective. The Iowa football coaching staff probably didn’t chuckle over it. But it more or less fits the definition of satire. It uses humor to expose flaws in the way we behave. And it avoids direct and nasty confrontation, which usually triggers antagonism rather than collaboration. Will it change the Iowa football program? I doubt it. They’re actually doing pretty good so far.

But satire as a strategy to inform and maybe change the public opinion will endure. The Hitchhiker’s Guide to the Galaxy by Douglas Adams is one of my favorite books and it satirizes governments and the foolishness of people. I first learned about The Onion newspaper while we were in the process of relocating to Wisconsin (a short adventure). It satirizes the Associated Press news style.

One of the most uproarious examples of parody is a TV show which is no longer available on cable television but still offered on a streaming service (I think), Mountain Monsters. It’s a hilarious sendup of all the Bigfoot hunter shows.

The added benefit of parody and satire and other such forms of humor is that they are safer than psychedelics—unless your target was born without a funny bone.

Two Vaccine Jabs in One Arm or One in Each Arm?

There were headlines about whether it’s better to get the flu shot and the Covid-19 updated booster in one arm or one in each.

It doesn’t matter. Sena got both in one arm. Mine were split. I think it depended on the preference of the person giving the shots.

The main thing is that you consider getting them, at least. That part is up to you.

HHS Campaign for Updated Covid-19 Updated Vaccine Booster

See the HHS Campaign for the Covid-19 updated vaccine booster for older adults-a high risk group. We’re scheduled for both the flu shot and the updated booster.

How to Get the Updated Covid-19 Vaccine Booster at University of Iowa Hospitals & Clinics

Here’s an updated link to how to get the updated Covid-19 vaccine booster (often called the Omicron bivalent booster). It’s sometimes faster to get this booster at local pharmacies, although there’s less urgency now.

Single Administration Therapeutic Interfering Particle (TIP) Reduces Covid-19 Viral Shedding & Pathogenesis in Hamsters

Proceedings of the National Academy of Sciences (PNAS) recently published a study showing:

Abstract

“The high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a primary driver of the COVID-19 pandemic. While existing interventions prevent severe disease, they exhibit mixed efficacy in preventing transmission, presumably due to their limited antiviral effects in the respiratory mucosa, whereas interventions targeting the sites of viral replication might more effectively limit respiratory virus transmission. Recently, intranasally administered RNA-based therapeutic interfering particles (TIPs) were reported to suppress SARS-CoV-2 replication, exhibit a high barrier to resistance, and prevent serious disease in hamsters. Since TIPs intrinsically target the tissues with the highest viral replication burden (i.e., respiratory tissues for SARS-CoV-2), we tested the potential of TIP intervention to reduce SARS-CoV-2 shedding. Here, we report that a single, postexposure TIP dose lowers SARS-CoV-2 nasal shedding, and at 5 days postinfection, infectious virus shed is below detection limits in 4 out of 5 infected animals. Furthermore, TIPs reduce shedding of Delta variant or WA-1 from infected to uninfected hamsters. Cohoused “contact” animals exposed to infected, TIP-treated animals exhibited significantly lower viral loads, reduced inflammatory cytokines, no severe lung pathology, and shortened shedding duration compared to animals cohoused with untreated infected animals. TIPs may represent an effective countermeasure to limit SARS-CoV-2 transmission.”

I Say Omicron and You Say Ahmicron

Well, we tried the Miracle Whip salad dressing on egg salad sandwiches the other day. I thought they tasted better than the tuna fish sandwiches we had before.

But maybe it was the mustard in the egg salad. Anyway, Sena says we’ll be going back to Mayonnaise after the Miracle Whip is gone.

The difference between Mayo and Miracle Whip may be debatable. But the difference between the updated Covid-19 vaccine Omicron bivalent booster and the previous Covid-19 vaccines is more important than just the difference between the two pronunciations of Omicron. I say OH-muh-kraan, you say AH-muh-kraan. You say tuh-May-toh, I say to-MAH-toh, etc.

Some clinicians are worried about the risk for substituting the wrong vaccine for the new bivalent booster. That’s more than just fussiness; administration errors have already occurred with previous formulations of the vaccines and their boosters. These are nontrivial, reportable mistakes.

Some say the different colors of the vial caps should be enough to prevent mistakes. The CDC advisory committee members disagreed.

It doesn’t seem to be enough to simply read the vial labels. Busy workers in pharmacies and primary care clinics have grabbled the wrong ones and injected them.

One person at the CDC ACIP meeting on September 1, 2022 said, “Structural problems required structural solutions,” referring to the vials which have similar packaging, an opinion shared by others. The Interim Clinical Considerations for COVID-19 Vaccines: Bivalent Boosters slide set makes the distinctions pretty clear.

I hope the pharmacies and other clinics get the pictures. Just because we’re all a little nervous about making mistakes doesn’t mean we have to call the whole thing off.